Inspection on 19/05/08 for Swarthdale Nursing Home

This inspection was carried out on 19th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Swarthdale Nursing Home 30/05/07

Swarthdale Nursing Home 16/01/07

Swarthdale Nursing Home 22/06/06

Swarthdale Nursing Home 03/10/05

Swarthdale Nursing Home 26/04/05

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector Marian Whittam Unannounced Inspection 09:30 19th May 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.V363000.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.V363000.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 Mrs Caroline Suttle 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.V363000.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. 30th May 2007 2. 3. Date of last inspection Brief Description of the Service: Swarthdale Nursing Home is a large Victorian house that has been adapted and extended for its current use and provides accommodation and care for up to 43 people, up to 5 of whom may have dementia. The home is in a quiet 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, 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 current and prospective residents in the Statement of Purpose and the service users guide and from the recently introduced newsletter. These and the latest inspection report are available within the home. The fees charged by the home range from £386.00 to £426.00 per week for residential care and £511.00 to £532.00 per week for nursing care as at the date of the inspection. An additional charge is made for personal toiletries, newspapers, magazines, also hairdressing and private dental services, private chiropody and any personal travel such as taxis. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This site visit to Swarthdale Nursing Home forms part of a key inspection. It took place on 19.05.08 and we (The Commission for Social Care Inspection, CSCI) were in the home for five and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager identifying what the service does well and what could be improved and how they plan to achieve the improvements. This was returned to CSCI in good time before the visit. • The service history. • Interviews with residents and staff on the day of the visit. • Observations made by us in the home during the visit. • Completed questionnaire survey forms from people living in the home and from healthcare professionals coming into contact with the service. During the visit we spent time with people living in the home and talking to them about their experiences. We looked at care planning documentation and assessments to ensure the level of care provided met the needs of those living in the home and made a tour of the building to inspect the environmental standards. Staff personnel and training files were examined and a selection of the service’s records required by regulation. The pharmacist inspector also visited the service as part of this key inspection and assessed the handling of medicines through the inspection of relevant documents, storage and meeting with the manager and residents. This inspection took five and a quarter hours. What the service does well: People living in the home we talked with spoke well of the staff and the help and support they get from them. The home provides a homely and informal atmosphere for residents and we saw that many staff have a good rapport with them and know them well. One person told us that, “The staff are very understanding”. The home is kept clean and tidy and many residents have chosen to personalise their bedrooms, to make them more homely, some with the involvement of their families. People who live in the home told us that the domestic and laundry provide a good service with helpful and friendly staff. Positive comments were made about the standard of catering and the range of meal choices being offered. One person told us, “Choice is much better, and Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 6 we get a lot of different things now”. Efforts are made to ensure residents are offered a varied and nutritious menu with fresh fruit and vegetables available each day and meat from local supplier. 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 is needed. This includes the local GPs and District nursing teams as well as specialist services such as the intermediate care team. The management team have a clear vision of what they are trying to achieve for residents through continuing improvements in the environment and the quality of life of residents living in the home. The manager, nursing and care teams have clearly been working hard to develop the service and to maintain the improvements being made. What has improved since the last inspection? The Statement of Purpose and service user guide for the service has recently been updated and improved so prospective residents and their families have up to date information to help them in their choice of home. The introduction of a newsletter has improved the sharing of information with residents and families. The management of medicines is being reviewed to make sure that safe systems are in place to protect the health of the people who live there. We found the handling of medicines was still being improved with the manager monitoring this. The manager is doing regular checks on medication to help identify problems quickly so that they could be put right without delay. Systems were in place so that people who were new to the service received the correct treatment and to prevent medicines running out. More emphasis is being given to activities provision within the service and looking at ways to provide opportunities for people to participate in recreation. This needs to continue to be improved and not allowed to slip. Improvements have been made to the environment generally in the home and this is part of a longer term programme. The kitchen has been improved and several areas of the home redecorated. Improvements are being made to the office and reception as well as in the laundry to provide better facilities for staff and residents. The improved system for recording and investigating complaints found at the last visit has been well maintained and this process is now more robust and transparent. This has helped people to have more confidence in using it. The manager has reviewed all the home’s policies and procedures and introduced new ones where a need has been found to further protect the interests of people living there. The improvements to the recruitment process have been well maintained and this is now given a high priority to protect resident’s interests. The manager Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 7 has now accessed occupational health support for staff as well. The planning and provision of training and development for staff continues to improve and be well supported by the management team. Overall the approach taken to quality assurance has improved with more audits being done, reviews of practices and quality