Inspection on 08/05/07 for Swanborough House

This inspection was carried out on 8th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swanborough House 10/05/06

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 Key Unannounced Inspection 8th May 2007 10:00 Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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.V336343.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 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.V336343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swanborough House Address Swanborough Drive Brighton East Sussex BN2 5PH 01273 696391 01273 603208 marylove@raphaelmedicalcentre.co.uk 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 Mary Ellen Love Care Home 31 Category(ies) of Physical disability (31) registration, with number of places Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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 May 2006 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 8th May 2007 is between £1100 and £1500 per week extra services such as chiropody, hairdressing and massage are not included and these charges are available from the manager. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 8th May 2007 over a period of eight hours and was facilitated by the home manager, Ms M Love. During the day a tour of the home took place and documentation, which included care plans, catering records, personnel files, medication records and health and safety records were examined. Prior to the inspection questionnaires were sent to residents, visitors to the home and health and social care professionals. Two questionnaires were returned from health and social care professionals, ten from residents and five from visitors. Twelve residents, twenty members of staff and a visitor to the home were spoken with during the time at the home Most questionnaires returned made positive comments about the home although one visitor stated that ‘There appears to be a high turnover of staff, particularly at management level’. Other comments received were that ‘ The three carers looking after (the resident) are highly competent, wonderfully patient and kind’. ‘ The food is good’. ‘ I don’t know how to make a complaint’, ‘The complaints procedure is difficult to understand, I tell my key worker’. ‘Most staff listen to me, but some people don’t’. A relative wrote: ‘ The care home, in our opinion, provides a good standard of overall care’. Staff that provide care for the residents are referred to as rehabilitation assistants at the home, and this terminology will be used throughout this report. Staff that provide individual therapies are referred to as therapists throughout the report. Thanks are extended to residents and staff for their time, courtesy and hospitality shown during the inspection. What the service does well: The home follows the Anthrosophical ethos of man being a holistic being and this underpins all services offered at the home including the catering. The home provides a service that aims to provide a good quality of life for people with acquired brain injury, with the focus being on rehabilitation into the community. The provider states that in the past year they have rehabilitated five residents to live their lives in the community. The home provides various therapies and activities for residents including employing a full time physiotherapist and art therapist, and holding woodwork, computer skills cookery current affairs and concept skills training. Residents Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 6 are facilitated to go swimming, follow their interests and take part in classes in the local community centre. A minibus is available for outings. There is a good staff training programme with training provided including brain injury, health care, equality and diversity and mandatory health and safety training. Nine members of staff (30 ) have gained the National Vocational Qualification level 2 or 3 in care, more staff having recently signed up for this course of study. Catering follows the Anthrosophical ethos with food offered being mainly locally grown and organic. A choice of meals is offered daily, with the chef being aware of the resident’s preferences and any food allergies. All cakes and puddings are made at the home. Residents spoken with said ‘ The food is good’, ‘ I don’t like the food but the cook makes me stuff I do like’. ‘ The cook knows what we like and does different food for all of us’. Good practice in the issues of ethnicity and diversity are evident throughout the home, with residents being assigned key workers who are of a similar ethnic or religious origin. There was evidence that residents are assisted to live their lives in a way that they wish in a non-judgemental environment. What has improved since the last inspection? Much improvement has been seen since the last inspection. The ethos within the home is much improved with staff speaking of an ‘open door’ policy and feeling able to discuss problems or concerns within ‘ a listening environment’. Staff also stated that a method to deal with their previous concerns when faced with challenging and often frightening behaviour has been put in place. They have attended challenging behaviour training and now have a chance to ‘de- brief’ and talk about their concerns at the end of the shift, and discuss actions to deal with these issues. Residents also spoke about the improved ethos in the home, saying that ‘ its not so tense now’. ‘Staff are always cheerful’. The standard of care planning has improved with care plans providing clear information on how care is to be given to meet the resident’s needs and in accordance with their wishes. Personnel files now include documentation required by regulation to ensure the protection of the residents in the home. The CSCI now receives reports on all incidents affecting residents including safeguarding issues, and information regarding complaints and concerns from visitors, residents and staff is now available in the home along with the actions taken to address these. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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.V336343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. People who use the service experience adequate quality outcomes in this area Prospective have sufficient information they need to make an informed choice of home. Not all residents have the statement of terms and conditions and therefore are not aware of rules operating within the home, which could affect them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a Statement of Purpose, which is also used as the Service User Guide, the master copy of this document has been reviewed to show changes in the home, but the reviewed copy has not yet been made available to residents. The home has also produced a pictorial brochure, which is written in a format easily accessible to residents and will be given to all residents. The manager undertakes a thorough pre-admission process on all residents prior to their admission to the home. A senior member of staff always accompanies her. Information from this document forms the basis of the care plan. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 10 All residents are now assessed prior to their being considered for admission to the home and the manager holds preadmission meetings with staff to discuss the care that will be required. The manager now takes the needs of the existing residents into consideration prior to admitting a new resident and staff are kept informed of the new residents needs. All new residents are admitted for a trial period and the span of this varies according to individuals. The Statement of Terms and Conditions meets the regulations, however there was no information to show whether some long-term residents have received this prior to the new manager taking up post at the home. Staff receive a variety of training relating to the specialised needs of the residents admitted to the home and this is ongoing. The home aims to rehabilitate residents to enable them to live in the community During the past 12 months five residents have been rehabilitated to live within the community. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 People who use the service experience good outcomes in this area Care plans address residents current and changing needs and residents are supported to take risks within their daily lives. Residents are able to take part in reviews of their care but there is no evidence that they are included in the care planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Six care plans (20 ) were examined, this amount were examined due to variations in care planning noted on a previous occasion. Recent developments in the care planning process have resulted in streamlining of the care plans into a format, which addresses the physical, psychological and social needs of the residents and the actions required to meet these needs. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 12 Care plans were concise and gave adequate directions to those giving the care whilst considering the manner in which the residents preferred care to be given. All care plans addressed current and ongoing needs and showed evidence of involvement of health and social care professionals. Risk assessments were in place for all residents, which identified risks and ways to minimise them whilst allowing residents to participate fully in their lives. However there were no records to show that residents had been consulted regarding limitations to their freedom of choice, and also care plans did not show that residents had been consulted regarding these. The home has formatted the care plans to allow evidence of consultation but staff had not put this in place. There was evidence in review notes that residents have been attending regular reviews, and in some cases there was a statement to show that a resident did not wish to be involved in either the review or the care plan. The manager is discussing ways of making care plans more accessible to residents by leaving them in their rooms or some other method. Some residents spoken with (3) did not know what was in their care plan. Residents meetings are held on a three weekly basis with issues regarding the running of the home, actions to be taken and other issues are held with residents, with their views listened to; minutes are taken of these meetings. Confidentiality is one of the central themes in the home, underpinning all the care that is given, and staff were aware of the importance of this. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17. People who use the service experience good quality outcomes in this area Residents are encouraged to develop skills leading to an independent life style. The standard of catering is good with a varied diet, which affords choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are involved in a number of opportunities to gain skills for daily life; courses offered by the home include woodworking, cooking, computer skills, current affairs, art therapy and concept skills. The home employs a full time physiotherapist with around 50 of the residents attending sessions 3-4 times a week. The manager is in the process of approaching various agencies to set up either voluntary or paid work for some residents. Residents are encouraged to shop for and cook their own meals when they are able, one Muslim resident shops for and cooks his own meals with the kitchen Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 14 providing storage for Halal meat. A Muslim rehabilitation assistant has been provided for this resident and assists him go to the mosque and with all dietary and other religious observances. All residents have a timetable, which identifies what therapies or classes they are attending on each day, and rehabilitation assistants are familiar with these and prompt residents to take part. Residents are also facilitated to attend courses at