Inspection on 22/06/06 for Swarthdale Nursing Home

This inspection was carried out on 22nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Swarthdale Nursing Home 19/05/08

Swarthdale Nursing Home 30/05/07

Swarthdale Nursing Home 16/01/07

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector Marian Whittam Unannounced Inspection 22nd June 2006 07:30 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.V289256.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V289256.R01.S.doc Version 5.1 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.V289256.R01.S.doc Version 5.1 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. 3rd October 2005 2. 3. Date of last inspection Brief Description of the Service: Swarthedale Nursing Home is a large old house that has been adapted and extended 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 £374.00 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. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection, including a visit to the home took place on 22/06/06 with three regulation inspectors spending ten and a half hours in the home and a pharmacist inspector spending six hours in the home. Pre inspection information, requested by CSCI, was completed and returned by the providers. Resident and visitor surveys were returned to CSCI before the inspection. Letters and telephone calls from relatives were received, and information from health and social care professionals, agencies, services and individuals coming into contact with the home were all used in planning the inspection. Information was also gathered on the service from records of previous visits, notifications, regulatory activities and complaints, concerns and allegations received and used in the inspection planning. The inspectors toured the premises in the morning and at intervals throughout the day, all parts of the home were seen and activities, meals and care and nursing practices observed. Policies and procedures, care plans, menus, systems for recording complaints, quality assurance systems, activities programmes, medication practices and records, financial, personnel, recruitment and training records as well as other records required by regulation were examined. Time was taken throughout the day to spend time talking 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. Discussions took place with the manager, with care and nursing staff, domestic and kitchen staff. What the service does well: Several residents spoken to liked living in the home and spoke well of the staff and the help they received and one said of nursing staff, “they are very good, very helpful and I can talk to them”. The home provides a clean environment for residents in bedrooms and communal areas and some residents have personalised 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 have a good rapport with residents and spend time chatting with them. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home has a statement of purpose/service user guide but this needs to be freely available by prospective and current residents. The documents need to be put together with residents in mind, including in other formats, at present it is a collection of policies and procedures that are often more relevant to staff than residents. It does not make clear the range of fees paid, the views of existing residents, include the last inspection report and provide information on how the home provides for the particular needs of residents with dementia. These would help residents make a more informed choice. A record must be kept of the provision of a written contract/terms and conditions to all residents coming into the home as all residents should have this and know what their rights and obligations are as they move into the home. The registered person must improve the homes capacity to meet the assessed needs (including specialist needs) of residents in the home through sustained Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 7 improvement in areas of weakness and unsafe practice that affect resident’s health, personal and social care. Residents and their relatives need to be sure the home can meet their changing needs. Changes in personal needs, nursing and health care needs must be promptly reassessed, detailed in the care plans, monitored and action taken to meet those changed needs if this longstanding problem is to improve. Also the resident’s psychological health and emotional well being must be regularly assessed. This applies also to reviewing and acting quickly where there is a risk of developing pressure sores or when one has developed. Nutritional screening must be improved, routinely undertaken on admission and reviewed, a record maintained of nutrition and special diets including weight monitoring and appropriate dietetic advice and action taken. Where used fluid and care charts must be consistently filled in to give a clear picture of the current situation. These are persistent areas of care that need to improve if the home is to fulfil the objectives and rights it states in the statement of purpose and to make sure that in choosing the home residents will have their needs met. The handling of medication is also an area of poor practice that must improve if resident’s health and safety is to be maintained. Complete and accurate Medication Administration Charts (MAR) must be kept for all prescribed medicines. There are a significant number of missed signatures for administration. This puts residents at risk from duplicate administration if staff administer a medicine that has already been given but not signed for. The home must review and improve ordering procedures to ensure that there is a continuous supply of medicines at all times for residents and that medication is given as prescribed. Failing to do this puts residents health at