Inspection on 06/06/07 for Swan House Care Home

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Swan House Care Home 24/09/09

Swan House Care Home 03/04/09

Swan House Care Home 11/04/08

Swan House Care Home 05/12/07

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 Ann Farrell Key Unannounced Inspection 6th June 2007 08:05 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.V342042.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.V342042.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 F/P01922 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) Vacant 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.V342042.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. 7th June 2006 2. Date of last inspection Brief Description of the Service: Swan House Care Home is a purpose built two-storey property providing care for up to 45 residents 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 service users 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 service users 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 residents 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 £658. The nursing element contribution is retained by the home. 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. Residents’ are also given their own copy of the Service User Guide, which they can refer to at any time they wish. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social care inspection (CSCI) is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision s that need further development The inspection was conducted over two days commencing at 8.30am and the home / provider did not know we were coming. This was the first statutory key inspection for 2007/2008. The manager was present for the duration of the inspection. Information for the report was gathered from a number of sources: a partial tour of the building, an examination of records and documents in relation to the management of the home plus conversation with managerial and care staff plus direct and indirect observation. Three residents who live in the home were’ case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. Five surveys were also received from residents and relatives after the inspection. What the service does well: People living at the home are supported by staff to maintain contact with their family and friends at a time that suits them. The home is a purpose built care home offering single bedrooms with en-suite facilities, so that persons living at the home can maintain their privacy. The environment was clean ensuring that persons living at the home live in pleasant surroundings. Residents’ are able to bring in their own possessions to personalise their own bedroom, ensuring that residents have a personal space that reflects their likes, preferences and individuality. A high number of staff have attended fire drill training giving them the skills and confidence to deal safely with such an emergency and therefore protecting and promoting the safety of residents living in the home. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 6 Fresh fruit and vegetables are available to residents; ensuring meals are both balanced and varied. The organization has a system where unannounced financial checks are carried out by a representative of the provider to ensure that systems for storing and checking residents’ personal money is secure and auditable and their financial interests are safeguarded. What has improved since the last inspection? What they could do better: The number and repeated occurrences of the same type of complaints demonstrate that the home is failing to address concerns adequately. Action needs to be taken to ensure issues are addressed and that persons living at the home have their needs met and that repeated occurrences of similar incidents do not occur. Staff knowledge in relation to adult protection policies and procedures is weak in some instances and therefore potentially places residents at risk. Care plans lack detailed information and in some instances contain no information to demonstrate residents needs have been assessed, monitored or met. This means that residents’ needs in some instances were not being met. Training has lapsed in a number of areas such as dementia and food hygiene. The induction programme does not link into the Skills for Care programme therefore it cannot be guaranteed that staff have the skills and competence to meet the needs of residents. Staff recruitment records must be comprehensive to ensure that a robust procedure is followed to promote and protect the well being of residents. The medication management must improve to ensure that residents living at the home receive medication as prescribed. The time of serving breakfast should be reviewed to ensure that residents do not wait excessive amounts of time for breakfast in the morning. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 7 The system for responding to call bells must be reviewed to ensure residents do not have to wait an excessive amount of time before their needs are met. Also a review of staffing levels must be undertaken to ensure there are sufficient staff on duty at all times. Residents must be empowered to make their own choices in relation to whether they wish to lock their bedroom door, have access to a GP and use a mobile phone. Activities should be reviewed in the home, so that there is a structured and over-arching approach to ensuring residents preferences are met and they are adequately stimulated. The cleaning schedule for the kitchen area must be reviewed and appropriate action taken to ensure there is not a risk to residents. The provision of a kitchenette area in the dementia unit must be reviewed so that staff do not leave the area unnecessarily to obtain drinks for residents and so placing residents and staff at risk. Residents being re admitted to the home following hospital admission must be reassessed by staff to ensure they can meet their needs and the appropriate aids/adaptations are in place. Communication between the various teams within the home must be reviewed to ensure that residents and their representatives are kept fully informed of residents’ needs. 