Inspection on 11/04/08 for Swan House Care Home

This inspection was carried out on 11th April 2008.

CSCI found this care home to be providing an Adequate 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 Care Home 24/09/09

Swan House Care Home 03/04/09

Swan House Care Home 05/12/07

Swan House Care Home 06/06/07

Swan House Care Home 07/06/06

Swan House Care Home 26/01/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow 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 Care Home Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ Lead Inspector Keith Jones Key Unannounced Inspection 11th April 2008 09:00 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 Care Home DS0000066099.V362037.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 Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swan House Care Home Address Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ 01922 407040 01922 407040 swanhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited 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) Care Home 45 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (45) of places Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 45 The maximum number of service users to be accommodated is 45. 2. Date of last inspection 5th December 2007 Brief Description of the Service: Swan House Care Home is a purpose built two-storey property providing care for up to 45 people with either dementia, social care and/or nursing care needs. The home is situated on a local bus route, adjacent to local shops. A passenger lift provides access between floors that enables people to access to all areas. Communal toilets and assisted bathing facilities are strategically located throughout the premises, so they are easily accessible to service users bedrooms. Individual accommodation is spacious with the opportunity for people to bring their own furniture and decorative items, so providing a homely atmosphere. There are two lounges with separate dining facilities on each floor and a wing on the ground floor of the home has been converted to provide dementia care. The environment on the dementia wing has been created to provide residents with the best possible living accommodation for people diagnosed with this condition so it best suits their needs. The home provides all support services in house including laundry, catering and housekeeping. The fees for accommodation and care in the dementia unit range from £355 to £500. The fees for accommodation and care for residential care range from £338.78 to £452 and for nursing the fees range from £425 to £697.48. The nursing element contribution is retained by the home. The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. Information in the form of Service User Guide and Statement of Purpose are available on entering the home, which provides information about the services and facilities enabling people to make an informed choice about moving into the home. People’ are also given their own copy of the Service User Guide, Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 5 which they can refer to at any time they wish. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A quality rating is provided throughout the report based on each outcome area for the people who use the service. These ratings are described as excellent, good, adequate or poor based on findings of the inspection. We considered that the information given to us confirmed that people were presented with the service they needed, and that the service was of a satisfactory standard to ensure peoples’ safety. This unannounced inspection was conducted with the Care Manager (Designate), Operational and Project Managers from Southern Cross Health Care, and senior nursing/care staff. A second CSCI Inspector was in attendance to conduct a Short Observational Framework (SOFI) exercise to observe interactions and state of well-being among residents. This inspection followed a Statutory Compliance Random Inspection on the 21/02/08, at which the Home was formerly acknowledged to have satisfactorily complied with Statutory Notices issued on the 8/02/08. The random inspection report was discussed, and it was noted that there were no outstanding requirements, and that all recommendations had been, or were in the process of being addressed. The Inspector acknowledged receipt of a comprehensive and well prepared Annual Quality Assurance Assessment (AQAA), and had received 12 completed surveys from people who use the service and families. There were 30 people in the Home at the time of inspection, with 17 requiring General Nursing care, and 8 people with Dementia needs. The tour of the home was carried out in a relaxed, courteous and professional manner. It was felt throughout the inspection that a sense of sympathetic confidence pervaded into daily activity expressed by those people met. Four people were case tracked, which confirmed the establishment of a much improved, comfortable and effective care home. 12 quality assessment surveys were received from relatives and people who use the service, all generally complimentary of standards. A sample of comments received included: “They treat the residents with dignity” “They (the staff) are as far as we are concerned very caring and kind people” “Could ask for something if you needed anything” Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 7 “Provides a very caring, friendly environment with good personal understanding of each client”, with reference to dementia care. “It doesn’t matter what time of day or night if mom has a problem, or if she is distressed, the home always phone and let me know” Relatives who were present during the inspection were complimentary of the family approach to care, the freedom they enjoyed and the involvement that the manager and her staff encouraged. It was evident that they were inclusive in the process of care. Everyone appeared comfortable and at ease with their surroundings. A sample review of the administration confirmed solid practice and effective management. Discussions with people who use the service and staff over the general standards of care and service provided, proved to be enlightening and very constructive. It is recognised that there have been no admissions for over 3 months following the Random Inspection, and that there was a disproportional numbers of senior managers and staff working, in response to CSCI statutory notices served. Nevertheless the Inspector was impressed with the commitment of the staff, and the observed quality of care and service. A full report was offered at the end of the inspection with open discussion with the senior managers of Southern Cross Health Care, including the Managing Director, and the Care Manager (designate). Overall the attitude in meeting the caring and organisational demands was highly commendable, with forward thinking, planning and application, each contributing to a good quality service emerging from a very difficult period. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. Potential service users and their representatives are able to gain information about the service from the Statement of Purpose and Service User Guide. Our inspection reports can be obtained directly from the provider, or are available on our website at www.csci.org.uk What the service does well: The Home was seen to offer a genuine commitment to care, with an open and personable approach, which reflects the confident relationship between Nurse/carer and people who use the service, involving their families in the process of care, ensuring a highly individual approach to meeting personal and health care needs. Assessment procedures and care planning is of a good standard, offering detailed information on each resident’s progress in the meeting of objectives. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 8 The housekeeping and support services have all contributed to the team approach, and are recognised by the management and the Inspector for the much-improved standards observed. Maintenance of good staffing levels, staff training and clinical supervision are well established in safeguarding the interests of people who use the service. What has improved since the last inspection? What they could do better: The working environment over the past three months has been achieved within a framework of crisis management. Having now achieved a sustainable level of performance the management team must recognise the need for the Care Manager designate to respond to a ‘normalised’ situation. The artificially low bed occupancy of 30 residents in 45 beds, with an improved staffing level set for full occupancy must be resolved. An application to remove the Notice of Approval on blocking admissions will be put forward to CSCI management. The Care Manager designate is to achieve registration with CSCI without delay. The achievements have been recognised, areas of detail highlighted in recommendations will continue to play a part in the ongoing development and maintenance of a re-emerging service. Continuing surveillance of medicine administration and minor environmental issues need reinforcement. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 9 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 Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 10 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 Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 and 6 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The services that people receive are centred on the needs, wishes and views of those who use them. The Home’s policies ensures that prospective service users have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. There have been no recent admissions to determine the effectiveness of admission policy, but the affirmed policy is that pre- admission assessment is conducted by the care manager at the point of referral, taking into account a multi-disciplinary and a community assessment. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 12 EVIDENCE: The revised Statement of Purpose clearly represents a description of the Home’s aims and objectives, philosophy of care and terms and conditions. It is recognised that the Statement of Purpose represents the foundation on which the Home operates upon, offering prospective service users and their relatives the opportunity to make an informed choice about where to live. A separate and well-produced Service User’s guide serves as a readable summary of the Statement of Purpose and supporting information, widely used to inform all interested parties. Versions with larger print, Braille, audio and pictorial representation are being prepared. The Home has a clear statement of contractual agreement. The Statement of Purpose indicates the terms and conditions, which are discussed with prospective service users and relatives prior to admission. Reference to the agreed bedroom of residence in the document would be recommended. Due to the postponement of admissions there was no available evidence to confirm adherence to the policy of clear, accountable pre-admission assessment. However it was firmly presented by the senior managers present that an assessment would be produced with the full involvement of prospective service users and family, allowing them to influence the direction of care. The assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longer-term goals and outcomes. Extensive examination of care records at the random inspection and this inspection showed a clear improvement in the assessment, planning, review and monitoring arrangements for care. In discussions with people who use the service and families, it was clear that they were aware of the information about the home, and are clearly involved in the care process. There were no people assessed and referred solely for intermediary care at the time of inspection. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 13 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 and 11 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care assessment and planning system is a well-organised, yet personalised process offering meaningful and valid documentation of care administered. A broad vision of needs is addressed through the care planning process, meeting personal and health needs. It is recognised that this reflects an individual profile of needs, discussed fully with family. The care team manage the provision of a secure and safe medicines procedure, although further improvement is needed to make sure that medication systems are fully safe to protect people who live within the service. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 14 EVIDENCE: There was evidence to show that a full review of the care process has produced a good standard of meeting care needs. The pre-admission assessment is geared to represent the foundation for an informative care planning process. Four individuals’ care files were tracked, following an extensive examination of care records at the last Random Inspection. Each demonstrated a system of detailed information on the individual, their life style and needs, events and contacts, procedures and actions measured on a daily basis and reviewed monthly. Effective risk assessments had been completed in areas such as manual handling, falls, nutrition, tissue viability, and continence. This enables staff to identify risk areas and put systems in place to reduce risks. The process has also established a life history and social awareness for each person, as an addition to care records, which has proved to be useful in enhancing understanding of personal needs. Staff who were present confirmed an effective understanding of need in discussion with the Inspector. This is complemented with a system of named Nurses and key-worker care staff. The home is divided into three areas. On the ground floor there was a separate unit for people who require personal support due to dementia and a unit for people who require support for reasons of personal care. The first floor is used for people who require nursing care, although one nursing person was cared for on the ground floor, who had been resident in the home for a number of years Examination of care records and observation of practice, confirmed that the provision of care for highly dependant people were of a good standard. Fluid, elimination, pressure care and attendance monitoring were seen to be present and managed efficiently. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that personal care was attentive to detail, and effective. Mouth care, fluid balance and pressure care routines were established, with sound observations and monitoring, including hydration routines. It was acknowledged that in January 2008 there were 11 pressure sores reported. There are none at present. Several relatives were visiting and were asked for their comments on the quality of the service and care given. There was a clear appreciation of the openness and opportunity to contribute. All comments were complimentary of standards, facilities and staff: “I feel they support my mother’s needs, she is a very independent lady still at 93, and they encourage her to retain her independence, but still monitor her carefully”, “ Provides a very caring, friendly environment with good personal understanding of each client”, “Family and friends are always made welcome”. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 15 The general environment throughout was one of a relaxed atmosphere, yet attentive. The observations from the SOFI exercise confirmed a positive interaction surrounding a portion of the person’s daily routine. Staff were seen to support individuals with their emotional, social and physical needs. The influence of a very pro-active activity schedule was seen to be encouraging interaction with a highly motivated and enthusiastic activity co-ordinator. There was a pay phone in the reception area, so that people can privately use the phone independently, whenever they want to. The policy of the Home is to maintain people’s own GP support wherever practical; otherwise people are registered with the local surgery. District nursing services and clinical nurse specialists are also received, within a positive professional rapport. A chiropodist has recently been engaged for the Home. There was evidence that suitable equipment has been secured and was deployed effectively. Carers were seen to interact with people who use the service with purpose and compassion. The facilities and bedrooms were presented to enable privacy for the individual, which included medical examinations and personal care procedures, being performed in private. Notices displayed in some bedrooms would be better situated in a more discreet manner. Bedroom doors had locks, lockable facilities were available in bedrooms, and en-suite facilities were available, so enhancing arrangements for resident’s privacy. The administration of medicines generally adhered to procedures to maximise protection to people who use the service. The storage was secure, with satisfactory added security for controlled drugs, with good environmental controls. The record of administration of systemic medicines was consistent, with no omissions observed. A controlled drug register was examined and found to be up to date. Staff training has been undertaken by Boots, and continues to be pursued actively by the care management team, with a frequent audit of systems by a senior nurse. The continued use of a ‘Homely Remedy’ process would require updating, to clearly identify the agreement of local GPs to an approved schedule of medicines. Oxygen stored at ground level would be safer secured by chain to the wall. The process of duplicating prescriptions on receipt of new stock is to be discontinued, leaving MAR sheets solely to record administration. On receiving out of hours prescriptive instructions temporary transcriptions should e verified and countersigned by a trained Nurse. The procedure for handling accidents and incidents was inspected and found to be satisfactory. Reports were informative, detailed and meaningful. Family and friends have relative freedom of visiting, those spoken to remarking on the importance of maintaining social contact. There was also an observed Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 16 knowledgeable, and positive attitude by staff towards people, and feedback indicating: “ It’s a smashing place, nice staff and very friendly”, “ As far as I am concerned it is run as it should be”, and “We have never seen anything at all that has bothered us”. Conversely one comment was “ chairs in each room for visitors to sit on. We have to sit on the bed or stand up”. Regular family/ service users forum meeting are helpful, contributing to improve communications and understanding. It is planned to hold twice-yearly surveys into quality of care and services. Individual spiritual persuasions were documented and individual diversity was seen to be respected. There are regular C/E services held, and a R/C priest attends on request. Relatives are welcome to stay as long as they liked in times of stress, including overnight stay. Swan House Care Home DS0000066099.V362037.