risk. The home must make sure that policies and procedures are in place for the handling of controlled drugs and that all hand-written medicines administration records are signed, checked and dated. The recording of the disposal of medicines must be improved to record all medicines within the disposal container being removed and there is a need to get and put into practice advice on the safe handling of medical gases in the home. The home must improve recording all medicines that are received into the service for residents. Medicines must be stored according to manufacturers requirements and kept in their original containers so that staff do not mix up multiple supplies. Storage for medicines should be improved to ensure that it is clean, tidy and organised and this might help to ensure that medicines that are out-of-date are disposed of. For those residents who are able and want to give their own medicines a risk assessments must be done and reviewed. Practices in the home must be monitored to see if the training being given including on dementia, abuse and privacy and dignity being given is being put into practice by staff. Although work has been done on gathering information and background from residents to improve opportunities for stimulation through leisure and recreational activities, this has yet to be put into practice. This must be implemented if provision is to improve and with it meet resident’s social and recreational needs, particularly those with dementia. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 8 Residents must be supported to exercise personal autonomy and choice in their daily lives, activities and care. This means improvement also in making call bells accessible for all residents to use within the home having regard for their conditions. Staff must offer resident’s assistance with eating where necessary, discreetly, sensitively and individually and use aids to promote independence. A real choice of appealing, wholesome and nutritious food suited to individual dietary needs must be provided. To support this the home must ensure adequate stocks and timely supplies of food, in food that is properly prepared including special diets. Records must be kept of the food provided to residents to determine whether the diet is satisfactory in relation to nutrition and resident choice. Although the home has improved and simplified the complaints system it must consistently record complaints, all verbal and written complaints and concerns raised must be recorded promptly when they are made. Robust and clear procedures for responding to suspicion or evidence of abuse or neglect, including whistle blowing and POVA referrals, must also be in place and fully understood by management and staff if residents are to be protected from abuse and poor practice. Although the home has plans for improvements and has done some refurbishment there are some areas of maintenance that need attending to make sure the home stays safe, hygienic and homely. The registered person needs to improve facilities for staff to take their breaks away from the resident’s communal areas and to make sure that breaks are staggered so they do not affect the provision of care and assistance. Staff need to be deployed and supervised so at all times there are staff available to meet the needs of residents. Infection control policies, procedures and good practice need to improve when staff use the kitchen to prevent the spread of infection. This includes improving cleaning regimes in the kitchen, recording them and following safe practice in storing and freezing food. The home must improve its approach to and understanding of the safe storage of substances hazardous to health to make sure such substances are not routinely left out in areas of the home posing a risk to residents. Significant improvements must be made in the recruitment practices to make sure they are robust and consistent, including obtaining two written references and appropriate current CRB and POVA checks for all staff, including ancilliary, before employment. There is a need to improve lines of accountability and authority in the home within the staff groups and from management within the home. The provider and manager must communicate to staff a clear sense of direction and leadership and governance for the service and make sure that staff are clear about their roles and that nursing staff are supported in leading and directing care. Please contact the provider for advice of actions taken in response to this Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 9 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 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.V289256.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose and Service User Guide give some information but are not clear and not easily available for prospective residents to make an informed choice about the services the home provides. EVIDENCE: The home has revised its Statement of Purpose and it incorporates within it the prospective service user guide, these also state the homes aims and objectives. The layout is such that the home has put together its policies and procedures that contain instructions to staff for example, information about how to inspect fire extinguishers, test fire alarms, contacting the fire brigade and fire instruction. The information is not put together to provide resident focused information about the home. There is no information in it on the range of fees, resident’s views or a recent inspection report or information on how the home provides for the particular needs of those residents with dementia. It is not on display in the home or in resident’s rooms. Relatives spoken with have not seen it, nor have residents spoken with. Residents and relatives survey comments indicate that inspection reports are not