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.V342042.R01.S.doc Version 5.2 Page 8 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.V342042.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3.6. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information about the services and or facilities provided is available to residents and or their representatives to enable them to make an informed choice about the home. The pre-admission assessment process was comprehensive ensuring residents’ needs are appropriately assessed prior to admission to the home, so providing confidence that their needs can be met when they enter the home EVIDENCE: The Service User Guide and Statement of Purpose was not inspected during this visit, but was observed to be available in the reception area. Copies of the Service User guide were observed in residents’ bedrooms, thus ensuring that Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 10 residents have information about the service, which they can refer to at any time that suits them. Three residents files were inspected in detail to determine the admission process. Enquiry forms are generated and added to as required which may lead to a pre-admission assessment. The pre-admission assessments were found to have been completed comprehensively. Information was also obtained from other professionals prior to admission, so ensuring staff are aware of what is required to meet residents needs before they enter the home and the appropriate preparation can be made for them. 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. The home does not provide intermediate care, but residents are admitted to the home for respite or long-term care. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health and care needs are not consistently being met placing them at risk. Medication management had minor shortfalls in a number of areas and therefore does not ensure residents continued well being. EVIDENCE: When residents are admitted to the home a care plan is drawn up for residents, which outlines the action required by staff to meet resident’s needs. The care planning documentation was comprehensive with an array of risk assessments taking place, however the evidence indicates that needs are not being met. An internal audit of care plans had been carried out six weeks prior to the inspection and from these a number of weaknesses had been identified. The shortfalls had been amended in some instances but not in others. The quality of care planning was mixed ranging from adequate to poor in quality. For example one resident was found to have no care planning instructions with some assessments, but these were not found to be completed Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 12 comprehensively. This particular care plan was discussed with the management team during the inspection. It was evident that this resident would be assessed at high risk in some aspects of their care due to a number of underlying conditions but these were not being acknowledged in the care plan resulting in an incident where the health and welfare of the resident was severely compromised. Despite this incident the resident continued to have no care plan in place at all. The care plans were able to demonstrate that health professionals were contacted and needs addressed. Short term complications and conditions had not been acknowledged in the care planning process, so there is a potential for lack of intervention or monitoring with some conditions by staff at the home. In some instances long-term care needs were not acknowledged in the care planning process such as cardiac conditions. Patterns and trends in relation to residents well being were therefore not being monitored or addressed by the staff. One resident who had recently been discharged from hospital following surgery did not have the necessary aids and adaptations in place to ease their ability to use the toileting facilities within the home. Staff informed the inspector that after several weeks their condition had improved but it had been difficult for the resident to use the toilet on initial discharge from hospital back to the home. The continence management assessment is good, but this was not necessarily leading to any care planning strategies to meet residents’ needs. A specific residents case was discussed with the management during the inspection, as practice in meeting their continence needs was not being tailored to the findings of the assessments, but based on routines. One relative commented that on some occasions staff had not passed information on to each other in relation to the changing care needs of residents. Another relative commented that their relative’s request to see a GP was overruled by care staff who felt that this was unnecessary. A further comment from another relative was that staff always informed them if their was a significant change in their relatives medical condition. These three comments gave a mixed picture as to how resident’s health care needs were being met in the home. Where a resident requests to see a doctor then they should not be denied access to their GP. Changes in condition should be communicated between groups of staff