Inspection on 26/11/09 for Swansea Terrace Nursing Home

This inspection was carried out on 26th November 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Swansea Terrace Nursing Home 04/01/10

Swansea Terrace Nursing Home 30/11/07

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Random inspection report Care homes for older people Name: Address: Swansea Terrace Nursing Home 108-114 Watery Lane Ashton Preston PR2 1AT two star good service 30/11/2007 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Anthony Cliffe Date: 2 6 1 1 2 0 0 9 Information about the care home Name of care home: Address: Swansea Terrace Nursing Home 108-114 Watery Lane Ashton Preston PR2 1AT 01772736689 Telephone number: Fax number: Email address: Provider web address: sobhimathew@yahoo.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Swansea Terrace Care Home Limited care home 44 Number of places (if applicable): Under 65 Over 65 44 0 old age, not falling within any other category physical disability Conditions of registration: 0 5 The registered person may provide the following category of service only - Care home with Nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Physical Disability - Code PD (maximum number of places: 5). The maximum number of people who can be accommodated is: 44. Date of last inspection Brief description of the care home Swansea Terrace is situated in the docklands area of Preston and it is close to shops, cinema and restaurants. The home provides nursing care to older people. The home comprises of 42 single bedrooms and 1 double bedroom. Bedrooms are situated on the ground and first floor, with access being available by a passenger lift. Care Homes for Older People Page 2 of 15 Brief description of the care home There are lounge and dining areas on the ground floor. Information about the range of fees for accomodation and nursing care can be obtained by contacting the manager directly. Care Homes for Older People Page 3 of 15 What we found: We looked at the information gathered by staff from Swansea Terrace about the needs of two people who had recently chose to live there who needed help with personal care and could see that the home had gathered some information about their needs. The information we saw did not tell us in any detail about the needs of people and why they needed to live in a care home so insufficient information was gathered on their needs. We saw that some information had been gathered about their social interests, medical information on their physical and mental health, how they communicated with people, maintaining their safety, help with personal care and some information about their life and the circumstances of why they needed to live in a care home so staff had limited information about the people they cared for and supported. Additional information had been provided by the local council that placed people in the home and this information was very detailed and provided staff with information about their needs so staff had information about the health and social needs of people and the health and social care professionals involved in their care. We saw that information gathered about the needs of people that use services was transferred in to care or support plans so staff had information to provide support and care. We could see some examples that the home uses a person centred approach to care but do not use person centred thinking and planning to provide care and support to people living at the home so their care is not always based around their needs and choices. Person centred planning is a really good way for people that use services to take control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. The care plans we saw were not individual to people using the service and included limited information about their personal routines and choices about personal care or if they could help themselves. The care plans we saw said where people needed care and support but did not tell us how people wanted their care to be arranged and how staff would provide support or care to help them to care for themselves or if care was arranged or planned around their daily routines. So care based on their personal preferences was not always provided. We saw information in care and support plans that guided staff to offer people a shower or a bath weekly but were not sure if this was decision of the person using the service. We saw that for people who lived at the home for a short period of time called respite care had what was called a core care plan. The core care plans we saw for one person did not contain any personal details about how they wanted their care to be arranged or their preferences about personal care and just had a set of instructions for staff to follow. The limited information obtained about the person before they had moved into the home had not been used in the core care plans and all other information about the person was incomplete. For example the person was Care Homes for Older People Page 4 of 15 known to have difficulty with eating but was not weighed. The information obtained before the person had moved in said they had supplement drinks but the core care plan in place to make sure their nutritional intake was sufficient said the person was not having supplement drinks, yet information was recorded on the persons medicine records that they were having supplement drinks several times a day so information about caring for the person was inconsistent. Care or support plans for people who were living at the home permanently were much better. These were written by staff and contained more information about the routines and choices of people living at the home. We saw good examples of how staff had developed a good way of talking with a person whose first language was not English. By using pictures of everyday items such as tea, coffee or sugar and symbols to represent meal choices and family members. By putting the name of the item or picture representing a person or family member in the persons first language staff were able to support the person to make decisions and choices about their care and lifestyle. We saw that documents were used to identify if people were a risk to themselves or others as they did not recognise they could place themselves at risk of harm or injury called risk assessments. We saw these were used to help staff understand the risk people were to themselves. For example the risk of falling when using walking aids or bathing without help or equipment so staff were able to make sure people were safe. We saw that the risk assessments identified areas were people could be at risk and gave staff guidance on how to reduce or manage the risk identified. We saw that risk assessments and care plans were reviewed monthly but the reviews said continue as plan so did not say if the care plans in place were working to support people or if the care provided was appropriate. Information about peoples social interests and lifestyle choices was limited and for one person not recorded so staff did not have information to provide individual care. We could not see examples of how people that lived at the home chose their daily routines and followed their own lifestyles. Care plans were kept in a locked filing cabinet and we could not see how they had been involved in the writing of their care plan so would not know what was written in them. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported by asking them questions and saw staff help them make decisions. We did not see care plans refer to how people made decisions about their daily routines and choices or how people that use services made decisions for themselves. If people that use services did not make decisions due to them having memory problems or they lacked capacity, experience or judgement to make them. we could not could not confirm why, when, where and how staff supported them to make decisions so were unsure what decisions they made for them or supported them to make. Care plans contained important information about the health of people that use services. An example of this was was when a person using the service had been found to have a pressure ulcer. The home had made sure the skin care specialist nurse had been involved in providing care and treatment. We could see that the pressure sores was healing well as nursing staff was treating it. The home had medical cover from local doctors surgeries so people that use services had their health needs looked at regularly. A nurse form the local NHS Primary Care Trust visits the home each week to look at the health needs of people living at the home and offers advice and support to staff at the home as well as Care Homes for Older People Page 5 of 15 looking at the medicines of people so regular health checks of people are made. We spoke with a health care professional during the visit and they said that staff usually asked for advice and followed advice given. The health care professional said that staff were not good at planning for events in advance. An example given was that senior nurse was leaving. The senior nurse was the only nurse employed at the home trained to take blood so the health professional arranged for other staff to be trained to take blood but they did not attend the training. The health care professional said that staff then relied on district nurses to take blood and that staff were not trained in other important areas such as male catheterising so relied upon NHS nurses and resources for things they could be trained to do. The health care professional said she had to highlight important developments and training to staff and the manager so they could keep themselves up to date with good practise and changes in the law such as The Mental Capacity Act and preferred priorities of care, which is were people living at the home make decisions about their care based on their preferences and choices. Medication policies and procedures were in place so staff understood their responsibilities and accountability for their actions when administering medicines to people that use services. The home had medicine storage facilities on the first floor. Medicine administration records were kept with specimen signatures of staff responsible for administering medicines. We looked at the arrangements for the ordering, receipt, administration and disposal of medicines and found some minor errors in recording of medicines administered by a senior care staff so staff were not aware if the people had received their medicines as prescribed. A Doctor returned a survey to us before the visit that said there were problems with the home ordering the correct quantities of medicines for people living at the home so they ran out of prescribed medicines. We did not see any examples of medicines being out of stock during the visit. An information board near the main entrance home displayed information about, staff, activities taking place inside and outside of the home. This also displayed the complaints procedure. Local clergy visit the home to speak with people living there and hold regular religious services so they have opportunities to practise their faith as well as people having the opportunity to attend the local church. At the time of the visit the home did not employ an activities coordinator so there was no one person to plan and encourage people to do activities. We saw staff occasionally sitting and talking with people that use services. We saw that the communal areas of the home usually had a staff member sat in them so people living at the home had contact with staff. We saw people living at the home sleeping at times so were not engaged in doing anything. Meals were seen to be varied and supported a balanced diet with advice sought from dieticians where necessary about individuals diet. The menu provided a varied diet and as the home had separate areas for dining meal times were quiet so staff could support people who needed help to enjoy their meals without interruption. We saw an example when a care staff member did not recognise that a person living at the home was having difficulty in eating their meal. The carer placed the meal in front of the person who was seated in a reclining chair with a small table in front and then placed a tabard over the persons head to protect their clothing but did not ask if the person wanted to wear it. The staff member did not ask the person if they were seated correctly and the dinner plate only had a fork on it. The person struggled to sit forward and eat their meal and took several minutes to eat one mouthful. The staff member was assisting another Care Homes for Older People Page 6 of 15 person to eat and could easily see the person was struggling to eat. Eventually the carer went to help the person eat but their meal would have been cold and did not offer to reheat it. This was discussed with the manager at the end