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 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were discussions with people who use the service, staff and examination of records in relation to social activities undertaken and general observations during to course of the inspection. The home had a relaxed atmosphere where people were encouraged to individualised lifestyles. Those who wish to bring in personal possessions are encouraged to do so. EVIDENCE: The daily routine was seen to be flexible and non-institutionalised, offering choice for meal times, personal and social activities. Discussions with residents and staff clearly identified a relaxed and informal atmosphere in which the people’s needs were paramount, with the security that there are familiar events to the day they could relate to. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 18 An enthusiastic activity co-ordinator has a high profile in contributing to the care planning process, and is clearly well accepted by people who use the service and staff alike. The recording of social activities was seen to be an integral part of care reporting and planning. Residents’ life histories are discussed and used as a basis for individualised social care offering choice and support. The Home boasts to celebrate people’s special days and occasions. The SOFI exercise demonstrated an attentive supervision in day rooms, with a positive feedback on staff, service users and family interactions. It was felt that more attention to background music/noise in the lounge would be beneficial. There is tendency for some staff to forget to explain and deal with the small issues of service, i.e. wiping eye drops overspill, explaining an action or aware of spillage on clothes. Nevertheless the overall conclusion was of a service generally delivered with care, compassion and familial confidence. There is a positive cognitive stimulation therapy programme, with sessions organised to stimulate and engage people with dementia. A garden room with external access is a useful, and popular feature. General discussion indicated positive consideration into further developments to enhance the programme. The Home operates an established open visiting policy, which was seen during the inspection. Relatives and friends are encouraged to maintain social links as part of the planning of care. One relative survey return was appreciative and complementary of the relaxed procedure, especially at the early days following admission. Personal choice and relative self-determination are respected in policy and action. Those who wish to bring in personal possessions are encouraged to do so. Those individual’s rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general décor. The tour of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. The Care Manager designate emphasised that the strength of protecting individuals’ rights was secured through the robustness of the policies and procedures in place, confirmed on examination of records. Advocacy procedures and services are available to those who require them, with an active consideration of the implications of the Mental Capacity Act 2007. The Home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. Lunch was served during the inspection and found to be an attractive and well-presented meal of fish and chips, poached cod or faggots. Three meals were provided daily, with hot and cold beverages and snacks available throughout the day. People that were interviewed confirmed that that the quantity and quality food provided was good, one comment given was: “The food and its presentation are very good’. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 19 Relatives also made the following comments about the food as follows: “The food appears to be very good with an excellent selection”. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. Special diets were accommodated with the cook making effort to engage with people to discuss personal preferences. Staff were seen to offer discreet assistance to those who required it. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, presenting a consistent record. The kitchen was seen to be clean, well equipped and kept in good preparation. COSHH signs and notices were in evidence with cleaning chemicals secure, appropriate and under control. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 20 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, 17 and 18 The quality in this outcome area is good. The home had a meaningful complaints policy, clearly identifying the CSCI as a resource to approach with a complaint or grievance. Two complaints had been received via the Commission since the last inspection. The home has a Complaints Procedure in place and people feel that their concerns will be listened to and acted upon. The homes’ Adult Protection procedure ensured that people were protected from abuse. EVIDENCE: People’s legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning, and policies in place i.e. the complaints procedure. The complaints policy was seen and records examined. There had been a marked decrease in the number of complaints received since the last Random Inspection (from 17 in January, to 3 in March 2008). Of the two received by CSCI each had been resolved satisfactorily. It was advised that complaints would be better dealt with through a ‘Concerns, Complaints and Allegations’ record, each supported by the appropriate