to ensure that residents’ needs are fully met. The manager will need to undertake a review of the communication system and address any shortfalls in the future. A dementia unit within the home has been created with an environment that is positive for residents experiencing cognitive impairment. Care planning in Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 13 relation to meeting this particular group of residents needs was poor, as it was not person centred. Residents care plans concentrated on weakness and needs, but did not acknowledge residents’ strengths and abilities. The independence and self esteem of residents in this unit is therefore not being acknowledged or promoted. Staff spoken to on the dementia unit during the visit demonstrated a kind, caring and individual approach to meeting residents’ needs. However not all staff working within the dementia unit have received training in dementia care, which is essential to equip staff with the skills and competences to look after and meet the needs of residents with this specific condition. There are three medication trolleys in the home, which are kept in a locked room on each floor of the home and chained, to the wall. Medication for disposal was kept on the ground floor, but was not secured in a locked cupboard, which is required for safety purposes. The medication trolleys were observed to be clean and organized so that medication could easily be located. The homes medication system consisted of a blister and box system with printed Medication Administration Record (MAR) sheets being supplied by the dispensing pharmacist on a monthly basis. The home is not keeping copies of the original prescription (FP10’s) so they are unable to check the prescribed medication against the MAR chart when it enters the home, thus the checking in procedure cannot be guaranteed to be sufficiently robust. Medication management was found to be variable and not always auditable. Some of the instances were due to stock not being carried over to the MAR chart from the previous month and not being recorded. Oxygen cylinders on both floors of the home were not chained to the wall, despite a chain, hook and lock being available to do this. The Acting Care Manager chained the cylinders to the wall during the inspection. Oxygen cylinders need to be chained to the wall in case of fire as this reduces the impact of an oxygen cylinder exploding and flying though the air. The daily recordings of temperatures were taking place in relation to the medication refrigerators to ensure that medication is stored at the temperature required to remain within the product licence of the drug. However the thermometer in the ground floor medication room indicated that the room temperature was 26 degrees centigrade. Medication room temperatures need to be recorded with a thermometer and if it is found that the medication room exceeds 25 degrees, then action must be taken to reduce the temperature as all medication stored in these areas will be outside the product licence and could possibly put residents at risk. The Controlled drugs and the register were audited and met the standard ensuring medication is stored and dispensed as required by law. Subcutaneous fluids are being used within the home for residents that are deemed to be dehydrated. The home was unable to locate a policy and procedure for the use of subcutaneous fluids although one was faxed over to the home from another home in the organisation during the inspection. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 14 Policies and procedures should be readily available to staff so that they have clear guidance. The MAR prescription for the subcutaneous fluids did not state how the fluids were to be given. One stated “infusion”, but did not indicate how long the fluids were to have been infused over. One member of trained staff was interviewed during the inspection of the home, and they informed the inspector that they had been taught to administer subcutaneous fluids by the previous care manager and had not attended a specific training course in relation to this. This member of staff was unable to identify which fluids they would not give subcutaneously. This is concerning as it demonstrated a lack of knowledge of the infusion they are being asked to administer. This particular member of staff was honest and open with the inspector and it was evident that they wanted to ensure that residents in their care got the best possible treatment. The Commission has been in discussion with the Primary Care Trust (PCT) following the inspection due to concerns identified in relation to the administration of subcutaneous fluids and they were unaware that such procedures were taking place in a care home setting. The PCT is also unaware of any training available to staff in the community to carry out such procedures. Residents living in the home can self medicate and there was evidence to demonstrate that this was taking place along with a self-medication risk assessment, so ensuring residents are safe to undertake the procedure. Residents were observed to be nicely presented and dressed appropriately for the season, their gender and culture. Relatives commented that clothing is nicely laundered. Carers were observed knocking on residents door prior to entering the room, so respecting their privacy. Some residents were observed to have a mainline telephone in their bedroom enabling them to make telephone calls when they wished. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents maintain contact with family, friends and the local community ensuring a wide and varied lifestyle. The meals were wholesome, balanced and appealing so providing a nutritional diet that meets residents’ needs. Nevertheless residents appear to wait an excessive amount of time for their breakfast to be served and they are not always able to exercise full choice and control over their lives due to restrictions placed upon them by the home. EVIDENCE: The home at present has a vacancy for an activities co-ordinator meaning that a consistent approach to activities was not being maintained and residents were not adequately stimulated. Staff on the dementia unit confirmed that they provide one to one time with residents in the form of cleaning and painting nails. They also ensure that the radio plays appropriate music for residents residing in that unit. Relatives confirmed that they were able to visit and take their relative out with them at a time that suited them and enabling residents to maintain contact with family and friends. Relatives also confirmed that staff would assist in Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 16 arranging transport for residents to go out into the wider community by either arranging the ring and ride service or ordering a taxi. This ensures residents that are able to access the community independently can do so. Relatives confirmed that residents could have a main line telephone installed in their bedroom. One relative commented that they had been informed that their relative could have a main line telephone installed in their bedroom but on enquiring about a mobile phone they were informed that these were not allowed in the home. There appears to be no logical reasoning for this and it is restrictive on resident’s choice and freedom. The staff stated that residents have a choice as to where they can take their meals. Breakfast was observed on the first day of the inspection being served at 9.15am. Lunch was being served at 1pm and tea at 4.30pm and supper at 8.30pm. Residents confirmed that they can have a drink before breakfast but some residents informed the inspector they were awake from 06.30hs, thus they would be waiting just under three hours for the first meal of the day. This seems an excessive amount of time. Also the gap between breakfast, lunch and tea was less than four hours. The kitchen staff informed the inspector that at 15.00hrs they check as to whether any residents would like a cooked tea. Breakfast and lunch were observed being served and the meals were attractively presented. Staff provided appropriate and discreet assistance whilst ensuring that resident’s independence was maintained. Comments received included, “food okay”, “Fresh fruit on trolley, and yoghurt every day” and “food good, better than home”. The food offered is mainly traditionally English as the home caters for predominately white European residents. The menus have been assessed as being nutritionally sound and fresh fruit and vegetables were included. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Systems in place do not safeguard residents and they cannot be confident that their views are listened to and acted upon or they are safeguarded from harm. EVIDENCE: The home had recorded twelve formal complaints since the previous key inspection and they were from a variety of stakeholders. The complaints recorded were around poor care practice, poor medication management, the attitude of staff and poor manual handling techniques. Evidence in the complaints log was not comprehensive in all instances and the inspector was informed that if the complaint was in relation to or partly in relation to the Care Manager then staff statements would not be kept at the home. Whilst in a large home there will inevitably be concerns raised from time to time the repeated occurrence of these concerns demonstrates that issues were not being addressed and resolved appropriately. One resident’s care plan demonstrated that families concerns were recorded in the care plan and not formally logged in the complaints record. The seriousness of the issues raised by this family and their relative meant this should have been recorded in the complaints record. The previous care Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 18 manager stated that they were not recorded formally as the family were happy with the outcome. This being the case then the complaint should have been recorded and it should have been acknowledged that the family were happy with the outcome. Complaints are a quality indicator of the service and not recording and auditing all concerns the home is unable to provide and meet the needs of all residents. Since the previous inspection the Commission had received two complaints, which were passed to the provider to investigate. Due tot eh findings it cannot be guaranteed that complaints/concerns would be dealt with appropriately and residents safeguarded. Staff knowledge in relation to adult protection was mixed, for example trained staff were unaware of the multi-agency guidelines and how to initiate these. Not all staff had received training in adult protection according to the training matrix supplied by the home. The home has a policy and procedure in relation to adult protection, but it was concerning that staff were not always aware of what it was or how to implement it, so placing residents at potential risk. The Commission is not aware of any adult protection investigations that have taken place since the previous inspection. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 19 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): 19.21.22.24.26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ live in a safe comfortable and well-maintained environment with their own possessions around them so that they live in a safe environment. EVIDENCE: The home was clean on the day of the inspection and was a pleasant environment for residents’ to live in. The garden areas for the residents were located at the front and back of the home and were accessible to residents allowing them to go outside for a change of scenery if they wished. The internal home environment consisted of two floors and the ground floor accommodated the majority of the social care residents live. The dementia unit was also located on the ground floor. The dementia unit does not have a kitchenette area. This means that staff cannot prepare drinks and snacks Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 20 outside of main meal times to suit individual residents preferences without leaving the unit. This practice should be reviewed to promote a more individual approach to care. Other areas of the home have kitchenette areas, which allow staff to provide drinks and snacks for residents. The first floor is where the majority of the nursing residents reside. All bedrooms are single occupancy and include ensuite facilities consisting of a toilet and wash hand basin. Records did not demonstrate whether residents were routinely offered a key to lock their bedroom door to enhance privacy. One resident said that they would like a key to their bedroom. This was discussed with the management team who stated the resident had previously had a key but was lost. This does not explain why the resident was not re issued with a key. This particular resident explained that they were able to lock their bedroom door whilst in the room only and they did this at night. This resident is therefore not being empowered to make their own choice as to when and how to secure their own personal space. Communal toilets and assisted bathing facilities are located throughout the home offering residents choice of shower or bath, which meets the needs of residents. All bedrooms and communal rooms have a call system enabling residents’ to summon assistance when required and all floors can be assessed by a shaft lift ensuring that residents with restricted mobility can access all areas of the home. Handrails were observed along the main corridors of the home; to assist residents with mobility problems and enable their independence within the home. Residents and relatives confirmed that on some occasions residents had to wait an excessive amount of time before the call bell was answered by staff, so their needs were not met in a timely manner. The laundry is well equipped and relatives commented that clothing was laundered to a good standard. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment practices need to be more robust to ensure that staff employed are suitable to work with vulnerable people and they are adequately protected. A review of staffing levels should be undertaken to ensure there are adequate staff on duty at all times to meet residents need. EVIDENCE: At the time of the inspection forty-four residents were living at the home. The workforce is split into three groups to cover the three separate units of the home. Rotas supplied demonstrated that one trained nurse is always available throughout the day and night to meet the needs of nursing residents. There are four care staff allocated to meet the needs of residents throughout the night for the whole of the home. During the day there two carers are allocated to meet the needs of the nine residents living in the dementia unit; four carers are allocated to meet the needs of residents requiring nursing care and two carers are allocated to meet the needs of social care residents. In addition to nursing and care staff the home also has domestic, laundry, administration and catering staff. Comments received back from relatives indicated that on some occasions residents waited an excessive amount of time for their call buzzer to be answered and their needs met. It is recommended that the home does a staff audit to ascertain whether needs of residents are being met by the current number and deployment of staff. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 22 A number of staff were spoken with during the inspection and they were found to be honest, friendly and enthusiastic about their role within the home. Staff recruitment files were examined for staff recently recruited to the home. Not all files contained two references and in one instance no references were available at all. The inspector was informed that verbal references had been obtained but there was no record to demonstrate this or any details of the verbal reference. Criminal Record Disclosure checks were taking place and these were kept at head office. Systems are in place to notify the manager of the results of these disclosures. The training matrix supplied to the Commission demonstrated that twelve of the thirty two-team leaders, senior care and care assistances had completed NVQ2 training or above in care. Consequently at present over 50 of carers do not have this qualification or recognised skills to provide them with the skill and knowledge they require meeting the needs of residents. The home has its own induction programme, which involves shadowing other members of staff for a set period. One member of staff recently employed at the home was asked about their induction programme. This consisted of shadowing a senior member of the care staff but skills and competences were not being formally recorded in any written format. This was discussed with the management team at the time of the inspection and they were under the impression that all new staff had been issued with a booklet as these had been distributed around the home. The management team confirmed that the induction programme does not encompass the