CARE HOMES FOR OLDER PEOPLE
Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector
Marian Whittam Unannounced Inspection 3rd October 2005 09:30 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.V253519.R01.S.doc Version 5.0 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.V253519.R01.S.doc Version 5.0 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.V253519.R01.S.doc Version 5.0 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. 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 people, including up to 15 older people who receive personal care only 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. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 3rd October 2005 over six and three quarter hours. The purpose of the inspection was to monitor compliance with requirements made at the previous unannounced monitoring visit, an unannounced inspection and an unannounced pharmacy inspection and to monitor if improvements at the last inspection were being maintained. A visit to investigate a complaint made to the CSCI was also made in June 2005; the complaint was upheld. Letters sent to the provider following the additional inspection and pharmacy inspection can be obtained from the CSCI office on request. The morning was spent looking around the home, observing and speaking with staff as they went about their duties and talking with 11 residents in the lounges and in their own bedrooms. The afternoon was spent looking at care plans, care records, training plans, complaints records and medicine records and administration practice. Policies and procedures were also looked at in the afternoon and the manager and provider were spoken with. Before the inspection information had been received by the CSCI, from relatives, visitors and health care professionals visiting their homes, about their experiences. What the service does well:
Many residents spoken to liked living in the home and spoke well of the staff and the care they received and one said of staff, “they did their best” and attended to their moving and handling needs “well”. The home provided a homely environment for residents and residents could personalise their bedrooms, as they wanted. One resident said that they “really liked” their bedroom, were comfortable in it and had everything that they needed in it. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
The detail and thoroughness of its pre admission assessments has improved but the home must also ensure that once residents are admitted their changing health and personal care needs are met promptly including the involvement of specialist services and prompt medical attention. Any changes noted in daily progress reports and following review must be reflected in the care plans to give up to date information to give the correct information for staff to follow. Residents must wherever possible be involved in developing their care plans and reflect their personal preferences. The home had made some progress in updating plans at the last visit but has slipped back again and any improvements made have to be maintained and monitored for a consistent standard of care to be achieved.
Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 7 Despite some improvement at the last monitoring visit medication handling and record keeping had also slipped back placing residents at risk from poor practice. This too needs to be monitored to make sure that any improvement is maintained to safeguard residents. . It is difficult for residents in shared rooms to maintain a minimum level of privacy when receiving personal care, being seen by health and social care professionals, family and friends or to enjoy interests due to inadequate screening. Records of complaints investigation were inadequately recorded. There needs to be more systematic and objective quality monitoring for the service that includes auditing and continuous self monitoring to measure the homes success in meeting its aims and objectives for residents health and welfare. Care must be taken to make sure that cleaning products are stored securely when they are not being used. A permanent solution needs to be found to the problem of very hot water in some areas of the home that poses a risk of scalding. This has been attended to in the past but must be done permanently and properly monitored. The provider must make sure that he visits the home in accordance with Regulation 26 at least once a month and supply a copy to the CSCI 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. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 8 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.V253519.R01.S.doc Version 5.0 Page 9 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): 3 Improvements have been made to the admission procedures to make sure that a pre admission assessment is completed before people come to live in the home. EVIDENCE: Residents coming into the home have records of pre admission assessments, done by nursing staff, in place and these had been completed in more detail than at the previous inspection. Social services management plans had been obtained where appropriate. Care plans had been developed from these assessments to provide staff with information on the action they needed to take. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 10 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 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 met. Personal support in the home was at times not offered in a way that promotes personal choice. The home has failed to maintain improvements in medicines handling in line with good practice guidelines to safeguard residents. EVIDENCE: All residents had a plan of care and some personal and clinical risk assessments. However, there are residents whose personal and healthcare needs were not being met fully or promptly. This was evident for a number of residents; one with increasing and obvious pain whose condition was deteriorating, one with poor oral hygiene, one with unresolved catheter difficulties and one whose assessed high dependence for personal hygiene was not being supported by staff according to care plan instructions. Despite care plans having been reviewed changes were not always updated within the plan or assessments, or the actions to be followed. This was evident
Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 11 for a resident with a dressing in place that was not recorded. Residents spoken with were not aware of what was in their care plans, recall seeing them or being asked about changes. Some residents described needs and preferences that had not been taken into account, such as being able to take a bath and go to bed when they preferred. Residents see medical staff in private in their bedrooms but for some less mobile residents in shared rooms screening was inadequate to provide basic privacy and maintain dignity during such consultations or during personal and nursing care, when visitors came or, for one resident, to enjoy interests such as listening to music which disturbed the other resident. Medication handling, administration practices, recording, monitoring of changing medication needs and monitoring of staff practices is poor and not in line with good practice guidance. This was evident for one resident who due to deterioration in condition was unable to take prescribed oral medication for pain relief. Nursing staff had not acted promptly to monitor the resident’s medication needs and get a prompt medical reassessment in order to offer effective pain relief. The lack of regular medication audits meant poor practices and errors are not picked up on and investigated quickly. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 12 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 and 15 Since the last inspection improvements have been made in consulting with residents and providing opportunities for recreation. The home has made limited progress on improving menus and choice of meals for residents. EVIDENCE: The home provided some daily activities, recorded resident’s general interests and organised social and religious events. Residents said that they could come and go as they pleased, see whom they wanted and take their meals where they wanted. A member of staff in the home coordinated the activities and had consulted with residents about what they would like and was trying to extend the range of opportunities for stimulation through recreational activities. Information on activities was posted on the notice board and some residents were aware that activities went on. Some residents were participating in a group activity during the visit, playing darts. There has been slow progress on developing new menus for residents and incorporating a choice of alternative meals for residents. Work is continuing with the catering staff to improve choice. The lunchtime meal was of good quality, attractively presented and residents said that they had enjoyed it. Residents spoken with said that they liked the
Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 13 food in the home and one said that the food “was grand”. Care staff stayed in the dining room offering assistance to individual residents where it was needed and the meal was unhurried and the atmosphere relaxed. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 14 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 and 18 A complaints policy and procedure is in place but record keeping needed improvement to follow up and implement action to protect residents. There are adult protection procedures in place and staff had received training and information on this to safeguard residents from abuse. EVIDENCE: The home has a procedure for responding to allegations of abuse and current multi agency guidance was available. Staff had been given training on adult protection procedures and responding to allegations of abuse. The home had received one complaint since the last inspection and had recorded this but it had not been thoroughly dealt with. It did not describe the action taken by the home or details of the investigation and the care plan concerned had not been updated to address the way the problem was to be managed in the long term. The home has a complaints procedure displayed on the notice board and in the service users guide. In June 2005 CSCI investigated a complaint regarding washing facilities in a residents bedroom, which was upheld. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 15 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, 22, 23, 24, 25 and 26 Recent investment has improved the décor and some furniture and fittings in the home. Continued planned refurbishment of the home and additional social areas will further improve the environment for residents and provide more social areas. Unsafe water temperatures and poor clinical waste handling were compromising the resident’s health and safety. EVIDENCE: The new owners had already invested in improving the inside and outside of the home and further improvements are planned. Communal space for residents to meet each other socially or to go in private is limited and some residents have commented on this. The owners are looking at the options available to do this within the limited available space. Aids and equipment, including wheelchairs and easy chairs are being stored in bathrooms and in the dining area and wheelchairs and hoists in corridors and communal areas detracting from a homely environment, posing a hazard and restricting the use of bathroom areas.
Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 16 Some residents spoken with did not want to share a room and were waiting to have single rooms when they became available. They had come into the home on that basis and felt they had little choice but were aware that the home would provide single rooms when they became available. Screening in double rooms was provided but in some cases was inadequate to provide privacy for personal care and when seeing people in private. There are bedrooms where there is not an emergency call bell in place. Systems for transporting clinical waste through the home were not hygienic allowing waste to accumulate before removal. Allowing large quantities of clinical waste to accumulate in the sluice and using resident wheelchairs to transport it increases infection risks to residents. Hot water temperatures in some areas of the home are not being regulated and water leaving the tap is very hot. This places vulnerable people at risk and an immediate requirement was issued to put this right within the next 7 days. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 17 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 and 30 Staff levels meet minimum levels and the increased numbers of registered nurses on duty at peak times of activity has increased and is more appropriate to the assessed and recorded needs of the residents in the home. EVIDENCE: An increase in the number of registered nurses, on the duty rota, on the busy morning shift is a more consistent now and better suited to the dependency and nursing needs of some residents. Residents spoken with said that staff were “helpful” and that “they do their best” but they were very busy and sometimes it took along time for them to answer call bells in the morning. One resident said they had been asked to wait to get up, as no one was available yet. However one resident said that when staff used the hoist to move them and get them up they “use it very well”. The home has a significant number of care staff with, or in the process of obtaining, NVQ level 2 competences in care and they are being supported to achieve this. Recent training on dementia care and adult protection has been given to increase staff understanding and awareness. The home has planned training areas over the year but this programme is not linked to supervision and staff do not have assessments of their individual training and development needs and individual training profiles on record. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 18 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): 32, 33, 36 and 37 There is a lack of guidance and direction for staff and poor quality review, auditing and monitoring of practices and procedures. This results in some unsatisfactory practices, which do not promote a consistent quality of care for residents or promote their health and welfare. Consultation systems with residents and relatives have been improved to promote opportunities for resident and family involvement on services delivered. EVIDENCE: Residents and family meetings have been organised and are due to take place to promote their involvement in the way the service is run. Staff meeting are being held for nursing and care staff. The addition of a nurse’s station in the lounge makes nursing staff more visible and accessible. While residents spoke well of the manager and nursing staff there were examples of the lack of overall management supervision of practices and
Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 19 auditing and review of systems for quality, evident in poor medication practices, inconsistent recording of care needs and care given and in not responding to changes in residents health needs quickly enough to ensure their health and welfare. There is not a clear and systematic approach to quality assurance, monitoring and reviewing systems that would help the home measure its success in meeting its stated aims and objectives. Staff are not being given sufficient leadership, guidance and direction. As a result practices continue that do not best serve residents and promote their health and welfare. Some cleaning substances were left out in bathrooms posing a risk to residents and an immediate requirement was made to store these safely. The CSCI has not received any recent evidence of visits by the Provider under Regulation 26. Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 2 3 2 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X 3 2 2 Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (2) Requirement All care plans must be updated following review to reflect changing needs and current objectives for health and personal care and actions to achieve these. Assessed health and personal needs and choices set out in the care plans must be carried out and in accordance with resident’s wishes Whenever possible residents must be involved in drawing up and changing their care plans. Changes in personal needs, nursing and health care needs and pain relief must be promptly assessed and action taken to meet those changed needs. All prescribed medication, including topical applications, must be signed for on the MAR chart at the time of administration and any reasons for omissions stated. Medicines with limited expiry dates must be marked with the
DS0000061688.V253519.R01.S.doc Timescale for action 07/11/05 2. OP7 15 (1) 01/11/05 3. 4. OP7 OP8 15 (1) 12 (1) 01/11/05 01/11/05 5. OP9 13 (2) 01/11/05 6. OP9 13 (2) 01/11/05 Swarthdale Nursing Home Version 5.0 Page 22 7. 8. OP9 OP9 13 (2) 13 (2) 9. OP9 13(2) 10 OP9 13(2) 11. OP10 12 (4) 12 13. 14. 15. OP15 OP16 OP22 OP22 12 (3) 17 (2) Schedule 4 23 (2) 16 (1) (2) 16. 17. OP24 OP25 12 (4) 16 (2) 13 (4) date of opening. Out of date medication must be taken out of use. The dose of medication administered must be documented on the chart where the dose varies. Medication signed as having been administered to a resident must not be left in containers on the dining table. Prescribed medication must not be used for anyone other than the person for whom they were prescribed. Arrangements must be in place to ensure the privacy and dignity of residents in shared rooms in regard to personal care, consultations with health and social care professionals and visits from family, friends and advisors. Revised menus offering greater choice must be put into practice. Complaints must be fully investigated and the outcomes and actions recorded. Appropriate storage areas must be provided for aid, equipment and furniture. Call systems with accessible alarm facility must be provided in every room used by the residents. Screening in shared bedrooms must be improved to ensure privacy. Permanent solutions must be found to maintain hot water temperatures close to 43 degrees centigrade to minimise risk. 01/11/05 01/11/05 01/11/05 01/11/05 26/11/05 26/11/05 01/11/05 26/11/05 01/11/05 26/11/05 07/10/05 Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 23 18. OP26 13 (3) Clinical waste must not be 30/10/05 allowed to accumulate and must not be transported in resident wheelchairs Staff must have an individual training and development assessment and profile The home must introduce systematic and objective quality monitoring processes including internal audits. The provider should visit the home in accordance with this regulation. Cleaning fluids must be safely stored. 30/12/05 30/12/05 19. 20. OP30 OP33 18 (1) 24 (1) 21. 22. OP37 OP38 26 (2) 13 (3) 30/10/05 07/10/05 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 Fluid balance, positional change and pain charts should be used to monitor changes where conditions are deteriorating and kept with the resident for staff to fill in at the time. Personal care records should be clear about what care has been given. A list of staff members authorised to give medicines should be kept, including a record of their approved initials. The contents of the medicines cupboard need review. The pulse should be taken before administration and recorded for residents taking digoxin. An audit of medication should be done at least monthly. Ways to improve communal space available should be considered to give residents more choice in where they can meet socially or in private. 2. 3. 4. 5. 6. 7. OP7 OP9 OP9 OP9 OP9 OP20 Swarthdale Nursing Home DS0000061688.V253519.R01.S.doc Version 5.0 Page 24 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
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