procedure. This would provide evidence that a consistent and effective process was in operation to deal with individual and family Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 21 concerns in a meaningful and effective manner. On examination of records and discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. The overall policy of openness and transparency was acknowledged. People spoken to confirmed that they did not have any complaints, and any minor grumbles were dealt with promptly and effectively, “If there was anything wrong I’d tell them”, “Staff listen to you, you can go at any time to the manager.” All people who use the service had received information on the procedure to complain, including reference to the CSCI. This process was evidenced on examination of the Statement of Purpose and case tracking as previously reported upon. Discussion with the care management confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. It was recognised that a full Social Services review before the Random Inspection had highlighted the need to re-establish a working relationship with review departments, especially on Adult Protection issues. An address of this problem had been discussed fully with Walsall Social Services. It had been agreed that Nursing and care staff would work with review officers throughout the procedure. Staff induction and in-house training programmes led by the Care Managers, clarified the responsibilities of all staff in their daily contact with people, especially their privileged position in protecting people from abuse, of all natures. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 22 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): 19,20,21,23,24,25,26 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The quality of décor and furnishings makes the Home a pleasant and comfortable place to live. The home is well appointed to meet the needs of an elderly population of residents in providing a safe and comfortable environment. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The overall environment was found to be safe for people’s comfort, within risk-assessed limits. The Home was safe and well maintained and very clean and hygienic. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 23 EVIDENCE: The home is entered from the car park through a secure entrance to reception which is comfortably furnished and where the registration and insurance certificates are displayed. A visual inspection of the exterior of the home was made during the course of this inspection, which showed pleasant areas emerging into springtime, shortly to be addressed by the gardener for people’s use. There is an annex attached to the first floor that has extensive space, used at this time for sleeping over, training and maintenance store. The home is well presented with a good standard of decoration and is furnished comfortably, is clean and hygienic with no unpleasant smells. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well-lit and airy corridors. There is a poorly guarded exit stairwell on the first floor. Wheelchair access was satisfactory throughout all areas of the home. The corridors have laminated floors and fitted with handrails and off which are the linen cupboards, which were observed to be kept locked. The Care Manager designate confirmed a willingness on the part of management to meet any reasonable demand for special needs. Efforts had been made to provide a homely atmosphere and the décor in most areas of home was found to be of a high standard. Recent decoration of bedrooms, new carpets and upgrades to bathrooms were very satisfactory. The dementia unit was bright and cheerful with a range of colours and fabrics to stimulate residents, enhanced with reminiscence themes. The home provided two lounge areas that were pleasantly decorated providing essential furnishings and items to provide a comfortable area where people were able to interact, seek reflective peace, or to entertain their guests. There were well appointed dining areas, newly furnished, where people were able to dine in comfort. Menus were displayed although they did not reflect the greater variety of food available on the day. Each of the en-suite bedrooms were seen to have been personalised with people’s possessions and some furniture brought in with them. A sample check of rooms showed that each had safe heating, restricted windows, controlled hot water supply, smoke alarm, staff call, bedside lighting and overhead lighting fitted with a dimmer. The nurse-call alarm system was satisfactorily tested, and service record checked. All personal electrical equipment where seen to be PAT tested. The names of the named Nurse and key worker were displayed. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration. People spoken to during the course of the Inspection expressed their approval of their accommodation standards, which Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 24 was complemented with the large number of personal items brought in to enhance the homeliness of their rooms. A development plan for 2008/09 is presently being drawn up and will be presented to CSCI on finalisation. A full unit risk assessment (fire risk) appraisal has been undertaken by the facilities manager of Southern Cross. There are adequate numbers of variable height profile beds available. There was evidence of individual arrangements to meet needs, sleeping chairs, fridges, oxygen supplies, etc. All bedroom doors had locks and lockable facilities were available in each room, so enhancing the arrangements for privacy. It was noted that a number of items such as incontinent pads etc continued to be stored haphazardly during the working day. A review of the storage facilities and arrangements will need to be undertaken. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. Numerous floral displays greatly enhance the presentation. Each bathroom had a bath thermometer, and hot water checked was within safe limits. It was noticed that a cracked shower screen represented a potential threat to injury. The laundry was well organised and equipped to a good standard. Notices regarding chemical handling in the areas that store chemicals are displayed. The process would benefit from COSHH poster displays in all areas dealing with chemicals. The infection control policy was readily available to staff. There are adequate sluice facilities, each having suitable arrangements to assist in control of infection. Notices regarding chemical handling in the areas that store chemicals need to display appropriate COSHH posters and information charts. The domestic services in the home were seen to be of a very high standard. The people who use the service and relatives spoken to, remarked that they find the environment always very clean and conducive. There was no evidence of unpleasant smells or unsightly debris anywhere throughout the inspection, much to the credit of all staff concerned. The kitchen was inspected with the cook and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. A cleaning schedule was in place, up to date and accurately reflecting the observed standards. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 25 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 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service, and on the examination of staff files, working rotas and discussions with staff. The staffing levels in relation to the number of service users in residence, and their dependency level was suitable to meeting assessed needs. The procedures for recruiting and appointing staff were seen to be consistent. Staff training records complement the effort placed into staff training. EVIDENCE: It was recognised at Random Inspection that an outstanding effort would be needed to achieve a satisfactory outcome. The have been extensive appraisal of staff performance and training, an increase in the deployed numbers of staff and a solid review of staff appointments. Three weeks of off-duty were examined, and showed good balance between skills, qualifications and numbers to provide a foundation for a good standard of care. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 26 The Care Manager designate works supernumerary and is supported by a team of Registered Nurses and Carers. Agency and Bank coverage have been used to support shortages of care staff, in tandem with overtime and flexible rostering to meet shortfalls. It was estimated that there is shortfall in recruiting a further 20 hours Registered Nurse to maintain the rota and minimise agency dependency, some 7 Nursing shifts a week have been covered over the past three months, although more recently there has been a noticeable drop in Agency Nurses used. At the time of inspection there were 30 service users, with the duty rotas confirming a staff coverage as thus: First floor a.m - 1 trained 4 carers p.m - 1 trained 3 carers n.d - 1 trained 1 carers Ground floor 2 Senior 3 carers 2 Senior 2 carers 1 Senior 1 carer It is recognised that over the past four months there has been a disproportionate numbers of senior care managers, and staff in relation to a smaller number of people who use the service. It is accepted that the actions taken were appropriate to establish a solid foundation of overall policies and procedures to enhance practice. It is also acknowledged that there will be a rationalisation of management in the immediate future, to consolidate the role of the Care Manager. The catering, domestic and laundry hours were determined and found to be appropriate for the size of the Home and the needs of the people who use the service. The Home has an activity coordinator, receptionist/administrator and maintenance staff. Southern Cross management have committed a high profile presence for the immediate future. The care management emphasised the Home’s commitment to training and to achieving targets for NVQ level 2. There are 15 staff with NVQ level II and level III, representing 51 achievement. Ten staff are presently undergoing NVQ training. There are 22 certificated first-aiders on the Home’s staffing establishment. Four staff files were sampled and found to be consistent in the process of appointing staff. It was evidenced that POVA and CRB checks have been made. The management have a reviewed procedure for interview, selection and appointment of staff, that has been seen to be effective. It is recognised that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of service users. Four on-duty members of staff were interviewed, each expressing their working conditions openly and with confidence. Those spoken with on the day Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 27 of inspection showed a professional attitude, and an infectious enthusiasm for their work. Each individual was complimentary as to the level of training they receive, and the improved management arrangements. Supervision was seen to complement an effective induction and training programme. Diversity and equality issues were discussed with staff, identifying a satisfactory appreciation of the subject. The care management is steadfastly committed to a learning environment. Staff induction programmes have been consolidated on a standard approach and have proven to be effective, forming the base upon which in-service supervision and training are planned. Overall the evidence shows a comprehensive account of a meaningful and important schedule of training to meet internal and external demand. Mandatory training is provided for all staff, and that other training had been undertaken, including dementia awareness (Yesterday, Today and Tomorrow), challenging behaviour and the Mental Capacity Act 2007. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 28 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): 31,32,33,34,35,36,37 and 38 The quality in this outcome area is adequate. The judgement is based on available evidence including a visit to the service, and on discussions with the care management team. The examination of policies and procedures with regards to the effective management of the Home, general observations during the process of the inspection, and discussions with people who use the service and staff. There is a confidence apparent in the interaction of service users, staff and the Home’s management, that demonstrated a much improved, positive relationship, that pervades throughout the service. EVIDENCE: Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 29 The Care Manager designate Maxine Cleobury has demonstrated evident competence over many years in running another Southern Cross Home. Following the poor reports in December 2007 and January 2008, it was decided to transfer Mrs Cleobury to Swan House in replacement of the previous manager. During these past three months she has been effective in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. An experienced Registered Nurse with a professional track record of practical and managerial experience, she has been part of the management team set up by Southern Cross reestablish good standards. She has been actively engaged in a full management audit, including an appraisal of the whole staffing resource for the Home. As part of the improvements made in keeping families and service users informed, a three time a month surgery is held, and a quarterly family meeting held. As yet Mrs Cleobury has to attain registered status for Swan House with CSCI, although the application has been submitted. The inspector was impressed by the openness, professional and pleasing confidence in the observed interactions of staff, relatives and service users. The relationships were seen to be of mutual trust and respect. This in itself represents a major improvement and removal of obstacles in achieving the objectives. Appropriate risk assessments are in place for residents, through care planning and recording, staff selection and the general environment, these are up to date and accurate. A comprehensive fire risk audit has been recently completed, which paves the way for a full risk analysis of the Home. Health and safety notices can be seen throughout the Home, although the use of institutional instructions would be more appropriately situated in more discrete places. The Registered Provider has presented a high profile in direction over the past few months, in establishing a wide range of management accountability and responsibility to good effect. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. These include a care plan review process that is recorded once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. This programme is to be forwarded to CSCI for further reference. The home has an open door policy and a commitment to equal opportunities. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were found to be well maintained in ensuring that the people’s rights and best interests are safeguarded. The Manager offered evidence of safe working practices including: - Code of Conduct, first aid, abuse awareness, COSHH management, and fire prevention. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 30 Relevant legislation was discussed and is fully understood by the management, i.e. changes from CSCI, updates on Health and Safety issues, diversity, etc. Attention needs to be focussed on the implications of the Mental Capacity Act 2007 for all senior staff, who are to be expected to cascade the information to all staff. The health and safety of residents and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical and gas appliances and regulation of the water system. Records inspected included, fire officer’s report, water, hoists and PAT certificates, and found to be satisfactory. The accident book was seen and found to be in order for staff and service users, with satisfactory reporting arrangements to Riddor. Financial arrangements are controlled by the administrative assistant in respect of pocket money, comfort fund and petty cash management. The systems were uncomplicated, easy to understand and effective. Southern Cross management conduct a quarterly audit. The administration and management of the Home has achieved a great deal in a short period of time in setting a solid foundation to practice care. Attention to a substantial number of Requirements, Statutory Notices and recommendations made by CSCI have been acknowledged. Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 3 3 3 3 3 Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? None 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 OP27 Regulation 18 (1) (a) Requirement That a suitable establishment of Registered Nurses be deployed to maintain trained nurse coverage of each shift. Timescale for action 01/05/08 OP31 2 8 (1) (a) That the Care Manager designate 01/06/08 attains ‘fit person’ status with CSCI as a Registered Manager. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP22 OP9 Good Practice Recommendations Identify the allocated room identifier in service users’ contract to complete a clear understanding of residency. Ensure a robust medication system to include: All medication should have clear directions about its use. • Two staff (one to be a Registered Nurse) must countersign handwritten medication details. • Homely remedies schedule be drawn up with GP attached to Swan House, to ensure safe practice and DS0000066099.V362037.R01.S.doc Version 5.2 Page 33 Swan House Care Home • • 3 4 OP16 OP19 administration of medicines. Discontinue to practice of re-writing prescriptions on receipt of new stock supplies. Chain Oxygen cylinders to wall when stored. A concerns, complaints and allegations book be established. That a full unit risk assessment programme be updated, to enable the management to review safety, and appraise facilities on a regular basis. The Shower screen on the first floor should be repaired to ensure a safety. A re-furbishment plan be drawn up to address improvements for 2008/09, to offer advance information on the level of development of the service. Ensure a safeguard to the stairwell on the first floor, to present a more effective protection. Ensure that cleaning items and provisions are stored appropriately to minimise risk of harm to people. As a course of good practice COSHH laminate posters should be located in areas where chemicals are stored 5 6 OP21 OP24 7 8 9 OP38 OP38 Swan House Care Home DS0000066099.V362037.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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