Skills for Care programme. The home should revise the induction programme to include all elements of the Skills for Care programme in order to ensure that care staff have adequate knowledge and skills initially and are competent to carry out their roles in order to meet residents needs. A wide range of training is taking place or has occurred in the past. Dementia training has been provided for some staff working on the dementia unit. As this is a specialist unit all staff should have some training in this condition to ensure that they possess a knowledge base to meet the residents needs. On the first day of the inspection the inspector spent time with residents and staff on the dementia unit. Staff working on this unit were observed to understand the needs of the residents and communicate in an appropriate manner to ascertain and meet residents’ needs. Approximately fifty percent of staff serving food have current food hygiene training whereas all staff involved in food preparation or handling require training in this competence to protect and promote well being of residents. Also approximately fifty percent of staff had received first aid training. This percentage ensures that someone is available in the building with first aid knowledge. The percentage of staff that had recently received manual handling training is high, providing staff with the appropriate skills to move and assist residents’ safety. Fire drill records Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 23 indicated also that a significant number of staff had recently attended a fire drill. Staff spoke enthusiastically about the fire training they had attended and were aware of the importance of being well trained to protect the well being of residents. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.35.38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although management and administration systems are in place they are not implemented in a robust manner to ensure residents’ needs are met and their safety is not compromised. EVIDENCE: The Acting Care Manager was present on both days of the inspection. She is a trained nurse with a number of years experience working in care settings, but has only recently been appointed to the home and has not submitted an application for Registration with the Commission. The management team at the home carries out monthly audits in a variety of areas. The Commission was informed that a residents meeting was to take Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 25 place soon. These need to be occurring on a regular basis so that residents can express opinions, raise concerns and make suggestions into the running of their home. Residents’ personal money is stored safely. The records of residents’ money had been computerized, so the system does not permit two signatures to be obtained for each transaction. Receipts were found to be available for residents’ money audited at the time of inspection, ensuring an audit trail could be followed. The money available and the records did not however correspond. The home was asked to recount the cash available and if this did not correspond with the records then all accounts needed to be reconciled to find where the error had occurred. The Commission was informed following the inspection that the organization had initiated an accounts administrator to visit the home and carry out an unannounced spot check in light of the concerns raised. This is to be commended as residents can be assured that the organization has systems in place to protect their money. Health and safety on the whole was well managed. There were however a number of areas that will need to be addressed, the kitchen being the main area of concern. The gas cooker was emitting a strange noise and on closer inspection, the gas burn jets had eroded away in certain areas. The staff at the home were unable to find the Gas Safety Certificate and an immediate requirement was left for this to be forwarded to the Commission. The Gas Safety certificate was forwarded to the Commission and a competent person had said the gas equipment was safe in February. A letter from the provider to the Commission following the inspection confirmed that a new gas cooker was on order. The deep fat fryer was covered in a thick layer of fat and the home had no cleaning schedule for it. The canopy over the cooker in the kitchen contained debris despite the fact that the inspector was shown records to demonstrate that this had been cleaned 3 days earlier. The home needs to review its cleaning schedule in both areas, so that food is not contaminated from debris and therefore placing residents at risk. Shelving in the dried goods areas were wooden with plastic covering. The plastic covering had worn in places making it difficult to clean. Labelling was not occurring for dried goods decanted into plastic containers, although staff were able to inform the inspector when stock had been decanted. This needs to be recorded so all staff are aware and residents are not placed at risk. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 x X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 2 3 3 3 2 3 2 3 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 2 Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) Requirement All care plans must be based on a comprehensive assessment and following this assessment a holistic person centred care plan must be drawn up. To ensure that staff are aware of the needs of residents and actions required to meet them. Short-term conditions and complications must be incorporated into the care planning process to ensure a holistic approach to care takes place and needs are met. Appropriate aids and equipment must be in place at the point of admission or change in a resident’s condition to ensure their needs are met appropriately. Appropriate systems must be in place for the management of residents continence needs to ensure it is managed effectively and the resident’s comfort is maintained. Timescale for action 30/09/07 2 OP8 13(4) 23(2)(n) 30/09/07 3 OP8 12(1) 30/09/07 Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 28 4 OP8 13(1) 5 OP9 13(2) Arrangements must be in place for residents to see a G.P. when they wish to ensure medical needs are met. A System must be installed to check the dispensed medication received into the home against the original prescription to ensure a robust system is in place for persons living in the home. All medication must be auditable to demonstrate that persons living in the home have received their prescribed medication and systems are in place to ensure they do. All medication must be stored securely to ensure no unauthorized access to residents’ medication occurs. 30/09/07 30/07/07 6 OP16 22 7 OP18 13(6) The medication room temperature must be maintained at below 25c to ensure that medication is stored at the approved temperature. Complaint management must be 30/08/07 reviewed to ensure all complaints are systematically recorded in the complaints record and include the nature of the complaint, the investigation, the outcome and resolution. This must be reviewed regularly to ensure all complaints are dealt with appropriately and systematically to ensure learning is achieved and prevent repeated failings. Staff must be aware of the adult 30/09/07 protection policy and procedure to protect persons living in the home from the risk of abuse. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 29 8 OP27 9 OP29 Sch 4 17(1) 10 OP30 18(1)(c) The number of staff and their deployment should be reviewed and audited and action taken to ensure there is sufficient staff on duty at all times to meet residents needs. Staff files must contain evidence to demonstrate that two references have been obtained for staff being employed at the home and residents’ well-being is protected. The induction programme for care staff must reflect the contents of the Skills for Care programme to ensure staff are adequately trained initially to undertake their role. Staff must receive training that is appropriate to their role and must follow a teaching plan to ensure that staff are adequately trained to carry out their role All staff who serve food must receive mandatory training in respect of food hygiene to ensure that staff have the skills and knowledge to under take this task competently 30/09/07 30/08/07 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP14 Good Practice Recommendations A culture of empowering persons living at the home should be promoted so that their wishes, choices and preferences in relation to having a key to their bedroom, access to a mobile phone and community services etc. Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 30 2 OP8 A review of the communication systems in the home should be undertaken and actions taken where any shortfalls are identified to ensure resident’s needs are met effectively. It is suggested that the lead nurse from the PCT is contacted for advice and guidance regarding the administration of subcutaneous fluids to ensure safe and appropriate procedures are followed and resident’s needs are met. Clinical policies and procedures must be available to staff to ensure they have guidance to carry out procedures correctly and effectively in the home and so protect the well being of residents. Persons living in the home must have access to activities, which consistently reflects their needs and preferences, so they receive appropriate and adequate stimulation. The serving times of breakfast must be reviewed for person living at the home to ensure that they do not wait excessive amounts of time before they are given the first meal of the day. Persons living at the home are offered a key to their bedroom unless their risk assessment indicates otherwise and a record of this conversation is kept in the care plan, in order to enhance privacy. That a kitchenette area be available on the dementia unit in the home, so that staff are able to make drinks and snacks for residents when they wish in order to meet their needs. Persons living at the home must not be kept waiting excessive amounts of time after calling for help via the call bell system, so ensuring their needs are met in a timely manner. At least fifty percent of staff working at the home have an NVQ 2 qualification or equivalent in care, so that they have the skills and competence to meet residents needs. It is recommended that regular meetings be held with residents in order to gain feedback about aspects of the home and provide them with some control over their lives. Systems for labelling decanted food needs to be reviewed and action taken to ensure food does not exceed the producers guidelines All areas in the kitchen should be kept clean at all times to prevent any infection. Shelving in the kitchen pantry should be reviewed and action taken to ensure that it can be cleaned easily, to prevent the risk of infection. DS0000066099.V342042.R01.S.doc Version 5.2 Page 31 3 OP8 4 OP9 5 6 OP12 OP15 7 OP24 8 OP19 9 OP22 10 11 12 13 14 OP28 OP33 OP38 OP38 OP38 Swan House Care Home Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Halesowen Local Office West Point, Ground Floor Mucklow Office Park Mucklow Hill, Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swan House Care Home DS0000066099.V342042.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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