Inspection on 10/05/06 for Swanborough House

This inspection was carried out on 10th May 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swanborough House 08/05/07

Swanborough House 10/11/05

Swanborough House 25/05/05

Swanborough House 13/10/04

Swanborough House 27/05/04

Swanborough House 18/07/02

Similar services:

Thorndene

Sutton Lodge Nursing Home

Wingham Court

Bethany Lodge

17 John Street

Red Oaks

Clare House Nursing Home

Broad Oak Manor Nursing Home

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

CARE HOME ADULTS 18-65 Swanborough House Swanborough Drive Brighton East Sussex BN2 5PH Lead Inspector Elizabeth Dudley & Jane Jewell Key Unannounced Inspection 10th May 2006 7:30 Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Swanborough House Address Swanborough Drive Brighton East Sussex BN2 5PH 01273 696391 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) Raphael Medical Centre Limited Thomas Druitt Care Home 31 Category(ies) of Physical disability (31) registration, with number of places Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is thirtyone (31), one of which is respite care. Service users must be aged between eighteen (18) and sixty-five (65) years on admission. The service users accommodated will be disabled due to an acquired neurodisability. 10th November 2005 Date of last inspection Brief Description of the Service: Swanborough House is registered to provide accommodation and personal care to 31 adults who have disabilities due to acquired brain injury. The home aims to provide a range of therapies and activities designed to promote rehabilitation. The registered provider is the Raphael Medical centre and the responsible individual is Gerhard Florschutz. The home follows the Rudolph Steiner philosophy of holistic living and all catering and therapies offered follow this philosophy. The homes literatures states that its vision is to develop and provide a residential rehabilitative unit and day care facility for adults with acquired brain injury, based on the Anthroposophic image of man as a being of body and spirit The home is located in Brighton with access to local amenities, which include the Whitehawk community centre. Public transport routes serve the area. The home consists of single rooms, most of which have ensuite facilities and there is a range of communal space which includes a dining room, lounges and a large rear garden. The fee range as of the 10th May 2006 is between £700 and £1600 per week. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 10th May 2006 over a period of twelve hours and was facilitated by Mr T Druitt, home manager. Two inspectors undertook the visit. The information contained in this report was gathered from a visit to the home, resident questionnaires, interviews with staff and residents and tour of the home. During the inspection, records which included care plans, training records, health and safety documentation and personnel files were examined. In the course of the visit many residents and staff were consulted regarding their experiences of the home. Thanks are extended to the manager, staff and residents for their help and hospitality during the day. What the service does well: The home provides a variety of activities and therapies which aim to aid residents to rehabilitate as much as is possible within the limits of their abilities. The rehabilitation programme is enabling some residents to move on to independent living and substantially reducing the dependency of some other residents. Residents spoken with stated that ‘the staff are kind’ and that ‘we are well looked after’, whilst relatives of residents spoke of the improvement that had been noted in the abilities of the residents and the benefits of the rehabilitation programme. One relative commented that the ethnic variation within the staff provided an open atmosphere in which different ideas were brought into the rehabilitation and therapies available. Residents, in the most part, said that the food was good and varied and that the cook was prepared to cook whatever they wished to eat. Most residents said that the activities and therapies provided were suitable and that they had help to participate in these. The home provides a good training programme which includes training in care and the psychological and physical conditions which affect the residents in the home, and health and safety training is also included and staff are encouraged to study for their NVQ 2 and 3 in care. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 6 Training for staff also includes training on the Anthrosophical ethos of the home and enables staff to pass on their understanding of these methods to residents, who can choose whether they wish to embrace this ethos. The food provided by the home is very good and is based on the Anthrosophical ethos. It consists of a variety of home produced meals which include meat, fish and vegetable dishes, and where possible these use organic foodstuffs. The chef is enthusiastic about the food which she prepares and residents are able to make choices of meals even if these are not on the menu for that day. Very positive comments were received about the food. The home has the “Clean Food Award”. What has improved since the last inspection? What they could do better: Based on feedback from a number of staff, it would appear that the current management ethos of the home does not always promote an open, transparent and supportive environment and this has an impact on staff turnover, and does not aid the safeguarding of residents. The manager must fulfil his legal responsibilities in the reporting of all notifiable events to the CSCI Residents need to be provided with terms and conditions of residency in order that they are aware of their rights and responsibilities whilst at the home. A few residents said that the complex needs of some of the residents detracted from the quality of the care and the amount of time that the staff had to spend with those of them that were reaching the end of their rehabilitation programme. Some residents stated that residents were being admitted that were not ‘suitable’ for this environment. Staff stated that they were very vulnerable with the present policies of non restraint within the home, and that some residents were often violent towards them or other residents, saying they ‘felt helpless’ that there was nothing they could do regarding this. A more rigorous pre admission assessment process is required in order to ensure that the home can meet the needs of the residents that are admitted, Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 7 and that these residents will be compatible with existing residents, and will benefit from the rehabilitation programme. The care planning process and risk assessments have been reviewed but further fine-tuning is needed to ensure that these provide the necessary guidance for staff on the range of needs of the residents. Parts of the home are in need of minor redecoration and repair in order to ensure that a consistently good and safe environment is provided throughout. During the inspection a number of disclosures were made by a resident and a staff member, about the abuse of a resident by a member of staff and the attitude of a number of staff towards residents. These concerns were investigated were investigated under the East Sussex Brighton and Hove Multi Agency Adult Protection Procedures. Whilst the allegations of abuse were not proven, concerns were identified about the home’s failure to follow the required procedures regarding reporting significant events. 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. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 & 5 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Residents are not provided with sufficient information to enable them to make an informed choice over whether to move into the home. EVIDENCE: The home produces a statement of purpose and service users guide providing information on a range of services and facilities offered. In addition there is a comprehensive brochure outlining the ethos of the home which is based on the Anthroposophical approach to life. Feedback received was that the range of literature was not always provided to prospective residents to enable them to make an informed decision as to whether to move to the home and whether the home would meet their needs. One resident stated that they were not aware of the Anthroposophical ethos prior to moving into the home. The manager stated that the home’s brochure is provided to all prospective residents when initial contact is made, however it is recommended that the statement of purpose and service user guide is also made available prior to the admission of the resident. This is to ensure that a range of information is made available upon which to base their decision as to whether to move into the home. This must be provided in a format which reflects the individual’s ability to understand and retain the information. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 10 Given the specific philosophies espoused by the home, it is imperative that efforts are made to ensure that all prospective residents, within the boundaries of the acquired brain injury, can make an informed choice about residing in the home. All prospective residents needs are assessed by the placement authority and the manager before a decision is made that needs can be met. The assessment undertaken by the home should be in a formalised format. This is needed to ensure that that a comprehensive picture of needs is identified, upon which to base a decision as to whether the home can meet their needs and to form the basis of the initial care plan. There is a wide range of needs amongst residents living in the home, ranging from people with complex behaviour patterns to physical needs. In addition, people are at various stages in their rehabilitation process with some ready to move on into independent living. This wide variation in needs currently presents significant challenges for staff in trying to ensure all residents receive the necessary level of staffing input. Some residents expressed their concern over the high needs of newly admitted residents and the impact this is having on their own lifestyle. Staff said that this had been partially addressed through the allocation of one to one workers throughout periods of the day. Pre-existing residents and their needs must be taken into account when prospective residents are being assessed for admission. The impact this will have on staffing levels must also be noted, and the ‘triggers’, which influence the specific residents’ behaviour, must form part of the assessment procedure. The manager must consider the impact that any inappropriate behaviour, that may be presented by the new resident, will have on the work force and existing residents. One member of staff stated that assessment of prospective residents would be improved if a multi-disciplinary assessment took place. Information was received following the inspection, that some residents had been moved from the Raphael centre to Swanborough House without consultation with their placing authority. Residents recently admitted to the home said that they had the opportunity to visit the home prior to their admission. Resident’s files showed that only some residents have received a statement of terms and conditions. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 & 10. Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Care plans do not provide adequate guidance for staff in meeting the needs of the residents. EVIDENCE: A sample of care plans was examined and these comprised many documents including rehabilitation plans, mobility assessments, psychological needs, cognitive function and daily living skills assessments. The sample identified that not all care plans provided clear guidance on the actions required to meet the needs, e.g. missing physiotherapy assessments, some specific care needs and triggers for challenging behaviour. Not all care plans were available for examination (9 out of 31 care plans were available), it was reported that this was due to them currently being retyped. The home must ensure that care plans are available at all times to inform and guide staff in the care to be provided. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 12 It was previously recommended that a record be maintained of any limitation agreed with residents regarding restrictions place on their freedom of choice and power to make decisions. This had not yet been undertaken for some residents. This has now been required in order to ensure that residents’ rights are being upheld. The manager reported that he had started to address this with the staff team. None of the residents consulted were aware of their care plan in spite of their involvement in their initial development. Currently none of these residents showed any interest in its development or review, whilst the short term memory loss often associated with acquired brain injury could explain why residents say that are not aware of their care, greater efforts must be made to ensure, wherever possible, that residents are an integral part of the care planning and review process. All relatives consulted were happy with the care and support provided by Swanborough House. Staff were observed to encourage residents to make informed decisions and choices according to their abilities and understanding. Residents are enabled to take reasonable risk as part of maintaining independence. A new format for the assessment of risk was introduced several months ago prior to the last inspection. These provide a comprehensive assessment for all levels of potential risk. However, some of the risks faced and posed by residents’ lifestyles, which were recorded on the previous format, do not include suitable control measures for managing risks, e.g. smoking in bedrooms. Confidentiality is respected and integral to the roles and responsibilities of the rehabilitation assistants in respect of the care of individual residents. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16 & 17 Quality in this outcome area is good; this is based on the available evidence including a visit to this service. In general, residents are enabled to develop skills towards leading an independent lifestyle. Meals are good offering both choice and variety whilst catering for specialist needs. EVIDENCE: Central to the ethos of the home is the development of individual life plans as part of the rehabilitation of residents. A significant proportion of this plan is the personal development of resident’s skills and abilities. This is attained through the participation in a range of therapies and group activities. Residents consulted with said they undertake a range of activities including woodwork, gardening, cookery, exercise, current affairs, computer studies. Gentle encouragement was observed being offered by a member of staff in trying to encourage a resident to attend their allocated session. The resident’s preferences were ultimately respected. Residents agree to their individual timetable with their key worker during weekdays, the weekend being used to undertake spontaneous activities and events. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 14 Individual programmes are displayed in resident’s bedrooms, however an example was noted during the course of the visit and feedback received, that these programmes are not always followed. However the manager felt that this was not truly representative of the situation. A variety of therapies are used which are central to the rehabilitation programme provided. This includes art, physiotherapy, music, massage, and aromatherapy. There are plans to employ an occupational therapist. The lift had recently been out of action for a number of weeks and comments received showed that this had had a significant effect on some resident’s lifestyles. This was due to their loss of freedom and independence, and feedback from staff was that this caused additional strain to their workload. It was discussed with the manager that thought needs to be given to how this situation can be avoided in the event of any future breakdown. A variety of therapies are used which are central to the rehabilitation programme provided, this includes art, physiotherapy, music, massage, aromatherapy and there are plans for an occupational therapist. Several residents consulted said that they did not participate in structured therapies and group sessions. However efforts were made to encourage them to participate and have some structure in their day. One resident said that they were not aware of the way that the home was run and its philosophy prior to admission, and expressed dissatisfaction with what they perceived to be the constraints that were being placed on them by staff. The resident also stated that ‘there was a lack of freedom over things you want to do, due to lack of staff’. Previous statements have been received regarding this in relation to staff absence. Previous problems with the minibus have now been resolved and this is used to access a wide range of leisure facilities. Feedback from residents was received, identifying that they would like more outings, and this relayed to the manager. Residents interact with the local community and maintain contact with family and friends as they wish. Residents spoke of how often their relatives visited them and how staff made them feel welcome. Feedback received from resident’s families stated that they were made to feel welcome when they visited. Residents are encouraged to develop and maintain personal relationships and to express sexual need, and receive any support or guidance required. However care needs to be taken to ensure that the rights of other service users and staff are respected at all times and where individual residents are behaving in appropriately, that this is dealt with and managed. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 15 During the visit residents were observed moving around the home, freely choosing which rooms to be in and what level of company they wanted to enjoy. Observations of the daily routines suggest staff try and accommodate resident’s personal wishes and preferences with regard to going to bed and rising. A resident said, “When I want to go to bed I always can go there”. During the course of the inspection two meal times were observed. Mealtimes were relaxed with sensitive and discrete care being provided. Meals follow Anthroposophical menus, the ethos of which is to provide a varied range of organic meals giving a balance between meat, fish and vegetarian meals. Meals were well presented and prepared to very high standard. Residents said that they were asked each morning what they want from the choice of meals. Many specialist diets are catered for including diabetic, weight reduction and addressing various allergies that residents have. Resident’s individual preferences were being accommodated with the chef often preparing up to ten choices of meals. The level of commitment shown by the chef and kitchen staff in ensuring that residents received an interesting and varied diet is to be commended. The home has the ‘Clean Food Award’. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Residents do not always receive personal support in the way they prefer and require. The standard of medication administration is good and ensures the safety of the resident. EVIDENCE: Not all care plans provide clear guidance on the personal care required by the resident. Staff were observed providing personal support in a sensitive and dignified manner which often included humour. However not all residents said that the personal support that they receive is carried out in a manner that promotes dignity and addresses their disabilities. Another resident stated that the level of personal attention had reduced due to the high needs of some of the other residents. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 17 Each resident is allocated two key workers, which work on alternative shifts to support the continuity of care. Most residents knew the name of their key worker and staff had a clear understanding of what this role involved. All residents are registered with a general practitioner and the Anthrosophical Doctor visits the home regularly. However residents have a choice over whether they wish to see the Anthrosophical doctor. The care co-ordinator oversees the health and medication needs of residents. She has attended courses in medication administration and has a knowledge of the range of medications within the home. She has had training in insulin administration which is overseen by the diabetic specialist nurse. Other members of staff have received training in this, and this must be updated at regular intervals. Other treatments are provided for which the care co-ordinator and some other members of staff have received specialist training. Medicines were well organised, however the range of policies needs to be specific to the home and must include a self-medication policy. The selfmedication policy must include a section detailing how often the medications are checked and the accountable person must also be responsible for judging the capacity of the resident for self-medicating. Some residents self medicate as part of their rehabilitation programmes and the accountable person must ensure their medicines are kept in a locked environment. All medication charts had been signed following medicine administration and the storage and disposal of medicines was good. Residents should keep their creams, ointments and other medication which is not included in the blister packs in individual containers, and creams, ointments and eardrops should be discarded within a month of opening. Stock control of medication was good. The box used to take medicines around the home to residents is reported to be currently broken; this must be repaired to safeguard residents. District nurses attend to dressings and any nursing care required. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is poor; this is based on the available evidence including a visit to this service. There is no consistency in the following of agreed procedures in the reporting of adult protection matters. EVIDENCE: The complaints procedure was in place and displayed, the home has a complaints file. Albeit that there was one entry in the complaints file, a number of residents in their feedback, stated that they were reluctant to make a complaint or unclear about how to do this. In the recent past, two concerns raised by residents have been passed to the CSCI. One resident stated that “its too hard and technical to make a complaint when and where the incident happens”. A number of concerns were identified at the inspection regarding the management of adult protection issues by the manager and staff. This includes failure to: • • • To notify CSCI of significant events affecting the well being of residents. To notify social services of complaints made by residents To handle disclosures made by residents in accordance with adult protection guidelines. This failure to follow the correct adult protection procedures place residents at further risk. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 19 The new programme of training identifies that staff have undertaken adult protection training. The home must ensure that that residents are encouraged and facilitated to make complaints where necessary. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,29 & 30 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. Residents live in a clean and homely environment, parts of which are decorated and furnished to a good standard. EVIDENCE: Considerable focus is placed on creating a natural and homely environment with emphasis on creating a light and airy feel to the décor. The majority of resident’s individual accommodation is decorated to a good standard. Parts of the home are in need of minor redecoration and repair in order to ensure a consistently well maintained, decorated and safe environment throughout. During the course of the inspection, the manager developed a plan of action to address these areas including timescales for their completion. All residents spoken with said they liked their bedrooms, and all rooms seen had been individualised by the residents. This included small items of furniture, audio equipment and pictures. Residents living in two independent living flats have access to their own kitchen and laundry facilities. There is a range of communal