CARE HOMES FOR OLDER PEOPLE
Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector
Marian Whittam Unannounced Inspection 16th January 2007 07:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Swarthdale Nursing Home Address Rake Lane Ulverston Cumbria LA12 9NQ 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) 01229 580149 01229 581333 Vishomil Limited Miss Helen Janice Watson Care Home 43 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (43) of places Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 43 service users to include: up to 43 service users in the category of OP (old age not falling within any other category). up to 5 service users in the category DE(E) (Dementia over 65 years of age). The home must at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The staffing levels for the home must meet the Residential Forum Care Staffing Formula for Older Adults. 22nd June 2006 2. 3. Date of last inspection Brief Description of the Service: Swarthedale Nursing Home is a large Victorian house that has been adapted and extended for its current use and provides care for up to 43 older and up to 5 residents with dementia. The home is in a residential area on the outskirts of the market town of Ulverston and approximately a mile from the town centre with all the usual amenities. The home is on a bus route and the station is less than a mile away. There are shops, a post office and a public house on the nearby residential housing estate. The home is on two floors and there are two passenger lifts for residents. There is a small private garden to the rear of the building with seating. At the front of the building there is a car park and garden areas and seating. There are two main communal areas on the ground floor, a lounge with a conservatory attached and a large dining room. Information is available to prospective residents in the combined Statement of purpose and service users guide; this is available from the office but not displayed in the home. Inspection reports are not displayed in the home. The fees charged by the home range from £363.00 to £478.00 per week as at the date of the inspection. An additional charge is made for personal toiletries, newspapers, magazines, dry cleaning also hairdressing and dental services and any personal travel according to information provided by the home. The home makes information about its services available through its service user guide, including the latest report, and statement of purpose. These are available within the home. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 16th January 2007. Three inspectors carried out the inspection, looked around the home and spoke with the manager, residents, relatives and visitors to the home and with nursing and care staff members, domestic and kitchen staff. Time was taken throughout the day to be with residents in the lounges and in their own bedrooms, speaking with visitors and relatives of the residents, having a meal with residents and spending time in communal areas with them. Staff recruitment records, training records, servicing records, and care plans and pre admission assessments were examined and a selection of records required by regulation. A pharmacy inspector did a full pharmacy inspection on all medication handling and records. Information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place, was completed and returned by the home manager in good time for the inspection. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their opinions and experiences of the home. What the service does well:
The home provides a clean environment for residents in bedrooms and communal areas and many residents have chosen to personalise their bedrooms, to make them more homely. Several residents and relatives spoke well of the domestic and laundry staff saying they were helpful, cheerful and worked hard. Some staff do have a good rapport with residents and spend time chatting with them and residents and relatives speak well of the nursing staff and nursing care. A resident and their visiting relatives felt the care was “Very good and the carers and manager very obliging” and the resident had been particularly pleased that a carer had gone to the trouble of getting them a last minute item they had wanted. It is evident from discussions with residents and their relatives that people feel their privacy and dignity are being respected. The home works with other healthcare agencies to monitor and maintain resident’s health and well-being and gets specialist help for residents when this
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 6 is needed. This includes the local GPs and District nursing teams as well as specialist services such as the intermediate care team. Residents are able to look after and take their own medicines if they wish and where it is safe to do so to help maintain their independence. The service has safe systems in place to ensure that residents receive the medicines they need when they need them and good records are being kept. The manager, nursing and care teams have clearly been working hard to develop better systems of working to develop the service and have responded well to the inspection process. What has improved since the last inspection?
