Inspection on 30/05/07 for Swarthdale Nursing Home

This inspection was carried out on 30th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 19/05/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ Lead Inspector Marian Whittam Unannounced Inspection 30th May 2007 09:00 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.V333877.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.V333877.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swarthdale Nursing Home Address Rake Lane Ulverston Cumbria LA12 9NQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01229 580149 01229 581333 Vishomil Limited Miss Helen Janice Watson Care Home 43 Category(ies) of Dementia - over 65 years of age (5), Old age, registration, with number not falling within any other category (43) of places Swarthdale Nursing Home DS0000061688.V333877.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. 16th January 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 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 combined Statement of purpose and service users guide, in the home’s brochure 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 £373.00 to £489.00 per week 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, aromatherapy massage and any personal travel such as taxis. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on 29th May 2007. Two inspectors carried out the inspection, looked around the home and spoke with the deputy manager, residents and with nursing and care staff members, domestic, laundry and kitchen staff. Time was taken throughout the day to be with residents in the lounges and in their own bedrooms, speaking with them and spending time in communal areas with them. Observations were undertaken using short observation for inspection (SOFI) techniques to help inspectors understand the quality of the experiences of people in the home who are unable to give feedback due to their dementia. Staff recruitment records, training records, servicing records, and care plans and pre admission assessments were examined and a selection of records required by regulation. A pharmacy inspector did a full pharmacy inspection on all medication handling and records the day before this visit. Information about the home and its services, asked for by the Commission for Social Care Inspection (CSCI), before the inspection took place, was completed and returned by the home manager in good time for the inspection. Before the visit information was also gathered on the service from records of previous visits, notifications and other regulatory activity. Questionnaires from residents and relatives about the service, provided by CSCI, were returned before the inspection took place and also provided information about their opinions and experiences of the home. What the service does well: The home provides a clean and tidy place to live in. People who live in the home and relatives say that the domestic and laundry provide a good service with helpful and friendly staff. A lot of the care staff do have a good rapport with people living in the home and spend time with them chatting with those who are able to and including them in what is going on. People living there and relatives and visitors speak well of the approach of the nursing staff and the nursing care they give. There are well organised care plan systems in place and under review so staff have clear instructions on how each person wishes to be cared for and their healthcare needs are monitored. People living there are able to bring in their own things from home, pictures, ornaments and suitable items of furniture and to make their rooms more homely and personal. Dietary needs of residents are well catered for with a balanced and varied selection of good quality food and home cooked meals. People living here say Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 6 they have a choice of food and that most of the time they enjoy what is offered. The home works with other healthcare agencies to monitor and maintain resident’s health and well being and gets specialist help and support for residents when this is needed. Residents are able to look after and take their own medicines if they wish and where it is safe to do so to help maintain their independence and choice. The manager, the nursing and care teams have been working hard to develop better systems of working to develop the service to make life better for people living in the home. They have responded well to the inspection process using it to help them work towards a better service. What has improved since the last inspection? The management and staff have been working on improving communication in the home and making information more accessible and clear. This is seen in the greater inclusion of care staff in care planning and staff handovers, in the improved statement of purpose telling people what they are offering, in the new brochure and with the introduction of a newsletter to keep everyone up to date. The good work on gathering information with residents and developing better organised and effective care plans and health monitoring continues. Of particular improvement is the more proactive approach being taken to managing wounds and skin changes. This is being better monitored, recorded and planned. Also the use of new pain charts and monitoring sheets for people being nursed in bed make monitoring and acting on changes easier. Social and recreational activities provision are being given a higher profile in the home and for those people who can take advantage of the group activities and join in with their ideas and opinions this is a notable improvement. The garden areas have been tidied and improved for people and are in the process of being planted with flowers and shrubs. Residents have been asked what they would like to see planted involving them in this part of their home. Improvements can be seen in reviewing some aspects of the service, including the care planning systems and records and some complaints monitoring. The survey system seeks opinions about the service from local doctors and health care professionals involved in people’s care. The improvements in the recruitment process to safeguard people living there have been maintained and the home has reached the 50 target for care staff with a minimum of Level 2 NVQ in care. Overall improvements that are made are being sustained and built upon which bodes well for the future development of the home for the benefit of the people living there. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 7 A less tangible improvement but evident was the greater feeling of openness within management and to new ideas and ways of working that can only benefit people living there. What they could do better: 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.V333877.R01.S.doc Version 5.2 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.V333877.R01.S.doc Version 5.2 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. 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: Information is being made easily available about the home for current and prospective residents and their families in the updated statement of purpose and service users guide, including resident’s comments and where the most recent report may be found, so people know what the home says it can provide. This information is available the foyer along with the recently introduced quarterly newsletter for residents and visitors. The statement of purpose and service user guide is also available on request in other formats such as large print and audio formats. The home has also recently developed Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 10 an informative brochure with relevant information and photographs for people who are looking into moving into the home. An assessment of the needs of people coming to live in the home is being done by the home manager or nursing staff prior to coming to live in the home. This helps the manager and nursing team decide if the services they offer will be able to meet individual’s personal, nursing, social and cultural needs. Additionally, where appropriate, a care management plan outlining individuals social care needs from social services is obtained. The pre admission assessments seen are clear, and where appropriate families, specialised care agencies and professionals are being involved in providing relevant information on people’s health and personal care needs and preferences. Records and plans of care indicate this involvement has included assistance and support for different people from the Intermediate Support Teams, community psychiatric nurses and specialist nurses for Palliative care, Parkinson’s Disease, diabetes and tissue viability. All prospective residents and/or their families are invited and encouraged to visit the home prior to admission. This gives them an opportunity to assess the quality and suitability of the home to meet their needs and preferences. However, some survey responses indicate that in reality they had little choice over the nursing home they went to live in, as there is so little available locally. One relative said, “there was no choice in our own area and there was time pressure to free my mothers hospital bed”. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 11 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 and 10 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 information for staff to meet resident’s individual care needs. EVIDENCE: Care plans are much improved from previous inspections and staff have worked hard to reorganise and make care plans and resident’s files much clearer and easier to use. Staff have clear instructions on how people want to be cared for and their healthcare needs are much more closely monitored. The new handover system whereby all care staff are present at handovers, not just nursing staff, means all those involved in someone’s care can contribute and all staff are up to date. Psychological and nutritional assessments, including the monitoring of weights are being done and used to monitor and respond to individual needs. Staff are also using and completing monitoring sheets in regard to nutrition, hydration, continence and positional changes for people who are frail or being nursed in bed. This makes it easier to monitor changes and care and has given more Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 12 consistency. There is a named nurse and carer system in place that has helped improve communication generally. The condition of people’s skin is being assessed more effectively and reviewed and there has been a significant improvement in the use of clear and thorough management plans. Also the nursing staff are using better tools for mapping people’s experiences of pain and these were seen in use and were useful for that person. The more detailed care planning and assessments being carried out is an example of developing good practice and contributes to improving the well-being of people living there. Practices around care planning, monitoring and assessments has significantly improved. To further build on this the staff should work on involving people as much as they can in developing and reviewing their own planned care and individual preferences to give them more choice and control over their daily lives. There was evidence of the home working with other agencies to monitor and maintain resident’s health and well being. This includes specialist services such as the intermediate care team and the community mental health team and involving specialist nurses such as palliative care, tissue viability and diabetes. However, actions and documentation relating to dosage changes of medication and medication provision for new residents and following hospital discharge indicate that systems for checking and communicating with medical practices and hospital must be improved to fully protect people’s health. A change of dose of one medication was not authorised by a doctor and a resident was discharged from hospital without some medication and the information provided by the hospital was poor. The manager should undertake and record regular medication and controlled drugs checks to ensure safe handling. There were, overall, good records for receipt, administration and disposal of medicines, showing that residents’ medication is being handled well. People living in the home were able to look after and take their own medicines if they wish and arrangements are made for residents having days out so that they can take their medicines with them and so have greater personal freedom and choice. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service have good quality food and while there are opportunities to take part in activities for the majority of people the social opportunities of people with dementia remains at a basic level. EVIDENCE: It is evident 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 attention. There is an activities coordinator in the home three afternoons a week to organise and lead activities, some in groups and some more one to one. The coordinator was not in the home during the visit. The weekly programme is posted on the main notice board in the hall and includes opportunities for religious observance and what is available in the local community. Care plans indicate some information is being gathered with residents and families on interests and life stories to inform activities and choices. The information being gathered needs to be used to help people engage in activities that have meaning and value for them rather than what fits in with home routines. For example two people spoken with wanted to be supported Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 14 go out more but as one relative commented “I have never known an outing to be arranged.” It was evident during a two hour short observation period that staff interacted well with those people most able to communicate and these people had good levels of engagement with other residents and were able to request assistance from staff when they wanted it. However those people with dementia had very little social interaction and supportive contact with staff and other residents. Contact with staff was regarding basic care needs. Staff spoke to one resident with dementia only twice in two hours, once to ask if they wanted a cup of tea and then to take them for lunch. This person was heard to say to another resident “I’m lonely are you?” to which the other person replied, “Yes I’m lonely too”. This resident was said by staff to be quite challenging to look after, often shouting out for attention. They were often taken to sit in their room so not to disturb other residents. Staff were seen to be in the habit of standing on the edge of the sitting room, in the corridor and if all looked settled they don’t go in. If they did, even for a few minutes, this could make a big difference for some people for having a quick chat and some human contact and seeing if anyone needed anything such as the toilet. Opportunities for leisure and recreational activities in and outside the home should be tailored to suit the preferences and capabilities of all the people living in the home. Particular attention and raised awareness is needed to provide social opportunities and support for people with dementia so they can have more involvement in daily life and some choices in their lives and so improve their quality of life. Despite dementia training having previously been given to staff an obvious understanding and awareness of the social and emotional needs of those residents with dementia was not always evident. It was noted that some of the non care staff were very good at interacting with residents as they went about their duties and would chat with residents and include them in their conversations. Menus have been improved which are alternated over a four-week period and the daily menus are being written on the menus board outside the dining room. The cook explained that the menu included ideas from residents, ensuring they reflected individual tastes. The cook also has information about preferences, special diets and how people preferred their meals served and discussed how pureed food was presented individually to make it more appetising and “normal”. People sat in the dining room having breakfast explained that they had a choice of breakfast and meal times and liked the food served. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 17 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure available in the home and basic adult protection procedures are in place to promote the protection of people in the home. EVIDENCE: The manager and staff are logging complaints using the revised system to log and investigate these seen at the last inspection visit. Records of the complaint, the investigation and actions taken are kept securely. Information on making a complaint is displayed on the notice board in the foyer and within the statement of purpose and service user guide. Information on contacting advocacy services is also displayed. Survey responses indicate that people are aware of how to make a complaint and that some have used the system. Comments received from surveys responses such as “efforts are made to respond but processes lapse” indicate that there is still work to be done in monitoring the quality of complaints handling. Quality monitoring of the complaints system would help the management identify reasons why there may be a lack of confidence in complaints processes. Adult protection training has been given to staff on recognising signs of abuse and on challenging behaviour. The deputy manager having attending a two day training course run by the local authority social services department on the protection of vulnerable adults is able to give training and support to staff in Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 16 this respect. The home uses the multi agency guidance to inform practices and has policies and procedures on whistle blowing. On examining the revised policies and procedures relating to protecting adults in the home it was noted that once again two sets of procedures were in circulation. One set was bought in to be part of a proposed quality assurance system and the other was the homes own established procedures. This needs to be reviewed to make sure staff know which they are to follow and how they must act when they suspected that abuse has occurred. On examination the revised policy also did not make it clear how to refer the matter to relevant agencies in the event of the manager not being available. A telephone contact for making a referral to social services would be a beneficial addition to the procedure. Great emphasis, in the procedure, is also being put on the manager and Director of the home making a joint decision whether to investigate, when that is a multi agency responsibility. There did not appear to be a policy to cover the referral of staff to the POVA List if they were suspected or found guilty of abuse. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 17 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, 22, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a clean and adequately maintained place for residents to live with necessary equipment they need to promote personal needs and independence. EVIDENCE: The home has an ongoing maintenance programme and policies and procedures in place on infection control and Legionnaires Disease. All the main areas of the home were clean and hygienic and there were no malodours. The home has effective laundry and domestic staff who maintain a clean environment and a handyman to keep the environment safely maintained. The garden areas have been tidied and improved and are in the process of being planted with flowers and shrubs. Residents have been asked about the kind of flowers they would like planted. A premises audit has been done to identify priorities for redecoration, refurbishment and improvement and a list Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 18 drawn up from that. This is important and timely as some drawers and wardrobes have broken handles, some furniture is mismatched and some soft furnishings and bedding are poor quality and décor in some rooms needs improving. Survey responses indicate that the cleaning and laundry staff are seen as providing a good service but that the décor and furniture is ”a bit tired and dated”. Shared social space remains limited for privacy in the lounge but the home is making better use of the dining room for residents use. People living there confirm they see visitors in private in their bedrooms if they want. The dining and lounge areas in the home are clean and homely and are used for different social occasions. Many residents have chosen to bring in some of their own possessions and pictures and this made their rooms more personal and homely. The three bedrooms in the home that are shared have screening in place for privacy. Resident’s bedrooms seen have a satisfactory standard of furnishing and decoration, some better than others, but it was observed that in some bedrooms there were no comfortable chairs for residents or visitors to use or one chair only. Call bells are available in all areas used by residents and these were accessible in bedrooms and toilets. In the lounge they were given to people able to use them and get staff for others who found it harder to get summon help or attention if needed. Staff do come to the edge of the room at the door and look in from time to time and carry on with their duties if everything looks settled. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 19 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: An examination of the staff rotas and observation of staff during the visit show that there are sufficient nursing and care staff to meet personal care needs during the day and night when the staffing is as rostered. There are two registered nurses on duty on the busy morning shifts when most personal care is being carried out and usually the manager or deputy providing a suitable skill mix with the six to eight care staff on duty. There were recent shortages when staff went off sick at short notice after a bank holiday. Despite such levels of staff responses to surveys from relatives indicate that there are still times when people have to wait for assistance from staff. The management are addressing the management of sickness leave amongst staff to improve contingency planning in this respect. There is an ongoing staff training programme with records of training completed. Currently there are over 50 of care staff trained to a minimum of NVQ level 2 in care and there are records of induction and foundation training. Mandatory training is up to date, including manual handling, food hygiene, fire Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 20 training, infection control and ten staff hold first aid certificates. A range of other training has been taken up by individual staff and for nursing staff to meet their professional development needs. Training planned for the future includes up dates and greater training on care planning. The significant improvements in recruitment practices found at the last have been maintained. Staff records show that appropriate references are being taken and appropriate CRB and POVA checks are now in place. Periodic checks on Personal Identification Numbers (PIN) for registered nurses are being done. The manager and owners needs to make sure it continues to maintain this improved level of practice in recruitment and training. Staff expressed that the atmosphere in the home was much improved with many more opportunities to air their views and that they were being asked more about issues to do with the running of the home that would improve residents lives. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard resident’s financial interests and basic self monitoring systems to promote quality for those living in the home. EVIDENCE: The home has a suitably qualified manager with experience of working with older people. The management structure now includes a deputy manager who is giving effective support to the registered manager and has done some useful work improving the care planning systems. Changes in the way information is communicated and recorded and better staff involvement in the handover and recording of care has had a positive effect on the culture in the home. Staff spoken with noted many more Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 22 opportunities to air their views and that they were being asked more about issues to do with the running of the home that would improve residents lives. This improvement needs to be fostered and built upon to promote a consistently open, positive and inclusive atmosphere for residents, relatives and staff. The manager has been working on developing a quality assurance and quality monitoring system for some time. A system has been bought in but there is no evidence that this is being incorporated into the home’s existing systems and has