available in the home. The last inspection report and information for residents was not seen to Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 12 be available in the home. The home does not make resident information available in other formats despite having residents with visual and hearing impairments. The home does have contracts with social services for those funded by them. A blank copy of the homes terms and conditions for residents was examined but there are no signed copies retained on resident’s files. Care management plans are provided by Social Services where they fund the placement and these are on file. The care plan has a copy of the pre admission assessment done by a registered nurse prior to admission to the home. All residents have an individual care plan based on the information obtained. From evidence gathered during the inspection, observation and comments made before and during the visit by residents, relatives, staff and medical professionals coming into contact with the home it is clear that residents with dementia and a high level of nursing needs do not always receive the specialist attention they need. Specialist services are involved including the Intermediate Support Team and psychiatric team but their recommendations not always fully followed up or monitoring done. This was evident for one resident the intermediate support team assessed as likely to leave the premises, but no risk assessment is in place even after found trying to leave the home. The home does not monitor to measure if it is meeting the objectives stated in the statement of purpose on meeting individual needs. This is evidenced by continued unsafe medication practices and some medication not given as prescribed, with care plans that do not reflect changes in need and management plans for specific problems and staff practices that are not properly supervised or directed. Therefore people entering the home cannot always be sure their needs will be met. The terms and conditions in use, provided by the manager, have information on the trial period of 4 weeks. The home has a policy on admissions encouraging prospective users to visit and an emergency admissions policy. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Resident’s individual care plans had been reviewed but not consistently updated to reflect changed needs resulting in personal and healthcare needs not always being well managed and met. Care and personal support in the home is not being consistently offered in a way that promotes personal choice and independence. The home has failed to improve medicines handling to safeguard residents and it is poor. This means that residents’ medicines are not always handled safely or appropriately putting residents at risk. EVIDENCE: All residents have a plan of care and some personal as well as clinical risk assessments and dates at which they had been reviewed. Documented discussions indicate residents and relatives are being consulted about some aspects of care planning. There is however poor monitoring and updating of changing healthcare needs to give an up to date picture of actual changing needs. The home has been doing work to improve care plans however this has not been effective in maintaining up to date working documents. Care plans and assessments are being done but there is little evidence that all staff use these plans as detailed person centred working documents reflecting Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 14 needs. Weights are not regularly done and monitored for all residents or nutritional needs assessments and monitoring. A resident’s care plan stated, a pureed diet and needs no assistance and no supervision. At lunch they were eating in bed, poorly propped up, with a plate on their lap, with a gap of approx two plate lengths away, a trail of food was on their chest between their plate and mouth. The food was not pureed or cut up into smaller pieces, the resident was poorly positioned and did need some help. A resident was observed having difficulty cutting and eating their lunch with food falling onto their clothes and had left three quarters of the meal. It was removed and replaced with dessert, but this was also left untouched. This resident is losing weight but no actions, records of nutrition or details about assistance required at meals in place. Their weight recordings were inconsistent with no action taken to get dietary advice. Charts to record fluid intake, diet and care in residents rooms are not always filled out with gaps of days between and so serve no monitoring purpose. A care plan for a resident with dementia recorded low mood, depression and does not socialise. No monitoring of psychological health is in place or individual activities planned to provide social stimulation or evidence of referral to specialist services for advice and support. One resident has a high risk pressure sore assessment score but an appropriate mattress was not used until some time after that assessment. The systems for administering medicines are poorly managed and poorly monitored. The recording of the receipt, administration and disposal is not being consistently recorded for all medicines, particularly medicines received in between monthly orders. Medicines were found to be out-of-stock, one for 5 days. A drug that is used to improve breathing was recorded as not available for three days. The resident was admitted to hospital on the third day with breathing problems. An audit was taken of medicines use for antibiotics and shows that medicines are not given as prescribed. The approach taken to privacy is evident from observation of the manager shouting personal information about a resident across a room and pointing at the resident. Some staff were seen to talk to each other to the exclusion of residents in the lounge. Other staff however did communicate effectively with residents enjoying a good rapport with them as they went about their duties. A relative said they felt the named carer was working well and staff had done “some nice things” like put flowers in the residents room and helped to sort out clothes and purchase new ones. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the home is now consulting with residents regarding their preferences relating to activities and interests at present the home is not currently providing suitable mental and physical stimulation for them. Due to the routines of the home and the task orientated approach residents, especially the more dependant, do not always have a lot of choice or autonomy. The meals are poor with little evidence that residents are offered either quality meals or choice and the needs of some residents are not being met. EVIDENCE: The home is in the process of consulting with residents regarding their preferences in relation to activities and hobbies and interests. Key workers are completing individual questionnaires with residents recording their interests, hobbies and asking them for any suggestions with regard to activities both in the home and in the community. An activities list has been compiled based on the feedback. This piece of work must be implemented and monitored for effectiveness. At present however there is no evidence of a programme of activities taking place, one resident spoken to said, “I can’t remember the last time I took part in an activity”. On the day of the inspection there were no activities observed with staff receiving no direction from nursing and management on providing them and spending time with residents to suit their capabilities. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 16 During the inspection there were numerous visitors to the home some of whom were happy to speak about their experiences of the home. One said after initial teething problems they had been happy with the service received. Another said “it is the little things that get missed like putting my relatives glasses on and only having one earring in”. Those residents who are able to go out, one resident went out with their daughter, which was a regular event. Another was attending a day centre, which they looked forward to. All the visitors said they are made welcome in the home. There are no activities involving local community events or organisations coming into the home place for residents except church services. Information on advocacy is available within the home on request. Based on observations, comments from relatives and the examination of care plans, residents do not appear to have a lot of choice or control in their daily lives. A visitor was seen to ask a member of staff for assistance for their relative with the toilet; the response was that they were “on their break”. Practices in the home do not allow residents to always actively chose when they wish to shower or bath, a rota is operated and it is not always recorded if residents have been given a bath. Some residents said they enjoyed the meals but the majority of residents spoken with said the quality of food varied depending upon who was cooking. Residents and some staff said some recent meals had not been edible. Four days before the visit eleven residents complained about the quality of the food and refused to eat it. On the day of the inspection the food stocks were found to be low including only five pieces of fruit for the whole of the home. A resident said their family usually brought in the soup they liked. Staff told inspectors of running out of basic provisions and having to go out and buy things like tea bags and biscuits. No records are available of the food that has been served to residents and the special and therapeutic diets provided therefore assessment of whether the diet is satisfactory in relation to nutrition or of any special diets prepared for individual residents is not possible. These records could not be found on the day of the visit. There were no aids seen in use to assist residents and promote independence with eating meals. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 17 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although there is a complaint policy and procedure in place some residents and relatives do not feel confident that their concerns will be responded to appropriately. Policies and procedures relating to mistreatment of vulnerable adults are inadequate and do not ensure maximum protection for residents. EVIDENCE: The complaints policy and procedure is displayed in the home and is in line with the requirements of the National Minimum Standards. Relatives and residents confirm they have recently been given some information regarding making complaints. There have been three complaints recorded since the last inspection. Two were recorded on file, the third, made by residents four days before the visit about food, has been brought to the attention of the manager but not logged or action taken at the time of the visit. Complaints must be recorded quickly so they are not overlooked. Feedback from some staff and relatives is that complaints and concerns raised are not always been taken seriously by management and not responded to with permanent solutions. However some relatives felt things are improving in this respect and that communication is getting better. There is information in the service user guide relating to voting in elections, advocacy and legal representation. Many residents have family or friends who act as advocates and provide support. The manager is in the process of delivering POVA training to all the staff team with dates planned and displayed on the notice board. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 18 Although the manager said their policy on mistreatment and abuse had been reviewed following a recent adult protection investigation by Social Services, there were five separate policy statements in the policy file. These are not easy to follow and also do not contain all the pertinent information required, so guidance is unclear and confusing for staff and residents. There is no mention of POVA checks or referral to the POVA list. The whistle blowing policy is brief and in need of review and updating in line with current good practice guidelines (“No Secrets”, Department of Health guidelines). The manager had spent a lot of time and effort devising in house training on Adult Protection targeting 2-3 staff at a time and giving them a training session. On interviewing staff, on the procedure for reporting suspected abuse one senior staff member was not aware of the lead agency for referrals of suspected abuse. The manager was not aware of the latest POVA guidance and her responsibilities in relation to it. The home has a suitable system in place to manage personal monies on behalf of residents. The records were checked against the monies held and found to be in order. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 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. Recent investment has improved some décor, furniture and fittings in the home but general maintenance and cleaning programmes need monitoring to maintain a safe and homely living environment. EVIDENCE: The new owners have made improvements to some bedrooms and to the outside of the home and further improvements to the gardens are planned. The home has maintenance staff for routine maintenance work. Communal space for residents to meet each other socially or to go for privacy outside their bedrooms is limited and some residents and relatives have commented on this. The owners have been looking at the options available to do this within the limited available space but with no conclusion. Staff are taking their breaks in the communal dining room consequently residents do not routinely use the area of their home beyond mealtimes. Staff breaks should not affect resident’s use of their communal areas in the home. The home needs to provide suitable facilities for staff to take breaks away from communal areas and for storage and changing. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 20 On touring the premises during the visit areas were identified for general maintenance. One room has a table with no edgings therefore it cannot be readily cleaned and a chair in the room was ripped. There is an old wooden cupboard/set of draws in a bedroom, which is broken, and again not readily cleanable. The lounge carpet has a join running the length of it. This has had tape applied to it, which is worn and unsightly, and at the ends there is no tape and the growing gap may present a trip hazard. Other bedrooms visited were well decorated, personalised and attractive but some were not personalised. One bedroom has carpet tiles that are dirty and stained and should be cleaned or replaced and the walls need cleaning in some places. A downstairs toilet has displaced lino tiles exposing the porous floor beneath. The home has call bell systems in the rooms used by residents but in some bedrooms and the lounge the bell was not situated in easy reach for residents to summon assistance. The inspector summoned assistance for one resident whose bell was on the opposite side of the bedroom. The fridge and food temperature records and kitchen cleaning regimes could not be found. The vents/extractor above the cooker are dirty and general cleanliness in the kitchen and refrigerator is unsatisfactory with old food and spills on the floor. Infection control practices are not satisfactory with staff routinely going in and out of the kitchen with their uniforms on and no aprons, they are moving from care tasks to the kitchen throughout the day. The only time aprons were observed being worn was when staff served lunch. Staff were observed to use the kitchen as a thoroughfare to go outside for smoking breaks. Communal areas and bedrooms seen are clean and tidy and survey responses commented well on cleaning staff. One said that the cleaners were “diligent” another that they “are always cheerful and did their best to respond to any requests” they made and that the laundry staff are helpful. The sluice was clean and tidy and clinical waste not allowed to accumulate. One resident spoken to said, “it always smells nice”. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff numbers are adequate overall but staff are not deployed in the best interest of residents and lack direction and leadership as to what is good practice, consequently frequently residents needs are not being met. The recruitment practices in the home are unsafe and are not robust enough to safeguard residents. EVIDENCE: Staff rotas on the day of the visit show the manager on duty, 2 registered nurses, 7 carers, 3 cleaners, 1 laundry staff, 1 cook and kitchen assistant, and a handyman. This should provide adequate numbers of staff and skill mix. However based on observation during the visit and comments from some relatives, residents and staff the deployment of care staff lacks direction and leadership. After lunch 6 care staff sat together in the resident sitting room having a coffee, engaging very little with residents in the room. Two carers left saying they were going for a break, and saying the others could go straight after. This break was taken in the communal dining room. One RGN sat with the resident’s chatting with them. At this time around the home many residents sat alone in their rooms or in bed receiving no stimulation, apart from having a TV switched on with football playing. The nursing staff have little control over the actions of some carers in directing care and taking their breaks. All