The Statement of purpose has been updated and improved recently and the home is starting to put a copy in new residents bedrooms to make information more easily available. The home has also produced a large print version of the information and is in the process of putting the information on tape for the visually impaired. This will improve access to information about the home. Overall the care planning and assessment processes within the home have improved with clearer and more relevant information being collected. The new style of personal care plan being developed by the home, using an appropriate nursing model, is a great improvement on the previous system in use, it is easier to follow and on the whole contains clear information. Psychological and nutritional assessments are now being routinely completed for residents. Records for receipt, administration and disposal of medicines have improved so that all medicines can be accounted for. The improvement in the handling of medicines seen at the inspection in November 2006 has continued at this inspection. The service now has safe systems in place to ensure that residents receive the medicines they need when they need them and good records are kept. The records for receipt, administration and disposal of medicines were good and showed that residents medicines were handled properly and given as the doctor intended. More suitable activities and a greater range are now being provided for residents during the week and the home now has a coordinator to lead this. Relevant information is being gathered on interests and life stories to inform this and the good work being done on activities needs to continue to make sure the individual information is translated into action for residents. The home is continuing to develop and improve this area of life for residents. New menus have been produced which are alternated over a four-week period. Consultation is now taking place regarding further changes to improve the menu based on feedback from residents to try to reflect individual tastes
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 7 better. A number of residents said that meals had improved recently and the meals now were “very good”. Significant improvements have been made to the way complaints are investigated and followed up by the management. The home has reviewed all its adult protection procedures to make sure they reflect current multi agency good practice and are clear and accessible to all staff. The home still has some work to do with relatives to restore confidence in the complaints process and demonstrate consistent good practice in the long term. The home has a programme for maintenance and has fitted a new carpet to the lounge and is redecorating bedrooms on a rolling programme. Better use is being made of the communal dining room, by some residents, for activities and for seeing their relatives. Staff now have their own staff room for breaks and storage. Improved cleaning regimes and good Infection control practices in the kitchen are being observed. Recruitment practices have now been significantly improved following persistent breaches of regulation with reference to Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks. Staff now have all required checks in place with appropriate references being taken and appropriate Criminal Record Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks in place. Changes in the way information is recorded and communicated and better quality assurance systems and resident consultation have resulted in the development of a more open and proactive management culture. This improvement needs to be fostered and built upon to maintain a consistently open, positive and inclusive atmosphere for residents, relatives and staff. Overall the home has made great improvements right across the service and the challenge for them will be maintaining the improvements and then building on that good work to take the service forward. What they could do better:
Overall the care planning and assessment processes have greatly improved but the manager needs to ensure that assessments are consistently acted upon and that staff are being given sufficient detail to deliver the appropriate care. This is particularly evident and crucial with the care of residents assessed as at risk of skin damage and those with wounds. Staff also need to make sure that when monitoring sheets are being used they are properly completed so that they are of value in monitoring resident’s care. A more formal way for carers to access and keep up to date with the care plans is also needed to ensure that residents care needs will be met as planned, rather than care staff trying to do this as they go along. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 8 Relevant information is being gathered on interests and life stories to inform activities but the good work being done on activities needs to continue to make sure the individual information is translated into action for residents. The needs of the individual and their preferences and capabilities should be considered in providing different recreation opportunities for residents. This more person centred approach to activities and routines would give people more control over their lives and help them be more actively involved in the way things are done in the home. Although medication practices are now safe and of a good standard there is a large quantity of medicines being kept and some storage is cramped and looks disorganised. The service needs to review storage and consider buying another medicines trolley and a larger controlled drugs cabinet to make it easier to find medicines. Whilst overall the environment in the home is satisfactory, the home needs to make sure it attends to issues such as torn upholstery, stained and split woodwork to keep that homely feel. It was observed in the lounge that call bells were not sited within easy reach of residents so they had to rely on staff noticing them or a fellow residents gaining the staffs attention when they wanted assistance. Call bells must be easy for residents to reach so they can get help when they want it or use some system of monitoring the residents using the lounge to better promote their dignity and choice. Although infection control procedures are satisfactory, as a good practice measure, the home should not use bars of soap in communal areas as this increases risks from cross infection during hand washing. Minor daily items of upkeep should be noted, renewed or dealt with quickly to keep a pleasant environment for the people who live there. Although the home is addressing quality assurance issues and consultation it could enhance the feeling of inclusion for residents and relatives if the results of surveys and consultation exercises were collated and the results published in the home. The home does not have a formal annual development plan for the home based on its now more systematic approach to quality monitoring. Formalising annual plans for the home between the providers and nursing management would improve communication and help clarify the homes aims and objectives, providing detail on the actions to follow and how improvements were to be monitored in the long term. The standard of record keeping is satisfactory overall but records of moving and handling training could not be found during the visit and need to be provided for evidence. The moving and handling trainer has recently left and signed records could not be found although the dates of the training are recorded. The home needs to make sure that the statement of Purpose is made easily available to anyone who may want to look at it, not kept in the office.