local centres and take part in community activities. However information was received that some residents have started activities and then these have been dropped, either due to lack of staff or other reasons. Residents are encouraged to maintain links with family and friends and to spend weekends with their families where appropriate, or with others important to them. There was no evidence of residents maintaining relationships within the home although the manager says she believes some of them do go out and see people. Questionnaires received back from relatives of residents stated ‘He( the resident) has benefited tremendously during his time at the home, he has been helped to achieve much within his abilities’. ‘Residents are supported to the extent to which their capabilities allow’. Residents say they can choose what time they get up and go to bed, but day staff say they are helping many to bed – The manager should ensure that resident’s choices are maintained in this area, and preferred times of rising and retiring documented in care plans. All residents are offered a key to their rooms within the auspices of a risk assessment and a tour of the home identified that some residents prefer to keep their rooms locked. All residents have a lockable drawer or cupboard The standard of catering is good, with menus following the Anthrosophical ethos of varying meat, fish and vegetarian days. Two choices are offered at every meal and the chef is knowledgeable about the different residents likes and dislikes, however she normally cooks several different menus as opposed to keeping to the two choices in order to meet residents preferences. The majority of residents spoken with stated that they enjoyed the food. Meat, vegetables and fruit are sourced locally with the emphasis on the provision of organically grown food in season, all meat is delivered fresh and the kitchen was recently awarded the ‘Good Food Award’ from the Environmental Health Agency. The kitchen was very clean and has recently been redecorated, with records in place. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 15 Snacks and drinks are available at any time. Staff were seen providing assistance to residents which maintained residents dignity and sense of independence. . The dining room is functional and does not lend itself to being an area in which residents would choose to socialise after meals or meet with friends or visitors. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 People who use the service experience good quality outcomes in this area Residents receive personal and health care which is given in a manner which respects their choices and promotes their wellbeing and is informed by a robust care planning system. The recording of medication demonstrates some good practice but some aspects of administration could lead to medication error and impact on the safety of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents said that staff provide personal support in a manner which meets their needs and expectations, and that they are able to choose their own clothing, makeup etc and to wear their hair as they wished. Resident’s preferences were identified in care plans along with actions to minimise any challenging behaviour that may take place whilst care is being given and any actions that may trigger this behaviour. The health care needs of residents are identified in the care plan. The home provides a full time physiotherapist, who sees approx 50 of the residents 3 Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 17 or 4 times per week and keeps notes on their progress. It is recommended that some notes be kept in the care plans so that rehabilitation staff are kept fully informed of the residents’ progress. The rehabilitation staff are guided by a health care co-ordinator, a senior member of staff with a professional back ground in health care. She is responsible for over seeing the health needs of the residents, overseeing all medication and arranging hospital appointments, accessing various health care professionals and ensuring that rehabilitation assistants receive accredited medication training and other health care training. Community psychiatric nurses, community nurses and occupational therapists visit the home. The community speech and language therapist attends the home on a weekly basis to assess residents and give advice. One resident who is nursed in bed has a pressure-relieving mattress and the Community nurses visit to give any wound care needed. Wound care plans should show what interventions the staff undertake and when the treatment is finished. Likewise the moving and handling care plans for this resident should indicate that two staff are required to turn the resident as this is not clear in the care plan. Both conventional General Practitioners and Anthrosophical doctors treat the residents, with residents having a choice over whether one or both takes charge of their treatment. The Anthrosophical doctor works alongside the records of the conventional doctor and any homeopathic or other nonconventional medication prescribed is checked to ensure compatibility with the conventional treatment, with General Practitioners being informed. The standard of medication administration, storage and receipt and disposal of drugs is good, with the home having a self administration policy for those who wish to self administer their own medication and appropriate risk assessments. Most medications in liquid form or external medications have their dates of opening recorded; it is considered good practice for this to apply to all liquid medications. At present drugs are double dispensed into containers from blister packs, which could cause residents safety to be compromised. This was discussed with the manager and she was advised to contact her pharmacist for advice on double dispensing. All rehabilitation assistants who give out medication have an accredited medication course. A recent update on the administration of insulin has taken place and insulin is administered in the presence of two members of staff. Staff have received training in the administration of insulin by the diabetic Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 18 nurse at the local hospital and this nurse remains accountable for their practice, reassessing frequently. Likewise staff have training in the administration of rectal medication and enemas, a registered nurse at the Raphael medical Centre was responsible for training and the accountability, but the present manager has taken this over using her own nursing registration for accountability. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 People who use the service experience good quality outcomes in this area Residents are protected by a system, which investigates their complaints and concerns in an open and transparent manner. Residents do not always put their complaints forward due to a perceived inaccessibility of the complaints procedure. Staff training and management actions in addressing issues relating to safeguarding protect resident’s safety. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy, which is displayed in the home and included in the statement of purpose/ service user guide. However some residents said that they found it difficult to understand and that the whole complaints procedure was too complicated, but records showed that residents have in fact made their complaints known to the manager or their key worker. The complaints procedure should be produced in a user-friendly format, which enables residents to make a complaint easily. This was discussed with the manager and provider who gave assurances that this would be addressed. A visitor to the home also said they had not been aware of how to make a complaint. The CSCI has received no complaints about the home, but records in the home showed that 24 complaints had been received since the last inspection. The majority of these complaints were minor and around food choices and laundry etc, most of these had been substantiated and addressed by the manager Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 20 Other complaints were from staff with one from a therapist regarding staff not attending to treatment during her absence. Two complaints were received from relatives and one from a care manager relating to care matters, these were substantiated an actions put into place to address these. A further complaint was from a resident regarding care and the manager has addressed this with appropriate action. There have been six safeguarding adult referrals since October 2006, three of these were relating to a resident who was impacting on the safety of other residents and actions, risk assessments and other means have been put into place to minimise this. A further allegation related to an incident with a member of staff and a resident. Appropriate action was taken. A third allegation related to a drug error the manager has taken action to address this and measures along with extra training, put in place. There was evidence last inspection that staff felt threatened by inappropriate and aggressive behaviour by residents. Training courses in dealing with challenging behaviour have been commenced, risk assessments put in place and opportunities provided for staff to discuss any anxieties with senior staff. Staff stated they now feel more in control and able to deal with any situations that arise. Restraint is not used in the home apart from bedrails on the resident nursed in bed and risk assessments are in place. The management of residents personal money kept by the home was addressed at the last inspection and found satisfactory. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 People who use the service experience adequate quality outcomes in this area Residents live in a clean and homely environment, parts of which are decorated and furnished to a good standard. However lack of privacy and the inaccessibility of call bells when using bathrooms may compromise the well being of residents. This judgement has been made using available evidence including a visit to this service. 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. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 22 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 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. The provider stated that plans are in place for new lounge carpets. The kitchen has been recently redecorated, and two bathrooms are currently out of action and are being refurbished into an assisted bathroom There are a sufficient number of toilets and assisted bathing facilities located around the home, with the majority of bedrooms providing en-suite facilities. Two further bathrooms are being converted into assisted bathrooms some of the communal toilet areas have frosted glass panels in the doors. Following previous requirements a privacy film has been fitted over these, however this does not provide sufficient privacy and the manager must address this. 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, a requirement was made at the last inspection to address this but this has not been complied with. 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 All areas inspected were found to be very clean and free from offensive odour. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area Residents are supported by sufficient numbers of staff that have training relevant to their role. The robust recruitment policy in place safeguards the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current rehab staffing arrangement is for staff to be rostered in two teams, each working day consisting of twelve and a half hours. Each resident has a key worker on each team thus providing continuity. Three rehabilitation assistants staff night duties, but there is a capacity for the manager to roster additional staff on duty for late evening or early morning if required. Staff spoken with said that generally, although busy, there were sufficient staff on duty. Catering staff, a maintenance person and domestic staff support rehabilitation assistants. Staff have a clear understanding of the role of the key worker and how this contributes towards residents attaining their individual goals. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 24 There are opportunities for training offered to staff. The training programme identified training in general care, mental health, brain injury Anthrosophical ethos, communication and relationships sexual health, substance misuse, as well as National Vocational Qualification level 2 or 3 in care and mandatory training. Staff undertake the in house induction course which consists of a weeks reading the policies and procedures, shadowing staff and mandatory training. The manager intends to commence staff on a recognised induction course. Nine members (30 ) of rehabilitation staff have the National Vocational Qualification level 2 or 3 in care, with further staff having enrolled on this course. All personnel files contain the documentation as required by the National Minimum Standards and associated regulations. Records showed staff have regular supervision within time scales as directed by the National Minimum Standards with the catering manager supervising her staff on a monthly basis Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good quality outcomes in this area. Management systems are in place to promote the safety and wellbeing of residents, staff and visitors, and to monitor services provided by the home to ensure they meet residents’ expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, Mrs Mary Love has been in post since July 2006. She has previous experience of management roles within a hospital setting, which had a similar resident group to Swanborough. She is a qualified nurse and holds a certificate in management, and is registered with the CSCI and is planning to undertake the Registered Managers Award. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 26 Since her taking up post at the home her main aim has been to ensure that care plans and care given meet the needs of the residents, and to oversee practical issues in the home such as recruitment and training. However the manger stated that there is still much work to be done and she is ‘working to constantly improve things and to ensure that the home not only meets the regulations but provides a stable home for residents and a good workplace for staff’ There have been improvements in the home over the past year and one of these was the improvement of the ethos in the home. Staff said there is an open door policy to the office, they can make their views known in staff meetings and they feel listened to. Residents said that they enjoyed living at the home and that they thought that the staff were good, relatives comment cards said that staff were kind and that their residents received all the help and care. A quality-monitoring audit is taking place; the home received the Investors in People and ISO 9000 award last year. Resident satisfaction questionnaires were sent out a few months ago but the manager has not yet audited responses. It is recommended that the views of stakeholders such as health and social care professionals and visitors to the home are obtained and used to inform practice within the home. Staff meetings are held monthly and residents meeting three weekly, minutes were seen of these. Residents and staff said that they could put their points of view across at these meetings. The manager is in the process of reviewing policies and procedures. All residents and staff records were kept in a secure environment and are up to date and accurate. All staff have received mandatory training which is updated as required. All records relating to the maintenance and servicing of equipment and utilities were in place and in date apart from the IEE (electrical wiring certificate) a copy of this should be kept in the home. It was seen that one resident had tied their room door open the manager must monitor this or contact the fire officer for advice. The public liability insurance is in place and in date, no financial records for the home were examined on this occasion. Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 27 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 2 2 3 3 3 4 3 5 CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No 24 25 26 27 28 29 30 Score 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 2 3 3 2 3 3 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 3 15 3 16 2 17 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000014246.V336343.R01.S.doc 4 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Swanborough House Score 3 3 2 x 3 3 3 3 3 2 x Version 5.2 Page 28 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 YA1 Regulation Reg 4 Reg 5(1) Reg 5(1)(b) Requirement That all service users receive a copy of the updated statement of purpose/service user guide 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. This was a previous requirement May 2006 Timescale for action 30/07/07 2 YA5 30/07/07 3 YA7 Reg 17(1)(a) Sched 3 (q) A record is maintained of any 30/07/07 limitation agreed with the service user as to the service users freedom of choice and power to make decisions. This was a previous requirement May 2006 That the manager consults with the pharmacist regarding the safe administration of medication. 01/06/07 4 YA9 Reg 13(2) 5 YA29 Reg 23(2)(n) That the call bell in the bathroom 01/06/07 addressed in the main body of the report is in a position to be easily available to wheel chair users. This was a previous DS0000014246.V336343.R01.S.doc Version 5.2 Page 29 Swanborough House requirement May 2006 6 YA29 Reg 12(4)(a) That a method of ensuring 01/06/07 service users privacy and dignity whilst using the bathrooms is put in place. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Swanborough House DS0000014246.V336343.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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