Inspection on 03/04/09 for Swan House Care Home

This inspection was carried out on 3rd April 2009.

CQC found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Swan House Care Home 24/09/09

Swan House Care Home 11/04/08

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 10/07/2009.

Key inspection report Care homes for older people Name: Address: Swan House Care Home Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 0 3 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Swan House Care Home Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ 01922407040 01922407010 swanhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited care home 45 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 45. The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 9, Old age, not falling within any other category (OP) 45 Date of last inspection Brief description of the care home Swan House Care Home is a purpose built two-storey property, which is divided into three units for the purpose of providing care. The home accommodates up to 45 people with dementia, social care and/or nursing care needs. The environment on the dementia wing has been created to provide people with the best possible living accommodation to suit their needs. All bedrooms have an en-suite toilet and wash hand basin, so enhancing the arrangements for privacy. People have the opportunity to take their own furniture and personal items in to the home, so providing a homely Care Homes for Older People Page 4 of 31 9 0 Over 65 0 45 Brief description of the care home atmosphere. There is a lounge/dining room on each of the units enabling people to socialise, and take their meals together if they wish. A passenger lift provides access between floors, enabling people access to all areas of the home. Communal toilets and assisted bathing facilities are strategically located throughout the premises, so they are easily accessible to peoples bedrooms. The home provides all support services including in-house laundry, catering and housekeeping. The home is situated on a local bus route, adjacent to local shops. Information in the form of Service User Guide and Statement of Purpose were available on entering the home, which provided essential information about the services and facilities, enabling people to make an informed choice about moving into the home. The full range of fees were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Acting Care Manager, senior nursing and care staff on duty. Our inspection of the home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 43 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with health care needs. To do this we looked at (case tracked) four care files of people who are using the service, from referral to the present time, and four staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people, relatives and members of staff, who took an active role in the inspection process, and contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Care Homes for Older People Page 6 of 31 Assessment (AQAA), and seven survey forms returned by people using the service. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 31 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: The home admits people who require long-term nursing or personal care. People who require personal care are cared for on the ground floor, and those people who require nursing care are accommodated on the first floor. On entering the home there was a very pleasant reception and waiting area, and information was available about the home in the form of a Service User guide and Statement of Purpose. We examined those documents, and found them to provide an informative description of the homes aims, objectives, and the way it operated. We acknowledged that the documents were presented to all enquirers, and that information did not contain information regarding fees. We saw that the Statement of Purpose could be produced in large print, as and when necessary to help people with Care Homes for Older People Page 10 of 31 Evidence: reading difficulties. Through our case tracking of four peoples care records we clearly identified that the Care Manager, or her deputy, at the point of reference, conducted the pre-admission assessment. We found that each record showed the attention to individuality, with the assessment formulating a care support plan, based on assessed, individual needs. This assessment is produced with the involvement of those people admitted and their family, allowing them to have an influence in the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. Comments we received from surveys sent out to people before the inspection: I came from hospital on respite care, and have decided to stay. The staff have been lovely. Found most information on the net. Then we visited the home unannounced. They were welcoming and gave us a tour of the home and the ward my father would be staying in. They took us to the dining room and the day room, every door was opened for us to see and questions were answered without hesitation. It felt comfortable from the first visit. Some others we went to visit would not let us in. We live round the corner from Swan House. It was always of interest to us. We came to have a look round and we were quite satisfied with everything. They answered our questions we asked honestly. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. Likewise people are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective user of the service. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving people, and their families in the admission process. Comments we received from surveys and with talking to people showed to us a confidence that people had in the service: We asked a lot of questions about mums care plan and the extent of the help that she would receive. We had some comments and descriptions from friends whos relatives were in the Swan House home. The information I received was very informative and helpful. Care Homes for Older People Page 11 of 31 Evidence: A person we interviewed on the day said: The nurse made me feel very welcome, she was very kind and included me in everything that was being discussed. Relatives spoken to during the inspection stated that one of the reasons for choosing the home was that they had previous knowledge of the home and its location. From our discussions it was clear that people are able to visit and assess the facilities and suitability of the Home at any reasonable time, and to meet with staff and management. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated when talking to people, and examining records on case tracking. The home does not provide intermediate care, but people are admitted to the home for respite or long-term care. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Those care records we examined provided clear evidence that the pre admission assessment represented the foundation for a well considered, and detailed care planning process, in association with Social Services reports. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, based upon dependency assessment and activities of daily living, in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with a substantial and very informative daily progress report. We confirmed that risk assessments are carried out on an individual basis and reviewed as required, these include mobility, tissue viability, continence and nutrition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The AQAA stated, and we confirmed, Care Homes for Older People Page 13 of 31 Evidence: that those people who use the service, families and friends are invited to participate in the care planning process. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Our observations showed that people using the service appeared to be content, comfortable and happy with their life style, and were complimentary regarding the quality of their lives and the care they were receiving at Swan House. Comments we received during the course of inspection from people using the service, visitors and visiting professionals: The staff are very kind and caring. If my father needs anything we are told immediately. If he needs hospital attention we are phoned, no matter what hour. And if they are taking him to hospital, he seems to react to staff all right, although he cannot communicate with them well as he has lost the power of speech. They seem to understand his needs, and that of my mothers when she visits. All the staff are caring, understanding and respect my mums privacy. We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the care manager is responsible for overseeing all matters relating to medicines, assisted by a senior nurse and a senior carer on each floor with the same responsibilities. The manager has effected a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. The manager was advised to obtain a receipt when handing over unused medicines to the contractors. Controlled Drug management was seen to be safe and comprehensive. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. There are regular Church of England services held monthly. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which Care Homes for Older People Page 14 of 31 Evidence: included medical examinations and personal care procedures being performed in private. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found arrangements for visiting were flexible, enabling relatives to visit at a time that suited them, and people using the service to maintain contact with them. Those relatives we spoke with at the time of inspection stated that when they visited they found staff pleasant and they were kept informed of any incidents, clearly identified a relaxed and informal atmosphere in which peoples needs were uppermost. The daily routine was acknowledged by us to be flexible and non-institutionalised, offering choice for meal times, personal and social activities, with the security that there are familiar events to the day they could relate to. An enthusiastic activity co-ordinator continues to present a high profile in contributing to the care planning process, and is clearly well accepted by those people using the service and staff alike. Her work is recognised as an integral part of the care process, as evidenced in examination of records, and discussion with staff, with weekly activities demonstrated by an activity notice, identifying the social events of that Care Homes for Older People Page 16 of 31 Evidence: week, which included film afternoons, bingo, trips for dances, afternoon teas and coffee events and entertainment organised by the Home. Peoples life histories are discussed and used to provide a profile basis for individualised social care, offering choice and support, although there remain a number of people who have not as yet had the profile added to the care record. Endeavors are made to organise activities and to ensure that all are given an equal opportunity to participate. To complement the process a senior nurse has been identified as a Dignity Champion, who holds meetings to discuss issues relevant to enhancing and respecting peoples dignity, and providing a personalised service. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. In spending some time in the lounge areas, we observed that there was more attention to social interaction, with staff seen to explain and deal with issues of care, for example, explaining an action or aware of spillage on clothes. Each of the lounge areas were staffed, although a more positive approach to activities and interactions in the nursing area would enhance the value of the day room experience. Nevertheless the overall conclusion was of a service generally delivered with care, compassion and familial confidence. A comment we received from a survey sent out before the inspection stated: Because my father is completely disabled, he cannot join in any of the activities. When we are not with him the staff do keep a check on him, and keep him company as much as they can. But we do see plenty of the other residents doing activities or being taken out. Recently there was a group of ladies coming back with carers from somewhere, and were having a good laugh, lovely to see. We acknowledged 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 a positive consideration into further developments to enhance the programme, especially after a long winter, and an improvement in the weather. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. We found that the standards of catering at Swan House to be satisfactory, offering a good service, to which those people we spoke with being complimentary of quality and quantity. On the day of inspection the breakfast was of a good standard with a choice of cereals, porridge, eggs, beans, bacon or sausage; for lunch there was a choice of fish or a ploughmans salad for lunch. There continues to be a reliance on sandwiches during the evening although it has been established through the Dignity of Care Care Homes for Older People Page 17 of 31 Evidence: programme that people do ask for mixed sandwiches and finger foods, instead of another hot meal. We were informed that this is being reviewed by the chef, with a view of introducing a new range of hot meals to tempt people into experimentation with new tastes. Menus are devised based on their preferences, and the dining experience has been reviewed and improved by the Dignity Champion of the home, and the nutrition co-ordinator. We found that the chef is involved in monitoring nutritional status of each person, and actively discussed options with the nursing staff or dietitian. A comment we received from people in the course of the inspection: The meals are generally satisfactory and we appreciate being able to dine in our own room. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We found that peoples legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies in place, for example, the complaints procedure, which we examined. The home has demonstrated their ability to register and handle complaints effectively through the complaints procedure controlled by the Care Manager. Our examination of the records showed that most were concerning domestic issues, and concerns over services, all were seen to be resolved to the satisfaction of all concerned. It was noted that the openness in recording, and the manner of managing concerns and complaints clearly demonstrated the acknowledgement of the management into dealing with peoples concerns in an appropriate and timely manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. We have received no complaints since the last inspection. We have not received any safeguarding referrals since the last inspection, and found the policy and procedure for handling issues of abuse (safeguarding) to be effective, and recently updated. We recognised that safeguarding referrals had been Care Homes for Older People Page 19 of 31 Evidence: satisfactorily handled by the Provider and Social Services. We examined four staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) check list. We found staff had received training on abuse at induction, this includes the right to Whistle blowing consistent with the Public Disclosure Act 1998. Safeguarding training has been completed for all trained and care staff over this year. There was evidence that there is further training regarding the Mental Capacity Act and Deprivation of Liberties, especially in development of dementia care and end of life care. Staff induction and inhouse training programmes, clarified the responsibilities of all staff in their daily contact with people, especially their privileged position in protecting people from abuse, of all natures. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: We recognise that the location of Swan House is suitable for a care home, a purpose built care home situated in an urban setting, with good communication links with Willenhall, Walsall and Wolverhampton. External access is satisfactory for visitors, with adequate parking. We found the patio area well maintained, offering a pleasant area for relaxation, although there is limited garden space located at the front and back of the home, which were secure and accessible, allowing people to go outside for a change of scenery if they wished. The external state of repair and maintenance is generally very good. On entering the home we found a pleasant reception area with some relevant information about the home, including our last inspection report. There was level access into the building, which was suitable for people who use wheelchairs, or who have mobility problems. The interior state of repair is at a high standard, the general layout is acceptable for its stated purpose, and access to all areas allows relative freedom, in a well maintained, clean and safe environment, offering pleasant surroundings. The acting Care Manager confirmed a willingness on the part of management to meet any reasonable demand for special needs. The nurse call alarm Care Homes for Older People Page 21 of 31 Evidence: system was satisfactorily tested, and personal appliance testing (PAT); that is televisions, radios, and other electrical appliances, were seen to be routinely tested. Bedrooms are well appointed, of a good size and accessible for wheelchairs and walking aids. On our inspection we found bedrooms to be well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying personal furniture and belongings. Bedrooms are assessed each time they fall vacant, for refurbishment and possible carpet replacement. Wardrobes were seen to be secured, although were regularly used to store bulky items and various decorations. An alternative way of storing will be met by the acting Care Manager. All bedrooms were single, with en-suite toilet and wash hand basin. We confirmed that all bedroom doors had locks and lockable facilities available in each room, so enhancing the arrangements for privacy. Overall the attention to detail has presented a good quality, yet homely and comfortable environment. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. It was advised that a more appropriate door naming system be introduced, to present a clear and dignified address for each person. We acknowledged that communal areas are furnished and decorated to a good standard to present an impressive, yet homely and comfortable environment. All communal areas were seen to be of a good standard, providing two main lounge areas that were pleasantly decorated, each with a small kitchenette area for making drinks and snacks, which was well maintained. We saw that each lounge provided good quality furnishings and items to offer comfortable areas where people were able to interact with their friends, or to entertain their guests. The rooms were suitably light and bright to allow people to take part in activities such as reading; and that social, cultural and religious events tend to take place in the lounges. The dementia unit was bright and cheerful with a range of colours and fabrics to stimulate people, and offer a degree of recognised familiarity. There was a separate garden room that was well decorated and lead out to the garden, and a separate themed bathroom that was pleasant and provided stimulation for people to talk about. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and odour-free. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Toilets are accessible to all, and within close proximity to all communal areas. The acting Care Manager was reminded to ensure that sluice doors be secured when not in use. Care Homes for Older People Page 22 of 31 Evidence: We inspected servicing records and found them to be up to date and accurate. The housekeeping services in the Home were seen by us to be of a high standard, and people spoken to generally remarked that they find the environment clean and fresh. There was one bedroom with a strong urinary smell, but was receiving attention that morning. A comment from a visiting daughter we spoke with: All the rooms at Swan House are very well attended to, always clean and tidy. The home achieves a high standard of cleanliness. The kitchen was inspected with the cook, and found to present a well equipped and organised area. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and likes and dislikes. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. The laundry was well organised and equipped to a good standard, procedures were in place for coping with soiled and infected linen with the provision of alginate bags to minimise handling and cross infection. Care Homes for Older People Page 23 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit. There are appropriate recruitment and training procedures to meet the changing needs of people using the service. Evidence: We confirmed that there were 43 people living in the home on the day of the inspection. Our examination of three weeks of staffing rotas showed to us a satisfactory balance between skills, experience and numbers to support a good standard of care. The Registered Manager, who is supernumerary, is supported by a satisfactory complement of Registered Nurses and care staff. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection there were two Registered Nurses and eight care staff on duty. We were informed that each Head of Department are responsible for monitoring performance, with the Care Manager attending night shifts on a regular basis. The Home has an activity coordinator, receptionist/administrator and maintenance staff. We established that there are satisfactory levels of housekeeping, laundry and catering staff. Southern Cross management have committed a high profile presence in training, monitoring and support for the Care Manager. Care Homes for Older People Page 24 of 31 Evidence: We sampled four staff files, and found them to be consistent and up to date. Staff are employed in accordance with the organisations code of conduct and practice, reinforced with the General Social Care Council policies. We recognise that the management have established a comprehensive procedure for the recruitment, interview, selection and appointment of staff, endorsing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure good standards and protection of people. A staff photograph in each file would be helpful. We confirmed through examination of records and talking with staff that all new team members receive a thorough induction programme, and an ongoing training and development plan. The records we examined showed that 75 of all staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further 15 undertaking NVQ training at the time of inspection. Overall the evidence shows a substantial account of a meaningful schedule of training to meet mandatory and specific demand. We recognise that there are currently two home trainers for mandatory subjects, and a member of staff has been identified to undertake accredited training in manual handling training. We found positive outcomes with the development of the Dignity Champion concept, resulting in all team members participating in reviewing care practice, suggesting ways to develop and improve standards, and in strengthening the team principle. Comments we received by surveying before the inspection and in the course of inspection: The older staff are very good, they always listen to comments and act accordingly when they can. Never had a problem with any of the staff, either carers or medical. If we need to know something it is answered or done. We have no complaints about the staff whatsoever. Very friendly and helpful. If the nurse is busy a carer always finds them immediately. There are always at least 4 to 5 members of staff on the nursing ward everytime we visit. Sometimes they are very busy. But there is always someone there. Records were available to demonstrate an