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 9 Comments from relative’s surveys indicate that some visitors did not feel welcomed by the staff when they came to visit. The home still has some work to do on building up relationships in some quarters. 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. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 2, 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is an informative service users guide and statement of purpose available for residents and pre admission assessments are done by the home to ensure individual needs can be met on admission. EVIDENCE: Information is being made available about the home for prospective residents and their families in the statement of purpose and service users guide, including resident’s comments and the most recent report, so they know what the home says it can provide. The home needs to make sure that the statement of Purpose is made easily available to anyone who may want to look at it, not kept in the office. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 12 There are records on file of the copies of contracts/ terms and conditions of residence provided to residents and for social services contracts and the provision of nursing care. An inspector spoke with two visitors to the home about the admission process. They felt they had been given “suitable information” although it was done in a rush due to the hospital discharge being at short notice. An assessment of need was completed by the home prior to admission ensuring the home was able to meet their relative’s individual needs. Residents needs have been assessed before and following admission to the home and their individual care plans developed from this. The assessments seen are clear, and where appropriate families, specialised care agencies and professionals are being involved in providing information on the health and personal care needs to be met for residents. This includes the Intermediate Support Teams, community psychiatric nurses and specialist nurses for Parkinson’s Disease, diabetes and tissue viability. However in continuing to develop the service the home needs to consider making the assessment and admission process more personalised taking into account individual anxieties and the speed with which transfers can take place. All prospective residents and/or their families are invited and encouraged to visit the home prior to admission. This gives them an opportunity to assess the quality and suitability of the home. However some residents and relatives expressed the feeling that in reality they had little choice over the nursing home they went to live in as there is so little available locally and hospitals need to transfer as soon as they can. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 13 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7, 8, 9, 10 and 11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a care planning and assessment system in place to provide information for staff to meet resident’s individual health, personal and social care needs. EVIDENCE: The new style of personal care plan being developed by the home, using an appropriate nursing model, is a great improvement on the previous system in use, it is easier to follow and on the whole contains relevant information. Various assessments and strategies are recorded to ensure staff can provide appropriate levels of care whilst promoting independence and choice. Psychological and Nutritional assessments are now being routinely completed and used to monitor and respond to individual needs as they are recognised, however records of weight are inconsistent. Staff need to make sure that when monitoring sheets are being used they are properly completed so that they are of value in monitoring care.
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 14 Nursing staff are doing skin risk assessments and four of those examined identified the level of risk to the individuals as high risk and also very high risk of pressure sores developing. There was however no detail in the care plan about how this risk was to be managed and what equipment should be used to prevent further damage to the resident’s skin. The care plan itself only covered very basic instructions, such as “monitor skin”. Management plans are not being put in place to give clear instructions to staff on prevention and management of such pressure area risks to residents. Similarly wound care plans need to be used where there is damaged skin being treated and redressed. One resident with a skin tear had no plan in place for its care and management only being reviewed in the daily notes. This lack of formal recording and review does not promote monitoring and the consistent management of wounds. A member of care staff was asked about the care they would give to one resident. As an experienced carer they gave a good description of the general care tasks she would carry out. The carer said they usually tried to grab a few spare minutes in the coffee break to read the care plans but confirmed there is no formal system for doing this and it was up to each carer how they did this. A more formal way for carers to access and keep up to date with the care plans is needed to ensure that residents care needs will be met as planned. It was proposed that this be taken forward to a staff meeting for full consultation. There was evidence of the home working with other healthcare agencies to monitor and maintain resident’s health and well being. This included local GPs and District nursing teams as well as specialist services such as the intermediate care team. It was evident from discussions with residents and their relatives that people feel their privacy and dignity are being respected. Staff were seen to address people in a courteous manner and dealt discreetly with personal care tasks. The improvement in the handling of medicines seen at the inspection in November 2006 continued at this inspection. The service has safe systems in place to ensure that residents receive the medicines they need when they need them and good records are kept. The records for receipt, administration and disposal of medicines were good and showed that residents medicines were handled properly and given as the doctor intended. One resident said they sometimes went out for the day and that staff made sure they had their medicines with them. They said that these were put in an envelope. It is recommended that this be discussed with the pharmacy to see if there are safer ways for residents to take medicines out in properly labelled containers. The medicines trolleys and the controlled drugs cabinet were not big enough for the amount of medication that was kept. Some medicines were difficult to find and there was some duplication of medicines that wasted space. It is recommended that the medicines are checked and those that are no longer required are disposed of so that residents are not at risk of getting medicines Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 15 that are no longer needed. It is also recommended that the service obtain another trolley and a larger controlled drugs cabinet. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides social activities within the home and there is variety and choice in the food on offer to residents. EVIDENCE: It was evident from comment cards received as part of this inspection and from discussions with residents that more suitable activities are now being provided for residents during the week. The notice board in the hall informed residents of the activities available both in the home and in the local community. This included activity days three times a week, which involved both one to one and group activities. Other activities and interests included hairdressing, a library service, chiropody, aromatherapy and massage. Relevant information is being gathered on interests and life stories to inform activities but the good work being done on activities needs to continue to make sure the individual information is translated into action for residents. The needs of the individual and their preferences and capabilities should be considered in providing different recreation opportunities for residents. This more person centred approach to activities and home routines would give
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 17 people more control over their lives and help them be more actively involved in the way things are done in the home. Comments from relative’s surveys indicate that some visitors did not feel welcomed by the staff when they came to visit. However another relative observed that, “I have noticed on many occasions how rude visitors are to staff and how calmly and politely staff deal with this, despite being provoked”. There was a notice advertising religious observance for all faiths, which was provided on a monthly basis in addition to specific church services for individual faiths both in the home and at a local church. New menus had been produced which are alternated over a four-week period. The manager explained that consultation was taking place regarding further changes to the menu based on feedback from residents, ensuring they reflected individual tastes. A record of the meals provided is maintained and includes alternatives provided to people who did not want the planned menu. The cook also had personal information about special diets and how people preferred their meals served. One inspector joined a group of residents for a meal, which was served in the dining room. The meal was well presented with the mealtime being a relaxed social occasion. Residents spoken with confirmed that the food provided was “good quality and the portions were more than adequate”. Another resident said of the meals that, “sometimes they are exceptionally good and other times they were edible, but you can always ask for something different if you don’t like what’s on offer. They do me a lovely egg sandwich, it’s done just how I like it”. A number of residents said that meals had improved recently and the meals now were very good. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is displayed in the home. Adult protection policies and procedures are in place and staff have been given training to promote resident’s protection. EVIDENCE: The home has logged 2 complaints since the last random visit and has a more robust system in place now to log and investigate these. Records of the complaint, the investigation and actions taken are kept securely. Action plans are developed from the investigations to help prevent the problem happening again, which is good practice. Residents survey responses indicate that they are aware of how to make a complaint, as were all the visitors who responded. However comments received from surveys responses indicate that residents and relatives feel some staff respond better than others and there may be, “very little action”. Information on making a complaint is displayed on the notice board in the foyer and within the statement of purpose and service user guide. Information on contacting advocacy services is also displayed. There has been one adult protection investigation undertaken by social services. This has been investigated by the relevant agencies and actions taken as a result by the home to prevent a reoccurrence. Adult protection training has been given in house, on recognising signs of abuse and on
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 19 challenging behaviour. The home uses the multi agency guidance to inform practices and policies and procedures on whistle blowing. The home’s Deputy Manager is away on a two day training course on protecting vulnerable adults run by the local authority social services department. This ‘Training the trainers’ course will allow her to give up to date training to all staff in the home and act as a management resource. Significant improvements have been made to both complaints investigation and in reviewing all adult protection procedures to make sure they reflect current multi agency good practice and are clear and accessible to all staff. The home still has work to do to in restoring confidence in the complaints process amongst some groups who come into contact with the service and in demonstrating consistency in the long term. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 20, 21, 22, 24, 25 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a tidy, adequately maintained and comfortable place for residents to live with necessary equipment they need to promote personal needs and independence. EVIDENCE: The home has an ongoing maintenance programme and policies and procedures in place on infection control and Legionnaires Disease. All the main areas of the home were clean and hygienic and there were no malodours. The home has domestic staff to maintain a clean environment. They also have a handyman to keep the environment safe and well maintained. One resident commented that, “the cleaning staff do well” and a relative that the cleaning and laundry staff are “always cheerful and helpful and that their relatives room is “clean and tidy”. The laundry is small but tidy and clean.