of the visit and the manager agreed to speak to the staff member concerned. We spoke with people living at the home and they said they enjoyed living there. A person living at the home spoke positively about the care and support he received from a carer and said Hes the best there is, lovely and polite and will do anything I ask him or what I want to do. He asks me what I want for my meal and helps me with them. I cant say enough nice things about him hes a lovely chap. I enjoy all my food its one of the best things about being here. Before the visit we received concerns from staff and a relative about the practise of a staff member. We asked the manager to make further enquiries and as a result of this we and the home received more information. The manager acted on advice from the administrators to protect people living at the home by removing the staff member from the service. Policies and procedures were in place to protect vulnerable adults called the safeguarding adults procedures. The safeguarding adults procedure is how we, the local council, police and other agencies respond to and manage allegations or suspicions of abuse against vulnerable adults. The manager provided recruitment records that recorded staff had received the safeguarding adults policies and guidance in a staff handbook. Staff had received training on how to recognise and respond to suspicions of abuse so staff should be able to protect vulnerable adults. We spoke to three staff and they said they had received safeguarding adults training while employed at Swansea Terrace. Staff said the training had helped them recognise poor practise and what they considered neglectful practise so were able to recognise and respond to suspicions or allegations of abuse or neglect to make sure vulnerable adults were protected. Staff were able to say what they considered poor practise but we were not confident that all staff had the confidence to report poor practise to the manager so not all poor practise would be reported. This was supported by a relative alleging that staff were aware of poor practise bit did not always report what they were seeing. The home use DVDs from a training organisation on training staff in safeguarding adults procedures. The manager was responsible for training and judging if staff were competent in understanding and following the safeguarding adults procedure. The manager has not had any experience of training staff in safeguarding adults procedure or dealing with allegations of abuse or neglect against vulnerable adults so at present lacks the necessary experience to train staff. The home had a copy of the Lancashire County Borough Council safeguarding adults procedure. Before the visit we received comments that the home was odorous and that the carpets were dirty. We looked around the building and could see that there had been redecoration of some bedrooms. We could see that the corridor carpets on the ground floor were stained and marked and the stains could not be removed despite continuous cleaning so need replacing as they give the impression the carpets are dirty. We looked at the bathing facilities available. We saw there was only one domestic bath available for people to use on the ground floor as well as a shower on the first floor. A bath designed for use by people who need a lot of assistance with bathing due to their Care Homes for Older People Page 7 of 15 physical or medical needs had been removed at this was broken and parts could not be replaced. People who needed the specialist bath had to use the domestic bath on the ground floor and get into this with the assistance of a portable hoist. The manager said people who could not use the domestic bath due to their physical needs were having bed baths so people did not have the choice of an immersed bath. The domestic bath on the ground floor is a plastic bath and was scratched so is a source of cross infection. We saw shower room on the first floor and the tiles in the bathrooms were marked where the spaces in between had become stained so did not give the impression the shower room was unhygienic. We saw the staff numbers in place supported the needs of people that use services so they had sufficient help with their needs. The home was not fully occupied, with vacancies and people in hospital and there were sufficient staff to provide care and support for the number of people living at the home. Additional staff were on duty to assist with domestic, laundry and catering duties. The manager works at the home five days a week and not included in the staff on duty so is available to offer support and supervision to the staff team. The manager said the administrators were proposing to review the staff numbers at the home and this may result in a reduction of staff between the hours of 08:00 to 20:00 so may impact on the current staff team numbers to deliver care to the people who live at the home who have high dependent needs. The AQAA says there are 29 people who require help with personal care and 17 of these require the help of two staff during the day and 28 people who require the help of two staff during the night. The home also plans to accommodate more new people so reducing the staff numbers while increasing the occupancy levels may reduce the level of care provided to people living at the home. We have not been told by the administrators about any proposed changes to the numbers of staff on duty between the hours of 08:00 to 20:00 so cannot confirm if staffing levels will reduce. The homes staff induction programme was said in the information sent to us by the manager to be based on Skills for Care induction standards which are nationally recognised standards for people who work in social care so care staff should understand their roles and responsibilities. The home employs 25 care staff and the AQAA says 12 of these have an NVQ level 2 qualification. An NVQ level 2 qualification is a nationally recognised qualification in social care. We examined the recruitment records of four staff employed at the home. Recruitment procedures were generally good and included staff having to complete an application form, full employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. We saw that one person had been employed with only one reference on their file and other people had been recruited without their employment history being checked in detail to see why they had left their previous employment. Referees given