comment cards received from relatives noted the fact that staff take breaks as they decide and at the same time. Among other comments made one resident said, “staff don’t talk, there are no activities, some of them are Ok but some nag, nag, nag”. Another resident said that one night carer, Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 22 was “very sharp” and told them to stop ringing the bell, left a heavy duvet on their feet when asked to move it, then walked away. Observations of how the staff are deployed throughout the day indicated that people with complex needs or who remain in bed, are not provided with real choices or individual support and interaction. Recruitment practices are not thorough and 2 references have not always been obtained before appointment. An unsatisfactory reference has not been followed up or reasons behind a refusal to give one. Gaps in employment histories are not explored. No copies of certificates of relevant qualifications are retained. Details of periodic checks on Personal Identification Numbers (PIN) for registered nurses are not recorded. Criminal Record Bureau (CRB) checks at the appropriate level are not obtained for all staff working in the home. No standard CRB checks have been carried out for ancillary staff. Some CRB checks have been transferred from previous employers, which is not safe practice. Records show one carer had been working in the home for 2 months before a CRB was obtained. Staff who were suspended, during a recent adult protection investigation, have had supervision on return to work, with their named supervisor. Staff files contained no details of whether these staff have had disciplinary action taken or an informal or verbal warning. New CRB checks have been requested on all the previously suspended staff but none had arrived back. On questioning if the manager had sought a POVA first check in the meantime, they were unaware of the need to do so. There are no records of POVA checks on staff working in the home awaiting the return of CRB checks. The manager has spent a lot of time devising training for staff and staff now have individual training files, stating the training done and needed. The home has an induction programme but training files did not contain evidence of these. Staff are being given in house training on abuse and dementia care and moving and handling training externally. NVQ level 2 training is underway and established but needs to continue to meet the required level of 50 of staff. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Care staff are not being given sufficient leadership, guidance and direction. As a result poor care practices continue that do not protect residents or promote their personal, health and social welfare. Lines of accountability and authority within the home are not clear and management is weak. Consultation systems with residents and relatives have been improved to promote opportunities for resident and family involvement on services delivered. However, quality assurance monitoring is still not implemented as a core management tool to improve services for residents. EVIDENCE: The home has a suitably qualified manager with experience of working with older people. However, interviews with and letters and comments received from medical, nursing and social care professionals regard the management approach as weak and often ineffective, as do some relatives spoken with and who responded to the survey. Observations of the approach taken by some Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 24 staff and the management process and discussions with the manager, residents, relatives and nursing staff underpin this. There is evidence of a lack of management understanding of some legislation, good practice guidance, the disciplining and deployment of staff, monitoring of medication and work practices. Comment cards and letters and concerns raised with CSCI about the service back this up. One relative wrote, “I feel the manager is not able to control or motivate them.” The home does not have an annual development plan for the home based on systematic quality monitoring. Effective quality monitoring systems are being started but are remain immature. Improvements can be seen in better communication systems and consultation with residents and families through surveys and especially through the named nurse system. Audits are however not being used effectively to identify and correct areas of weakness especially in medication. The quality assurance audit tool the home has bought needs to be fully implemented as a core management tool. The home has a suitable system in place to manage personal monies on behalf of residents. The records were checked against the monies held and found to be in order. Supervision is being done for staff, looking at training needs and practice areas staff need to be clear about. However where practices are evidently poor the owners and manager are not taking clear steps to supervise and review practices on a continuous basis and make sure competence and good practice is achieved and maintained. Routine maintenance, equipment testing and servicing are being carried out. T Records show staff fire training has been done at the required intervals and that electrical testing of portable appliances done, lifts and hoists serviced, alarms serviced, periodic electrical testing and water temperature testing in place and servicing to promote residents safety. COSHH substances were left out in the kitchen posing a safety risk and must be safely stored. Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 25 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 2 2 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 1 2 2 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 2 X 3 2 X 2 Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 5 (1) (b) (d) Requirement The statement of purpose and service users guide information for residents must include • The most recent inspection report. • Information on the range of fees. • Resident’s views. • Be made available to prospective and current residents. • How the home provides for the needs of people with dementia. A record must be kept of the provision of a written contract/terms and conditions to all residents. The registered person must demonstrate the homes capacity to meet the assessed needs (including specialist needs) of residents in the home. All care plans must be updated following review to reflect changing needs, professional advice, monitoring and current objectives for health and personal care and actions to DS0000061688.V289256.R01.S.doc Timescale for action 31/07/06 2. OP2 17 (2) Schedule 4 12 (1) 31/07/06 3. OP4 31/07/06 4. OP7 15 (2) 14/07/06 Swarthdale Nursing Home Version 5.1 Page 27 achieve these. This requirement was to be met by 07/11/05 extended for completion to 31/12/05. This requirement was given a final extension to be fully met by 20/04/06. 5. OP8 12 (1) Changes in personal needs, nursing and health care needs and pain relief must be promptly reassessed, detailed in care plans, monitored and action taken to meet those changed needs. This was to be met by 20/04/06 Residents who are identified as at risk of developing pressure sores must have appropriate prompt intervention and equipment required, recorded in the care plan and fully reviewed on a continuing basis. Resident’s psychological health and well being must be monitored regularly and preventative and restorative action taken and care provided. This was to be met by 03/07/06 Nutritional screening must be undertaken on admission and reviewed, a record maintained of nutrition including weight and appropriate advice and action taken. Where record charts are used to monitor fluid intake, nutrition and care they must be completed by all staff. Complete and accurate MAR charts must be maintained for all prescribed medicines. This was to be met by 01/01/06 and again by 14/05/06. DS0000061688.V289256.R01.S.doc 31/07/06 6. OP8 12 (1) 16 (1) 31/07/06 7. OP8 13 (1) (b) 14/07/06 8. OP8 14 (1) (a) (2) 17 (1) (a) Schedule 3 12 (1) 31/07/06 9. OP8 31/07/06 10. OP9 13 (2) 14/07/06 Swarthdale Nursing Home Version 5.1 Page 28 11 OP9 13 (2) To review ordering procedures to ensure that there is a continuous supply of medicines at all times. This was to be met by 01/01/06 and again by 14/05/06 The registered person must ensure that policies and procedures are in place for the handling of controlled drugs. The registered person must ensure that all hand-written medicines administration records are signed, checked and dated. The registered person must ensure that medicines are administered as prescribed. 14/07/06 12. OP9 13 (2) 01/08/06 13. OP9 17(1)(a), Schedule 3(3)(i) 13 (2) 01/08/06 14. OP9 14/07/06 15. OP9 23(2)(l) 16. OP9 13 (2) The registered person must 01/08/06 obtain and implement advice on the safe handling of medical gases The registered person is required 01/08/06 to record all medicines within the container that are awaiting disposal, and to ensure all further medicines are recorded appropriately. The registered person must ensure that medicines are stored according to manufacturers requirements. The registered person must ensure that medicines are stored in their original containers and that staff do not mix up multiple supplies The registered person must review storage to ensure that it is clean, tidy and organised The registered person must DS0000061688.V289256.R01.S.doc 17. OP9 13 (2) 01/08/06 18. OP9 13 (2) 01/08/06 19. OP9 23(2)(l) 01/08/06 20. OP9 13 (2) 01/08/06 Version 5.1 Page 29 Swarthdale Nursing Home 21. OP9 13 (2) ensure that medicines that are out-of-date are disposed of The registered person must ensure that all medicines that are received into the service are recorded. The registered person must ensure that risk assessments are done for all residents who selfmedicate Practices in the home must be monitored and training and staff arrangements put in place to ensure the privacy and dignity of residents is respected at all times by staff and management. This was to be met by 02/04/06 and again at 03/07/06 Regular, planned and coordinated activities must be provided in the home to give all residents the opportunity for stimulation through leisure and recreational activities inside and outside the home that suit their individual needs, recorded preferences and capabilities. The home must ensure that residents with dementia, other cognitive impairments and physical disabilities are given particular consideration in the provision of activities to meet their social and recreational needs and preferences. Residents must be supported to exercise personal autonomy and choice in their daily lives, activities and care. Staff must offer resident’s assistance with eating where necessary, discreetly, sensitively and individually and in line with care plans and use aids to promote independence. DS0000061688.V289256.R01.S.doc 01/08/06 22. OP9 13 (2) 01/08/06 23. OP10 12 (4) 18 (1) 31/07/06 24. OP12 (16 (2) (m) (n) 31/07/06 25. OP12 12 (4) (b) 16 (2) (m) (n) 31/07/06 26. OP14 12 (2) (3) 31/07/06 27. OP15 12 (1) 31/07/06 Swarthdale Nursing Home Version 5.1 Page 30 28 OP15 16 (2) (i) 29 OP15 12 (1) 30. OP15 17 (2) Schedule 4 31. 