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 21 During the course of the day as the inspectors looked around the premises some areas of practice that could be improved were seen. It was noted that bars of soap were being used in three communal bathrooms, and this is not good practice and can result in cross infections. Bars of soap should be kept for personal use only and not left in the communal bathrooms for general use. In two toilets/bathrooms where pipes have been boxed in behind toilet bowls the wood has become stained and in one the veneer was lifting, which meant it will not be able to be cleaned effectively. Some of the chairs in the home are specialist chairs for people with physical disabilities that are on castors. It was noted that two of these were ripped in places exposing the foam padding, which should now be repaired or replaced. These daily items of upkeep should be noted, renewed or dealt with quickly to keep a pleasant environment for the people who live there. Cleaning regimes and good Infection control practices in the kitchen are being observed. The dining and lounge areas in the home were clean, well lit, and homely and could be used for different social occasions. Resident’s bedrooms seen have a satisfactory standard of furnishing and decoration. Many residents have brought in their own possessions and this made their rooms more personal and homely. The three shared bedrooms in the home have screening in place for privacy. Communal space remains limited for privacy in the lounge but the home is making better use of the dining room for residents use and for privacy with families when they visit During a 50-minute period of observation staff were seen infrequently in the main lounge where there were up to 16 residents some of whom were unable to move themselves. There were no call bells within reach of them making some of them totally reliant on staff noticing them or a fellow resident gaining the staffs attention when they required assistance. Call bells must be made easy for residents to reach and use or an appropriate way to monitor the lounge so residents can get help when they want it and so promote their dignity and choice. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff numbers are adequate overall but staff are not always deployed effectively. The recruitment practices in the home are adequate to safeguard residents. EVIDENCE: The staff rotas for the week beginning 15.1.07 were examined. The rotas showed sufficient nursing and care staff to provide adequate personal care. There are two registered nurses on duty on the busy morning shifts. There is a full compliment of staff on both day and night shifts with cover being provided for staff absences. The deployment of staff should be looked at for the main lounge to ensure vulnerable residents are not left alone without any means of gaining staff attention. Staff should make sure that the lounge area is checked often during the day and that bells are accessible if no staff member is going to be in there with residents. Comments from some relatives and some residents suggest that they do not feel some care staff are always interested in them. A resident survey response said of staff that, “ their own interests occupy a large amount of their attention” and a relative felt it was “very lonely in the lounge” and that if
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 23 residents in there wanted help “you have to go looking for someone. One relative did say that, “some carers are great but others are dreadful”. Although staff morale and commitment to service improvement is evident from many of the improvements going on in the home work still needs to be done to promote team working with all staff and across all areas of practice. Training for NVQ Level 2 and 3 in care is being provided and the home is working towards achieving the 50 level asked for by the National Minimum Standards. Staff training records show staff have received induction and foundation training and showed what had been done and what was needed for each staff member. Two senior carers are doing dementia awareness training to provide in house training for the other staff. Recruitment practices have now been significantly improved following persistent breaches of regulation with reference to Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks. Staff records show that appropriate references are being taken and appropriate CRB and POVA checks are now in place. Details of periodic checks on Personal Identification Numbers (PIN) for registered nurses are now being recorded. The home needs to make sure it maintains this improved level of practice in the long term. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and promote their health and safety. EVIDENCE: The home has a suitably qualified manager with experience of working with older people. The manager, as part of her professional development, is also undertaking management training courses relevant to the role to help further develop management skills. The home also has a new deputy manager who is giving effective support to the manager and doing some useful work improving the care planning system and medication practices. Changes in the way information is recorded and communicated and better quality assurance is resulting in the development of a more open and proactive management
Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 25 culture. This improvement needs to be fostered and built upon to maintain a consistently open, positive and inclusive atmosphere for residents, relatives and staff. The home had systems in place to safeguard resident’s monies and a check showed transactions are recorded and accurate. Records and servicing contracts indicated that the home had systems, training and practices to promote resident health and safety. Records show that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists, and alarms are being serviced, and that periodic electrical testing has been done. The manager is currently working on a quality assurance system for the home to ensure care planning is regularly reviewed and monitored by them or senior staff. Improvements can be seen in reviewing policies and procedures, in the care planning systems, medication audits, complaints monitoring, better communication systems and consultation with residents and families through surveys and especially through the named nurse system. To promote better communication the results of surveys and consultation exercises should always be collated and the results published in the home. The manager is aware of the areas that the home needs to continue to improve and develop but the home does not have a clear annual development plan. Formalising annual plans for the home between the providers and nursing management would improve communication and help clarify the homes aims and objectives and how they are going to maintain and improve the standard of the services. This could provide focus and detail on the agreed actions to follow. Formal supervision is being given to staff and annual appraisals are being done looking at training needs and practice areas staff need to be clear about. However the manager does not have any structured, formal supervision given to them appropriate to the demands of their role and this should be provided. Fire training is being given to staff and fire lectures and drills recorded and fire risk assessments have been updated following changes in legislation. Overall records are being properly and securely maintained, however, the records of moving and handling training could not be found during the visit and must be available for evidence. The moving and handling trainer has recently left and signed records could not be found although the dates of the training are recorded and have been provided. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 14 15 2 3 3 2 X 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 2 2 X 3 2 3 2 Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13 (4) Requirement Timescale for action 30/01/07 2. OP7 15 (1) (2) (b) 23 (1) (2) (a) 3. OP22 When a risk of skin breakdown is identified for a resident a management plan must be put in place to give clear instructions on reducing and managing this risk. Wound care management plans 30/01/07 must be used to monitor and review wound care management and progress. Call bells or a means of 30/01/07 summoning assistance must be made easily accessible to all residents using the lounge to promote their dignity and choice. 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 OP1 Good Practice Recommendations The statement of purpose/service user guide should be
DS0000061688.V319485.R01.S.doc Version 5.2 Page 28 Swarthdale Nursing Home 2. 3. OP3 OP7 4. 5. 6. 7. 8. 9. OP8 OP8 OP9 OP9 OP12 OP19 10. 11. OP26 OP31 made more easily available to anyone who might want to look at it. The home needs to consider making the assessment and admission process more personalised taking into account individual anxieties and the speed of hospital transfers. A more formal and consistent way for carers to access and keep up to date with the care plans should be developed with staff to ensure that residents care needs are met as planned. Records of weight gains and losses should be done and recorded consistently Staff should always complete monitoring sheets for residents in order for them to be of to be of any value to the resident’s care. It is recommended that the registered person discuss with the pharmacy ways that residents can take medicines out of the service in properly labelled containers. It is recommended that storage of medicines be reviewed and that the service obtains a further medicines trolley and a larger controlled drugs cabinet. A more person centred approach should be considered in providing different recreation opportunities for residents with different preferences, social needs and abilities. Minor items of environmental upkeep including torn upholstery and damaged wood work should be renewed or dealt with quickly to keep a pleasant and hygienic environment for the people who live there. It is recommended all bars of soap are removed and kept for personal use only and not left in the communal bathrooms. The manager and Provider should make sure their roles, responsibilities and levels of authority in the management process, especially around budgets, are clear to both to give greater clarity for the manager to be able to discharge their responsibilities rather than waiting for the Provider to act. Annual development plans for the home should be formalised between the providers and nursing management to improve communication and help clarify the homes aims and objectives and provide detail on the actions to follow. The manager should receive formal, structured supervision appropriate to their role to support them and this should be recorded. Detailed evidence should be provided that staff have been
DS0000061688.V319485.R01.S.doc Version 5.2 Page 29 12. OP33 13. OP36 14. OP38 Swarthdale Nursing Home trained in safe moving and handling techniques. Swarthdale Nursing Home DS0000061688.V319485.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP 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
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