contributed to some confusion re there are now two sets of policy and procedure statements available to staff. Improvements can be seen in reviewing aspects of the service, including the care planning systems and records, some complaints monitoring, better communication systems and consultation with residents and families through surveys and especially through the named nurse system. The survey system seeks opinions about the service from local doctors and health care professionals involved in people’s care. This includes the occupational therapist and community mental health team and their comments are in the home’s guide. Collating the resident’s and relatives survey for general viewing and so people can see where action is being taken would promote openness and be good practice. However audits need to be carried out across the service, be systematic, recorded and look closely at any issues raised. Formal supervision is being given to care staff and annual appraisals are due The management and nursing team needs to make sure that supervision is carried out on a daily basis too as part of the normal management process on a continuous basis. This will make sure that staff are putting the theoretical training they get into practice as they work with people with dementia and can be supported to improve if they are not. Neither the manager nor the nursing staff have records of any structured, formal supervision being given to them appropriate to the demands of their roles and this should be provided. The home has systems in place to safeguard resident’s monies and a spot check showed transactions are fully recorded and accurate. Senior staff periodically check the monies and receipts for accuracy. Records and servicing contracts indicate that the home has systems, training and practices to promote resident health and safety. Despite this during the visit it was observed that staff were transporting people around the home in wheelchairs that did not have footplates in place. These keep feet clear of the floor and doorposts but near misses were observed and this is not a safe moving and handling practice. Records show that servicing and maintenance of equipment is being done, that electrical testing of portable appliances lifts and hoists, and alarms are being serviced, and that periodic electrical testing has been done. Fire training is being given to staff and fire lectures and drills recorded and fire risk assessments have been updated following changes in legislation. Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 23 Swarthdale Nursing Home DS0000061688.V333877.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 3 9 2 10 3 11 X 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 2 3 3 X 3 X 2 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 X 2 Swarthdale Nursing Home DS0000061688.V333877.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 Changes made to medication must be supported by written evidence that these have been authorised by a doctor to ensure people receive the correct medication. There must be protocols, to include documentation, in place to ensure that new residents have all the medication they need on admission to the service. This will ensure they receive the correct medication. All staff using wheelchairs to move people around the home must have footplates in place to protect people’s feet. This will ensure they avoid injury. Timescale for action 01/07/07 2. OP9 13(2) 01/07/07 3. OP38 13(5) 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 26 1. OP7 2. OP9 3. 4. OP9 OP12 5. 6. OP18 OP18 7. 8. 9. OP18 OP24 OP36 10. 11. 12. OP33 OP33 OP36 Staff should involve people as much as they can in developing and reviewing their own planned care and individual preferences to give them more choice and control over their daily lives. It is recommended that discussions be held with the medical practices and the supplying pharmacy so that prescriptions for regular medication are supplied on a 28day basis for ease of ordering and to ensure that they do not run out. Regular controlled drugs checks should be undertaken to monitor compliance with procedures and protect people using the service. Opportunities for leisure and recreational activities in and outside the home should be tailored to suit the preferences and capabilities of the people living in the home with particular attention to providing social opportunities and support for people with dementia so people can have some choice and control in their lives. There should be a clear policy statement to cover the referral of staff to the POVA List if they were suspected or found guilty of abuse. Clear information should be available on how to refer to social services under adult protection in the event of the manager not being available and a telephone contact for making a referral to social services so staff can act quickly to protect residents. To avoid confusion for staff in the area of adult protection only one set of procedures should be in use and subject to quality checking at any one time. All bedrooms should have the same basic level of comfortable good quality furniture and soft furnishings in their rooms and comfortable chairs for people to sit in. The management and nursing should make sure that supervision is carried out on a daily basis as part of the normal management process to make sure that staff are putting the theoretical training they get into practice as they work with people with dementia and can be supported to improve if they are not. The resident’s and relatives survey should be collated for general viewing and so people can see where action is being taken. Quality audits should to be carried out across the service, be systematic, recorded and look closely at any issues raised by them. The manager and nursing staff should receive formal, structured supervision appropriate to their roles to support them and this should be recorded. DS0000061688.V333877.R01.S.doc Version 5.2 Page 27 Swarthdale Nursing Home Swarthdale Nursing Home DS0000061688.V333877.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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.V333877.R01.S.doc Version 5.2 Page 29 - 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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