on application needed to be clearer as one person gave a referee who was a family member and another person had given a referee as someone they had worked for but did not include them in their employment history. Another person had supplied information about convictions but this information was not consistent with information about their CRB check and we could not see that the manager had discussed this information with the person so were unsure if the manager was confident the person was suitable for employment. Care Homes for Older People Page 8 of 15 Staff were provided with training which included moving and handling, dementia care, managing challenging behaviour, safeguarding adults, food hygiene and health and safety as some examples. The manager was responsible for training staff using the variety of training DVDs available including moving and handling. The manager said he did not have any advanced training in providing moving and handling training theory and practise so was not experienced in training staff in this area of practise and delivering training to newly inexperienced staff. The manager said the administrators were planning to introduce a new training programme using the administrators own training department. At the time of the visit the manager was working in the home. The manager is inexperienced in managing a care home with nursing having previously held a senior position within a care home. The manager is not yet registered and had applied for registration but before the visit took the decision not to proceed with the application to register as manager. The manager was open and honest about their lack of experience in managing a large care home with nursing so is able to identify areas where they need to develop important areas of their management experience. The manager completed some checks on things in the home to make sure the home was managed properly. The manager gathered information about the home, how safety was maintained and that people that lived there were satisfied with the care they received. This was called quality assurance and was done by doing checks called audits so the administrators could see the home was managed. We looked at an audit the manager had completed on the care plans used in the home but we could not see how the audit identified things that needed to be improved as the information recorded said an audit had been done but not what the manager had found. We saw that the manager had been given a lot of new policies and procedures to introduce so the administrator could be aware of any matters in the home which needed to be improved upon and could tell the manager if he was doing a good job or needed to make improvements. We could not see how the new policies and procedures would work as the administrators had only been responsible for the home for a few weeks so could not see how the administrators had identified areas for improvement. The manager said there would be management changes at the home but we have not been told about these by the administrators so cannot see how the administrators are monitoring the quality of management at the home. What the care home does well: People that use services live in a welcoming and comfortable homelike care home, which has been maintained and has a choice of quieter areas in which to sit as well as dining space so have more choice where they spend their day and free time. People that live at the home made positive comments about living at Swansea Terrace and said, I cant say enough nice things about the carers. The food is one of the best things about living here. The home provides staff with a training programme so staff were provided with training and support to do their jobs. There is a stable staff group who have positive attitudes to the people that live there so staff generally treat people with dignity and respect. Appropriate staffing levels are provided so people that use services were supported around their needs. Care Homes for Older People Page 9 of 15 The personal care and health needs of people that use services are usually met to a good standard so they are supported to maintain their personal appearance and hygiene. A varied menu is available so people that use services can choose different meals. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 10 of 15 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 11 of 15 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 The home must improve how 01/02/2010 it gathers important information about the needs of people that use services before they move into the home. So staff have important information and plan how to meet their different needs. 2 12 16 The training on safeguarding 01/02/2010 adults must be improved. So people that use services are protected from harm and staff understand their responsibility in reporting poor practise. 3 12 16 People that use services must be asked about their social interests and offered the opportunity to be involved in recreational and social activities of their choice. So they can live fulfilling lives. 01/02/2010 Care Homes for Older People Page 12 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 4 19 16 Appropriate and suitable 01/01/2010 equipped bathing facilities must be provided in sufficient numbers. So people with high levels of personal care needs can have access to bathing facilities that suits their needs. The recruitment of staff must 01/01/2010 be improved. So people that use services are protected from harm. 5 29 19 6 30 18 The training on safeguarding 01/02/2010 adults must be improved. So people that use services are protected from harm and staff understand their responsibility in reporting poor practise. 7 31 8 An application to register as the manager must be made to the Care Quality Commission So that we and the people that live and work at Swansea Terrace will be confident the home is run in their best interest. 01/02/2010 8 33 24 Quality assurance must improve. So mistakes made in management of medicines, recruitment of staff and training in safeguarding 01/02/2010 Care Homes for Older People Page 13 of 15 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action adults are not repeated so the home is managed more effectively and the welfare of people living there maintained. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 14 of 15 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. 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