32. OP16 OP18 17(2) Schedule 4 12 (1) (a) 13 (6) 33. OP19 16 (2) 34. OP20 23 (3) The home must provide a choice of appealing, wholesome and nutritious food suited to individual dietary needs. The home must ensure adequate stocks and timely supplies of food, in adequate quantities, varied and properly prepared that residents might reasonably require. Records must be maintained of food provided to residents in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and of any special diets prepared for individual residents. All complaints, verbal and written must be recorded promptly when they are made. Robust and clear procedures for responding to suspicion or evidence of abuse or neglect, including whistle blowing and POVA referrals, must be in place, in line with legislation and good practice guidance. General maintenance must be monitored regularly and attended to promptly and include: • Torn and damaged furniture must be repaired or replaced. • The gap in the lounge carpet must be made safe or the carpet replaced. • Marks on walls must be cleaned off or repainted. • The dirty carpet tiles in room 8a must be cleaned or replaced. • The displaced lino tiles in downstairs toilet No.2 must be repaired or replaced. The registered person must DS0000061688.V289256.R01.S.doc 14/07/06 14/07/06 14/07/06 31/07/06 31/07/06 31/07/06 14/07/06 Page 31 Swarthdale Nursing Home Version 5.1 35. OP22 36. OP26 37. OP26 38. OP27 39. OP29 40. OP29 41. OP31 42. OP32 43 OP33 provide for staff suitable facilities for changing, storage and taking their organised breaks. 16 (2) (c) Call systems with an accessible 23 (2) (n) alarm facility must be easily available for all residents to use within the home having regard for their conditions. 13 (3) (4) The kitchen and refrigerator must be kept clean and hygienic, good practice followed in the storage of food and cleaning regimes and records maintained. 13 (3) Infection control policies, procedures and good practice guidance must be observed by all staff when using the kitchen and monitored by management to prevent the spread of infection. 18 (1) At all times there must be staff available, organised and deployed appropriately to meet the assessed health, social and welfare of residents. 19 Robust and consistent Schedule recruitment practices including 2 two written references and appropriate CRB checks must be followed for all staff, including ancilliary, before employment. 19 Checks with the Protection of Schedule Vulnerable Adults register must 2 be made for staff commencing work and whilst waiting for their CRB check 12 (1) (a) There must be clear lines of (b) accountability and authority within the staff groups and from management within the home. 10 (1) The provider and manager must 12 (1)-(5) communicate to staff a clear sense of direction and leadership and governance for the service. 24 (1) (a) The registered persons must (b) (2) (3) fully implement the new quality assurance audit tool, develop an annual development plan for the DS0000061688.V289256.R01.S.doc 14/07/06 14/07/06 14/07/06 31/07/06 14/07/06 14/07/06 14/07/06 14/07/06 31/07/06 Swarthdale Nursing Home Version 5.1 Page 32 44. OP36 18 (2) 45. OP36 18 (1) 10 (3) 12 (1) 46. OP38 13 (3) home that is systematic in planning, action and review and implement systems of continuous self monitoring and internal audits. Staff must be supported to maintain good practice and be supervised in the workplace on a continuous basis as part of the normal management process. The Providers must provide support for the management role through providing a clear job description, formal, recorded supervision and a training needs assessment and resources to ensure competence to fulfil management responsibilities. A permanent solution must be found to safely store all substances hazardous to health. A second immediate requirement was made 02/05/06. An immediate requirement was made. Food must be correctly stored in refrigerators and frozen food labelled with the date. 31/07/06 31/07/06 22/06/06 47. OP38 13 (3) 14/07/06 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. 2. 3. Refer to Standard OP1 OP1 OP1 Good Practice Recommendations The statement of purpose/service user guide should be made available in formats suitable for intended residents. The service user guide and statement of purpose should be easily accessible in the home. Resident’s views of the home should be included in the service user guide. DS0000061688.V289256.R01.S.doc Version 5.1 Page 33 Swarthdale Nursing Home 4. 5. 6. 7. 8. 9. OP7 OP9 OP12 OP13 OP15 OP16 10. 11. OP18 OP20 Personal care records should be clear about what care has been given. An audit of medication should be done at least monthly. Information about activities should be circulated to all service users in formats suited to their capabilities. The home should make it clear what areas of the home are available for greater privacy. The home should use aids designed to promote independence when eating and drinking. The registered persons should consider developing plans and consultation to improve residents, relatives and staff confidence that their complaints and concerns will be listened to, taken seriously and acted upon. The home should obtain a copy of the Department of Health guidance “No Secrets” to inform practice. Ways to improve the use of communal space available, including the dining areas, should be considered to give residents more choice in where they can meet socially or in private or for activities. Staff should not use the kitchen as a thoroughfare. Staff breaks should be organised and overseen and staggered around the needs of residents. The management should be monitoring and observing staff practices to make sure the training given is being put into practice. Periodic checks should be done on nursing Personal Identification Numbers (PIN) for verifying registration status to practice. The providers should involve themselves sufficiently in the daily running of the home and in directing it through long term strategic planning. 12. 13. 14. 15. 16. OP26 OP27 OP29 OP29 OP32 Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swarthdale Nursing Home DS0000061688.V289256.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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