facilities located around the home including lounges on each floor as well as games and meeting rooms. The ground floor corridor is the main thoroughfare and meeting area and as a result is very Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 21 busy at peak times during the day. This presents many challenges to staff and residents in ensuring that all those using this area remain safe. Parts of this area are in need of redecoration and repair. It was reported that the home’s owners take active roles in the aesthetics of the home with several staff stating that they are reluctant to move or add anything to the environment in communal areas, without first seeking permission. This needs to be considered in respect of the inclusion of the residents in decisions about the environment in which they live. There are a sufficient number of toilets and bathing facilities located around the home, with the majority of bedrooms providing en-suite facilities. Some of the communal toilet areas have frosted glass panels in the doors. Following previous requirements a privacy film has been fitted over these. Discussion occurred on whether this film provides the necessary privacy when using these facilities. It is recommended that privacy curtains be installed to ensure maximum privacy. There is a wide range of individual aids and adaptations to assist resident’s mobility and independence. These include walking aids, variable height beds, grab rails, assisted baths, pressure relief mattresses and hoists. Bedrooms have a call point that enable assistance to be summoned and the inspector observed these being answered promptly when the alarms sounded. In order to address previous concerns around accessibility of a call bell in one bathroom, this call bell has been affixed to a windowsill, however this has resulted in limited access, e.g. residents in a wheelchair would not be able to reach this. The provider had previously agreed to obtain an extension cord but this has not been undertaken. All areas inspected were found to be very clean and free from offensive odours. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35 & 36 Quality in this outcome area is adequate, this is based on the available evidence including a visit to this service. There is a good staff training programme in place. The required recruitment procedures are not being applied. EVIDENCE: Staff have a clear understanding of the role of the key worker and how this contributes towards residents attaining their individual goals. The deployment of staff has been reviewed by having the facility to increase the number of staff during peak periods. The current staffing arrangement is for staff to be rostered in two teams, each working day consisting of twelve and a half hours. A number of staff reported that tensions between these two teams was a contributory factor in the high levels of staff turnover and sickness reported. Although not all residents spoke positively about the staff, comments received that were very positive included “Get on all right with them”, “all right” and “great”, “the staff at Swanborough have the ability to speak to the people behind the disabilities and problems”. Interactions between staff and residents observed during the inspection were sensitive and respectful. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 23 There is a good training programme in place and staff confirmed that this training has taken place. Training includes preparation for NVQ 2 and 3 and also training relating to the specific conditions of residents admitted to the home. Some training in Anthrosophical values also takes place. All staff have had the necessary mandatory training. Eight members of staff have gained their NVQ 2 in care. Although the home does not currently attain the National Minimum Standard of having 50 of staff with NVQ 2, there is evidence that work is being undertaken to achieve this. All staff have a thorough induction programme which meets National Training Organisation standards on commencement of their employment at the home. Staff meetings are taking place, however much feedback was received from staff about their reluctance to raise areas of concern or how practice would be improved, due to their lack of confidence in their views being heard and acted upon. Four personnel files were examined and two of these identified that two member of staff were working without a POVA first check being obtained. This is not acceptable under current regulations and the manager was requested to address this immediately. No member of staff has received a copy of the GSCC (General social care code of conduct) handbook. There was evidence that staff supervision is taking place at intervals as dictated by National Minimum Standard 36. Much feedback was received regarding staff currently not feeling supported and valued by their senior management. This is further discussed under Standard 38. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 & 43 Quality in this outcome area is poor; this is based on the available evidence including a visit to this service. The current management ethos for the home does not appear to promote an open, transparent and supportive culture. Residents and staff are protected by the homes health and safety procedures. EVIDENCE: The manager, Mr T Druitt has been in post as manager for the past thirteen months. He has obtained in NVQ 4 certificate in management of care and also his registered managers award. He was registered as manager by the CSCI earlier this year. His responsibilities include implementing policies and procedures in the home and he is in the process of undertaking this, having recently updated some policies and introducing others. He has recently undertaken further medication training. As previously noted, concerns were raised regarding the manager’s failure to follow adult protection guidelines and notify CSCI of events adversely affecting the well being of residents. All persons consulted spoke positively about the manager’s approachability and his focus on resident’s needs. However not all Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 25 staff felt that the