meetings and incident analysis to inform practice. The management approaches being taken in the home have improved and are systematic and structured and consequently planning is better. Staff morale has also improved and a there is more organised deployment of staff improving care and support for people living there. Overall the new manager, staff and owners are continuing and maintaining the changes and improvements across the service and need to continue 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 care plans relating to medicines contain clear details of how they are managed to ensure people receive safe and consistent treatment. The service must make sure that all records of medicines administered to people are completed accurately to protect them from errors that could affect their health. It is recommended that staff mark medicines packets with the date of opening so that audit of all medication is possible to show they are administered correctly. It is recommended that medication times be reviewed where people repeatedly miss their medication at nighttime because they are asleep. Within care planning and assessment the manager should make sure that personal profiles/pen pictures for people are developed with them including details of their social needs, interests and abilities. We recommend that the named nurses/carers re start the useful work done previously with residents and relatives to gather information to help staff develop activities provision social choices and give support. Feedback should be actively sought from people using the service through regular residents meetings as well as from life plans. The manager should consider ways to include the views of residents in their care plans about the way their personal care is delivered, their choices and decisions. Where any photograph is taken of a person’s wound then consent to do so should be clearly obtained and recorded to protect individual rights to privacy and dignity. Although environmental improvements are taking place the owners should make sure that any damaged or torn upholstery on chairs is repaired or replaced promptly to maintain a good standard of furnishing. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 8 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.V363000.R01.S.doc Version 5.2 Page 9 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.V363000.R01.S.doc Version 5.2 Page 10 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, 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. The admission procedure ensures a full assessment of needs is completed prior to admission and that there is information for people to find out about the home before going there. EVIDENCE: The Statement of Purpose and service user guide for the service has recently been updated and improved so prospective residents and their families have up to date information to help them in their choice of home. The information was clear and included room sizes and fees as well as what the service offers to provide and what it does not. This information can be made available in other formats if required by people to meet particular needs. People told us they had information about the service before they moved there and survey responses supported this. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 11 The notice and menu boards in the foyer of the home also give information about what is going on in the home and the daily menu choices. There is also a newsletter to keep residents and families up to date with what is going on in the home and changes being made. The manager or nursing staff do the pre admission assessments before they accept a resident to try to make sure that they can meet their needs and prepare their admission. Prospective residents and relatives are encouraged to visit the home and look round before making a decision. There is a months trial period following admission followed by a care review to make sure that the home is meeting people’s needs and expectations. A nurse spends time with prospective residents and/or families during visits showing them around, discussing any particular needs and answering questions. We saw this taking place on the day of the visit. We looked at four people’s care plans and the pre admission assessments that had been done to make sure the home was able to meet an individual’s needs before they came to live there. The pre admission assessments we looked at contained the relevant information from which to develop a basic individual care plan. We discussed with deputy manager the need to include as much as possible the individual resident in the assessment process to get their thoughts and feelings. Where the care assessment has been done by social services a copy is included in the care plan. Where appropriate other care agencies and professionals have been involved in providing information before admission and advice after admission. The service does not provide intermediate care. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 12 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. The care planning and assessment systems provide general information for staff to meet resident’s individual health and personal care needs. Some shortfalls in medication recording could affect the health of people. EVIDENCE: All residents have an individual plan of care that is clearly set out and easy to follow. The care planning system is continuing to be developed, evaluated and improved. The information in the plans was well organised and easier for staff to follow and update. It is based on initial assessments and the plans set out individual’s health, nursing and personal care needs and including individual clinical risk assessments. Care plans set out the health and personal needs and nursing problems and the nursing and care actions needed but this does not always reflect the individual resident’s own perspective very well. The manager should consider ways to include the views of residents in their care plans about the way their personal care is delivered, their daily choices and decisions. There was only a small amount of information on people’s life stories and social and recreational preferences and capabilities in the plans we looked at. We Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 13 discussed with the deputy manager the importance of being clear about a person’s social care needs in developing more individualised plans and for planning overall and individual activities provision. We recommended that the named nurses/carers worked with residents and relatives to gather background information and ‘personal profiles’ to help enhance social care choice and support. Work had been done on this at the last visit but this has lapsed and needs to be restarted to make sure the activities provision continues to develop to suit people’s needs and preferences. The risk of falls and skin integrity is being assessed and care plans and assessments are being reviewed regularly using