on going process of regular supervision and supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: We acknowledge that the Registered Care Manager, Maxine Cleobury, has continued to demonstrate clear competence over the past year since registering with us, in establishing a solid professional management style that has been implemented, to achieve good standards of set aims, objectives and care. An experienced Registered Nurse with a professional track record of clinical and managerial experience. The Registered Providers have continued to demonstrate a high profile in monitoring, and with management support. We acknowledged the openness and confidence in the observed interactions of staff, relatives and people who live in the home, seen to be of mutual trust and respect. Care Homes for Older People Page 26 of 31 Evidence: Several comments made by people who live at Swan House, and visitors we spoke with, reinforced the strong foundation of confidence they had in the management of care. The manager and nursing staff are very approachable and fair, she (the manager) is seen to lead by example in keeping the standards of care as high as possible. My father is not an easy man to care for with his disabilities, with my mother unable to cope herself. Was at first concerned, but now she has no worries at all. She gets on well with all the staff and they understand her sharp temperament. My father is comfortable and well looked after. Our examination of records showed appropriate risk assessments are in place for people, through care planning and recording, staff selection and of the general environment, these are up to date and accurate. The services completed AQAA states that the home has quality monitoring systems in place, and that they also consult the people who use the service and their relatives about the service. This we found to be true. The outcome showed a clear indication that the home is run in those peoples best interests. Some comments made by relatives: Mums room very well furnished, overall very pleased with standards. Communications are excellent, staff are very good and helpful, and telephone us immediately if anything happens. We recognise that the Providers, with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. An examination of administrative, monitoring, planning and care records showed an organised and a professional attitude to effective record keeping. The Care Manager conducts spot checks through weekly risk monitoring report, including bedrails, wheelchairs, hoist and sling checks, and accidents. We advised the personalisation of movement and handling slings to reinforce infection control safeguards. Social Workers review meetings are often a vehicle for assessing quality. Quality audits are undertaken every 6 months for each department, and action plans implemented were areas are found to be deficient. Resident and Relative meetings are held every three months with the manager, and every month with the activity coordinator. We were informed that the atmosphere is kept informal so people feel free to speak openly. We identified that individuals are encouraged to be independent with regard to financial affairs with the assistance of their relatives. Small amounts of cash were efficiently handled by the administrative officer, checked quarterly through the Providers offices. Our inspection found the records system to be satisfactory, so people can be assured that the organization has systems in place to protect their money. We noted that out of hours management of monies was kept in a small safe in the 1st floor treatment room, but the safe was not adequately secure. It was advised to only use the secured safe in the ground floor treatment room until remedial Care Homes for Older People Page 27 of 31 Evidence: action could be taken. We made a random sample examination of the procedures manual, and found it to offer a very comprehensive reference, although some procedures require up dating to reflect changing circumstances. All care staff receive six sessions of individual formal supervision annually, confirmed with staff, and on examination of records. We discussed equality and diversity issues with a number of staff and managers, covering a wide range of issues, including culture, food, religion and staffing. We found that the health and safety of people who use the service and staff, are promoted with safe storage of hazardous substances, regular electrical PAT, servicing of gas appliances and regulation of the water system. The accident book was seen and found to be in order for staff and people using the service, with a three monthly analysis of trends and frequency undertaken by the manager. We found the administration and management of the home is efficient, uncomplicated and sensitive to the needs of people living in the home. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 19 19 That utility rooms be secured when not in use to ensure the safety of people living in the home. That each bedroom door to be fitted with a clear, robust name plate to provide people with a dignified and clearly recognisable address. That wardrobe tops are clear of stored items to ensure the health and safety of people living in the home. That staff personnel files contain an up to date photograph, to firmly establish the identity of each individual member of staff. That clinical and operational policies and procedures be kept up to date, to ensure staff have an accurate reference to apply effective standards of care. That the unsecured safe in the first floor treatment room be secured to an adjacent wall, to ensure the safe and secure managements of valuables held in temporary store. That movement and handling slings be personalised to ensure safe use for people, and minimise cross infection risks. Page 30 of 31 3 4 19 29 5 33 6 35 7 38 Care Homes for Older People Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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