manager had sufficient decision making powers to effect any significant change. Inspectors were concerned to note in discussion with staff, comments regarding what some perceived to be a ‘bullying culture’ operating within the home which they believe to be responsible for an “atmosphere of fear and demotivation” and “intimidation and bullying” with a “crushing effect on morale.” The management need to take urgent action in order to engage with staff and to promote a sense of staff feeling involved, and confident of their place in the life of the home. Quality assurance within the home needs expanding, the manager must implement a thorough quality assurance programme. Some parts of this are being addressed i.e. service user questionnaires and this must be extended to include views of staff, stakeholders and visitors to the home. It must also include an annual development plan for the home, taking into account proposed maintenance and refurbishment. Regulation 26 visits (The visits of the provider to the home which assess the functioning of the home) are sent to the CSCI at monthly intervals. Policies and procedures are in the process of being updated and the manager must ensure that they are relevant to this home and comply with current legislation and recognised professional standards with reference to recent research in care and health and safety. Medication policies relating to the home and including a self-administering of medication policy, which meets the standard, are required. All records within the home are securely stored and up to date. Residents can have access to their records and be involved in the care planning process. All certificates relating to the maintenance of utilities and equipment were in place with the exception of the Landlords Gas Certificate, this has been a previous requirement and is repeated. Fire alarms are tested monthly and fire drills take place. All staff have undertaken mandatory health and safety training. Infection control measures are in place and gloves and aprons provided and all accidents are recorded. The inspector discussed a recent incident in the home where a resident was missing and the home’s failure to report this in line with regulations. Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 2 3 1 4 3 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 1 34 1 35 3 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 2 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 x 2 2 2 2 3 2 2 Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 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 YA5 Regulation Reg 5(1)(b) Requirement That a terms and conditions of residency is developed and agreed with each service user or their representative and a copy retained in the home. That care plans detail the actions that need to be taken by staff to ensure that all aspects of the health, personal and social care needs of the service users are met, and which make explicit the actions required to meet these needs. A record be maintained of any limitation agreed with the service user as to the service users freedom of choice and power to make decisions. That personal risk assessments include the actions required to manage or reduce identified risks. That the box used for the transportation of medication to service users is repaired to safeguard residents. That a policy addressing self medication by residents and the corresponding risk assessments are put in place. DS0000014246.V290585.R01.S.doc Timescale for action 30/06/06 2 YA6 Reg 15(1) 30/07/06 3 YA7 Reg 17(1)(a) Sched 3 (q) Reg 13(4) 30/06/06 4 YA9 30/06/06 5 YA9 Reg 13(2) 30/06/06 6 YA19 Reg 13(2) 30/06/06 Swanborough House Version 5.1 Page 28 7 YA23 Reg 13(6) 8 YA29 Reg 23(2)(n) 9 YA34 Reg 19 10 11 YA34 YA38 Reg 18(4) Reg 10(1) 12 YA42 Reg 37 13 14 YA24 YA42 Reg 23(2)(d) Reg 13(4)Reg 23 That the registered person shall ensure the home follows its own internal procedure and multi agency procedure for the protection of the vulnerable adult. That the call bell in the bathroom addressed in the main body of the report, is in a position to be easily available to wheel chair users. That staff do not commence employment until the home has obtained at least a POVA First check. A copy of the GSCC code of practice to be given to all staff within the home. That a review of the current management culture operating in the home is undertaken to ensure that the home is being managed in an open, positive and inclusive manner. That the CSCI is informed in writing of all incidents and accidents, including adult protection incidents that occur within the home. That all parts of the home are in a good state of repair and reasonably decorated. That the manager provides a copy of the Landlords Gas Certificate to the CSCI. (This was a previous requirement by 10/02/06) 10/05/06 30/06/06 10/05/06 30/07/06 30/06/06 10/05/06 30/07/06 30/07/06 Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 29 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 YA1 Good Practice Recommendations That the statement of purpose and service user guide are made available to prospective service users prior to their admission to the home. That a written format for the assessment of prospective residents is developed, in line with the homes admission criteria and that of the National Minimum Standards. That all creams and ointments and other medications not in the blister packs, prescribed for service users are kept in individual named containers. That all creams, ointments and other external preparations including eye drops are discarded within a month of being opened, to preserve the integrity of the medication. That the quality monitoring system is expanded as detailed in the main body of the report. That the policies and procedures comply with legislation and current research and are specific to this home. 2 3 4 4 5 YA2 YA19 YA19 YA39 YA40 Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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 Swanborough House DS0000014246.V290585.R01.S.doc Version 5.1 Page 31 - 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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