care plan. Wound care plans were detailed, progress monitored and management clearly planned. Although we recommended that where any photograph is taken of a person’s wound that consent is clearly obtained and recorded to protect privacy and dignity. Records show that people have good access to health care services and appropriate health care professionals to support individual needs such as dietician, speech and language therapists and tissue viability nurses. Survey responses from local GPs indicated their satisfaction with the service and that their advice is sought and appropriate action taken to manage people’s health care needs. The pharmacist assessed the handling of medicines as part of this inspection and found the manager was continuing to develop and improve the way medicines were being managed, and this included doing regular audits. Systems were in place so that people who are new to the service receive the correct treatment, and to prevent medicines running out. However, it was not possible to tell when some packets of medicines were started and this makes it difficult to check that they are given correctly. It is recommended that staff mark the date of opening on medication. Some records of medicines administered to people were not accurate and these errors could cause harm. Some records of administration were not signed and on other occasions records were signed even though medicines had not been given. On occasions people repeatedly missed night time medication because they were asleep. It is recommended that this be reviewed so that treatment is not missed unnecessarily. The records for a person taking a medicine that needed regular blood tests and close monitoring had little information. It was recommended that the service used a system to doublecheck blood tests and the required dosage of medication. This was organised immediately by the manager. The service has basic policies and procedures for dealing with death and dying and arrangements are in place to access other more specialist help to support staff. The management team is in the process of developing this aspect of service provision. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 14 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): BNMS 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service have a choice of good quality food and there are some opportunities to take part in organised group and individual activities and to maintain social contacts. EVIDENCE: We saw from surveys received before the visit, from observations during the visit and from talking with people living there that opportunities for general social and recreational activities in the home are being given much more emphasis and support. There is an activities coordinator in the home three afternoons a week to organise and lead activities, some in groups and some on a one to one basis. The activities coordinator was in the home during the visit and we saw them involved in both group and individual activities with people. One person told us how much they had enjoyed a trip out shopping with the activities coordinator. The weekly activities programme was on the main notice board in the hallway and included opportunities for religious observance in the home and from people’s own ministers if they wanted this. The recently introduced ‘Newsletter’ also has information on forthcoming events such as the Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 15 planned Summer Garden party. There was also information about what is available outside the home. We could not find individual activity plans in place to give information on people’s choices in daily activities, their preferences, abilities and particular conditions affecting their participation. We discussed with the deputy manager how, as they developed a more person centred approach to activities and home routines that this could give people more control over their lives. We spoke with one resident who told us about the interests and hobbies they had enjoyed in their life but the things they told us about were not part of their individual plan. We discussed this with the deputy manager who was aware of the need to develop a more structured and individualised approach to leisure and recreational opportunities in the home. The management team is currently reviewing this so that the service can look at providing meaningful activities that are more individually tailored than at present. This should, when done, make leisure and recreation more focused on the individual’s goals and capabilities. We found that people were able to have family and friends visit when they wanted and that they were being supported to keep outside links with some people choosing to go out with family and friends. One person told us that they had “made some nice friends here since I came in”. We saw from surveys received before the visit, from observations during the visit and from talking with people living there that the quality and choice of food provided has improved. One relative commented that, “The meals have improved significantly and the management and staff should be commended for this”. The daily menu choices were varied and nutritious and people told us that, “The food is very good, we have an excellent cook. I have put weight on since he came”. We visited the kitchen, which has been reorganised and improved and spoke with the chef. He discussed with us the changes he has made to improve the catering and use of the kitchen, including monitoring popular choices when revising menus to reflect resident’s preferences and now includes salmon and, smoked haddock as requested by residents. We discussed how pureed food was presented individually to make it more appetising and “normal”. The chef uses local butchers and green grocers and incorporated fresh fruit and vegetables in the daily menus. The chef does the baking and the afternoon cream tea looked very appetising and people told us it was. Residents may now also have a cooked breakfast if they want this. Cleaning regimes and good infection control practices in the kitchen are being observed. We observed at lunchtime that people choosing to eat in their bedrooms had aids to assist them in this such as plate guards and those needing assistance were being given it. The atmosphere in the dining room was relaxed and the food well presented. People told us they had enjoyed their meal. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The home has an effective complaints system and procedures and training to promote residents safety that both residents and staff are aware of. EVIDENCE: The home has logged 7 complaints since the last inspection and one has been passed by CSCI to them for investigation. All have been dealt with in accordance with the home’s procedures and timescales. The service now has a more robust system in place 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. The approach being taken by management to concerns and complaints made about the service is much more open now and the emphasis is about learning from them to help prevent it happening again. This includes making policy and procedural changes where a need is indicated. People we spoke to in the home and survey responses indicate that they are aware of how to make a complaint and knew who to speak to if they were unhappy. Comments we received from surveys responses also indicated that the way complaints are dealt with has improved. A relative told us, “I have made complaints in the past, however I have seen significant improvement and give the owners, management and staff credit for that. I have always Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 17 acknowledged that they do a difficult job, it is pleasing they are now doing it very well”. 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 available. We found that people living in the home are being supported to exercise their right to vote and several did so by post in the local elections. The service has clear and up to date policies and procedures on safeguarding vulnerable adults that has been reviewed regularly. Training has been given to staff on recognising abuse and the actions to be taken, this is ongoing on a rolling programme and is taught by senior staff that have attended the appropriate training courses to do so. There is a whistle blowing procedure for staff and those we spoke to were confident that the manager would support them in reporting bad practice. The service has a clear grievance procedure for staff and policies and procedures on bullying and harassment to protect staff in their work. Policies are in place regarding restraint and a recording system if this arises. The use of bed rails that restrict movement is done under risk assessment and reviewed and keypads are only in use in areas where access by residents would pose a risk to them, such as the laundry and sluice. There have been no safeguarding referrals made since the last inspection. The improvements that have been from made to both complaints investigation and all adult protection procedures have been maintained and monitored since the last inspection to show a good level of consistency. The manager and staff have done much to help restore confidence in the complaints process amongst some groups who come into contact with the service so people may feel able to speak more freely. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 18 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 good. This judgement has been made using available evidence including a visit to this service. Improvement of facilities and refurbishment of the home has taken place and is ongoing to provide a generally good standard of accommodation within the home that is safe, clean and homely for people living there. EVIDENCE: Since the last inspection the home has been continuing with its planned programme of refurbishment and repair to improve the home for those living there. General maintenance is continuing along side the environmental upgrading in specific areas of the home, such as the kitchen and laundry. All the main areas of the home were clean and hygienic and there were no lingering malodours. The home has sufficient domestic staff to maintain a clean environment and one person told us that, “ The standard of cleanliness is excellent” and also commented positively on the efficiency of the laundry service. They also have a maintenance person to keep the environment safe and well maintained. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 19 There is one large communal lounge incorporating a conservatory area was clean and well lit and this has been reorganised to give two more distinct seating areas that encourage group seating rather than institutional. Furnishings in the lounge were of a generally good standard but we saw that some specialist chairs for people with physical disabilities that are on castors were ripped in places exposing padding, and we recommended these should be repaired or replaced. We discussed this with the deputy and an audit of maintenance needs is currently being drawn up. During the afternoon activities were taking place in the lounge with ball and floor games. However some people did tell us that it could get noisy in the lounge at times and then they went to their room for quiet. The dining room does have a small quieter area at one end and we saw that some residents and their families were using that for more privacy during the afternoon. Outside the grounds are being attended to and kept tidy and there is seating for people who want to sit outside. The majority of bedrooms have en suite facilities including the three double bedrooms that also have screening to promote privacy. Many people have brought in their own possessions and this made their bedrooms more personal and homely. Improvements have been made to some bedrooms, with twentysix rooms having been redecorated and several have new carpets, there was new furniture in some bedrooms and on order for others. This is part of the ongoing improvements planned for the home that included the redecoration of all hallways and corridors. There are accessible toilets and bathrooms on both floors and bathing aids, a specialist bath and moving and handling equipment to help promote people’s independence and safety. Equipment and adaptations to help residents get around the home are provided and call bells are accessible in areas used by residents. Infection control procedures are in place, including for the risk of Legionella and water testing is done to prevent the risk of scalds. Infection policies and procedures have been revised and updated to reflect current good practice. Advice has been sought from the specialist Infection Control Nurse and training is being done on a rolling programme for infection control. We saw staff following appropriate precautions when going about their work and disposing of waste. Major improvements were beginning on the laundry during the visit to bring it in line with best practice infection control guidance. Work is being done to create two distinct areas in the laundry, with separate ‘clean laundry’ and ‘dirty laundry’ areas to reduce the risk of any cross infection. Work has begun on improving the office space for management and administration and there is a nurse’s station on the first floor now making staff more accessible. A new reception area is planned in the entrance with an administrator working there and also to meet people as they come into the home and direct and assist them. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. People who use the service are protected by the recruitment procedures and training in place. EVIDENCE: We looked at staff rotas and there is a full compliment of staff on both day and night shifts with cover being provided for staff absences. The rotas showed sufficient nursing and care staff to provide personal care. There are two registered nurses on duty on the busy morning shifts. There is a training plan for 2008 in place and a development plan stating the aims for the training objectives for the year. One aim for the year is to have 75 of care staff trained to a minimum of NVQ level 2 in care. Currently the number is just under 50 and when those presently doing the course have finished will be over that level. There are records of induction and foundation training given to staff and individual records of training done including manual handling, food hygiene, fire training and infection control training from the specialist nurse. Three members of staff are due to do a Moving and Handling trainers course to provide training in the home and as a resource for staff. The significant improvements in recruitment practices found at the last inspection continue to be well maintained. The recruitment procedure is being followed to promote resident’s safety and interests. Staff records show that Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 21 appropriate references are being taken up and appropriate CRB and POVA checks are being done before staff start work in the home. Periodic checks on Personal Identification Numbers (PIN) for registered nurses are being done and recorded. Domestic, laundry, catering and maintenance staff are employed in sufficient numbers to ensure a good service. Residents commented positively on the nursing and care staff and also the domestic staff. We observed domestic staff chatting with residents as they went about their work and including them in their conversations. One resident said, “ The staff are very caring, dedicated people and cater to all my needs. They give me so much kindness, I cannot praise them more highly” and another said that staff were “very understanding”. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 22 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 good. This judgement has been made using available evidence including a visit to this service. The manager provides a clear leadership for staff and procedures are in place to safeguard resident’s interests and monitor quality for those living in the home. EVIDENCE: The home has a new registered manager, Mrs Caroline Suttle, who has experience of working with older people and undertakes training required for her role. The registered manager has a clear focus on improving the service for people using it and communicates a clear sense of direction and leadership. She has reviewed policies, procedures and work systems and practices in the home and is working with all staff to run the home in a transparent and consistent way. The manager has acted decisively in disciplinary matters to Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 23 protect the interests of people living there. The management team has implemented several changes that have had positive outcomes for the people living there and lines of authority and accountability are clear. The information provided in the Annual Quality Assurance assessment (AQAA) indicated that the manager is clear about what the service needs to do to develop and improve and is clear about how they intend to do this in the long term. The service is using surveys to gather information on people’s views of the service and whether they are meeting their expectations, these are currently going out for this year. The manager has also met with local GP surgeries to try to improve this aspect of the service. There are regular staff meetings being held with staff and quality meetings that also include incident analysis. This allows staff feedback as well as internal reviews of policies and procedures and information sharing. Residents and relatives also need to have regular meetings to have a forum to express their opinions and affect the way their service is run. We looked at staff supervision and found that staff were being given formal and practical supervision regularly. The manager has already reviewed all the service’s policies, procedures, and practices in the home to reflect good practice and current legislation. These have been properly organised and available to staff and any one who wishes to see them. We checked on the small amounts of money being held on behalf of residents. This was being managed properly, checked and recorded. We checked on the records about health and safety in the home and these were in order. Health and safety is being monitored by an outside agency and has recently been inspected. There were systems in place to promote and protect the health, safety and welfare of people living in the home, visitors and staff. This was demonstrated through the regular fire safety checks, and health and safety training. We saw records of inspection dates for services and equipment within the home, such as moving and handling equipment, water temperatures and electrical and boiler testing. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 24 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 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 2 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 3 Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 25 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 OP9 Regulation 13 (2) Requirement Records for the administration of medicines must be accurate to prevent errors that could affect the health of the people who live there. Timescale for action 12/06/08 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 OP7 Good Practice Recommendations The manager should make sure that personal profiles/pen pictures for people are developed with them within care plans including details of their social needs, interests and abilities. The manager should consider ways to include the views of residents in their care plans about the way their personal care is delivered, their choices and decisions. It is recommended that staff mark medicines packets with the date of opening so that audit of all medication is possible to show they are administered correctly. It is recommended that medication times be reviewed where people repeatedly miss their medication at nighttime because they are asleep DS0000061688.V363000.R01.S.doc Version 5.2 Page 26 2. 3. 4. OP7 OP9 OP9 Swarthdale Nursing Home 5. 6. 7. OP9 OP10 OP12 8. 9. OP20 OP33 Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Where any photograph is taken of a wound then consent to do so should be clearly obtained and recorded. We recommend that the named nurses/carers re start work with residents and relatives to gather information to help develop activities provision social choices and support. Where upholstery is torn or damaged on chairs it should be repaired or replaced promptly to maintain a good standard of furnishing. Feedback should be actively sought from people using the service through regular residents meetings as well as from life plans. Swarthdale Nursing Home DS0000061688.V363000.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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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