CARE HOMES FOR OLDER PEOPLE
Swillbrook House Rosemary Lane Bartle Preston Lancashire PR4 0HB Lead Inspector
Phil McConnell Unannounced Inspection 09:30 23rd June 2006 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 Swillbrook House DS0000066401.V291936.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. Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Swillbrook House Address Rosemary Lane Bartle Preston Lancashire PR4 0HB 01772 690317 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) Swillbrook Care Homes Ltd Mrs Susan Ann McWilliams Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection The service is registered to accommodate a maximum of 23 service users in the category OP (older persons 65 and over) 20th October 2005 Date of last inspection Brief Description of the Service: Swillbrook Care Homes Ltd owns Swllillbrook House. The Home is registered with the Commission for Social Care Inspection to provide care to older people of both sexes over the age of 65. Swillbrook House is located in the rural area of Bartle, Preston. The property is a large converted farmhouse with extensive gardens and outdoor space, with ample parking being available. The home is registered to care for 23 older people on both a permanent or respite basis. Due to the homes rural position most of the staff are from the local area. The home has 3 double bedrooms and 17 single bedrooms. A total of 15 bedrooms have toilet en suite facilities. There are 2 lounges, a dining room and a quiet area. A passenger lift is in place, which allows residents to move throughout the home independently. Appropriate aids and adaptations are provided to meet service users’ individual needs. Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced which meant that the provider was not aware that the inspection was to take place. The inspection was carried out by one inspector and took place over a period of seven hours, with a further short visit taking place the following week to give some feedback to the registered manager. The focus of the inspection was to review any requirements or recommendations from the last inspection and to assess all of the key standards identified in the National Minimum Care Standards for Older People. The registered manager was present during the inspection and there was also the opportunity to speak to some of the service users, staff members, the deputy manager, three service users’ relatives, a clinical nurse manager and have a short telephone conversation with the owner (took up ownership in January 2006) and on the follow-up visit, there was the opportunity to have a discussion with a local authority social worker who has been liaising with Swillbrook for a number of years and some of her comments were: “The home has managed some difficult situations very well” “Everything you ask for they do, they have put strategies in place for difficult and complex situations” and “they always provide good care” At the inspection there was a really good atmosphere in the home and the service users, staff, and the visitors who were spoken to, commented individually about the “good atmosphere in the home” and “since the new owner has taken over, things are much better” Four service users’ files were examined and discussions took place with a number of service users throughout the inspection. Policies, procedures and staff files were also examined and a full tour of the home was undertaken. What the service does well:
The service users who were spoken to said, they are well looked after and had no complaints. The inspector was able to have lunch with the service users in the dining room and there was a calm, relaxed and unhurried atmosphere, with people chatting to one another. The meal was good, appetizing and well presented. Some of the service users commented, “The food is always good and nice”. In general observation it was observed that most of the service users ate all of their food.
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 6 The staff team is relatively unchanged since the last inspection, with just two new members of staff joining the team and it was evident during the inspection that there was a good rapport between service users and staff. A relative spoken to at the time of the inspection told the inspector that she visits her mother regularly and she was very complimentary of the care provided to her relative, saying that “There is a still and calm atmosphere within the home” and that “Residents are treated as individuals and their needs are catered for, my mother has significantly improved since coming to live here” another relative said, “I think it is great here, the staff are absolutely brilliant, nothing appears to be too much trouble”. Individual service users were also complimentary of the care received. The home employs a number of overseas staff; records examined provided evidence that appropriate checks are carried out prior to an offer of employment, although one staff member still requires a Criminal Records Check (CRB) to be carried in this country. (The person does have clearance from her country of origin) Staff spoken to said, “Things are a lot better now since the new ownership, they are nice people to work for and things are getting done” and another member of staff said, “I have worked here for over ten years and I have never known it to be so good, it is a pleasure to come to work”. What has improved since the last inspection? What they could do better:
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 7 Although care plans are more detailed, they could do with some extra development to further ensure that individuals’ needs are being appropriately met. Staff files in general were untidy and limited in information, it would be beneficial if ‘ring binder’ files or equivalent were introduced, this would help avoid any confusion with loose pages getting lost or filed incorrectly. To be more pro-active with the key worker system that is planned, this would bring further clarity of ‘specific staff duties’ and benefit the service users. The recreational and leisure activities within the home are insufficient to help promote motivation, interest and stimulation to individuals. The service users would benefit from a planned and varied timetable of events and activities, which they could choose to attend, either inside the home or outside. There are still some interior environmental issues (re-decoration and repairs) to be carried out. All of the above were discussed with the registered manager and an assurance was given that these items would be addressed. 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. Swillbrook House DS0000066401.V291936.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 Swillbrook House DS0000066401.V291936.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (The home does not provide intermediate care) Quality in this outcome group is – ‘Good’ An appropriate and satisfactory assessment process is in place. EVIDENCE: The homes policy and procedures for new admissions to the home were present and up to date. Most of the homes policies were reviewed in February 2006. Three service users were case tracked’, including two of the most recent admissions to the home and all of their files contained relevant assessment documentation including: admission assessments, care plans and up to date daily record sheets. Service users spoken to and staff were familiar with the assessment process. One person had been admitted for respite following a fall and the service users’ relative informed the inspector that “a social services assessment and the homes own assessment had been completed” and “I think it’s great here, I have complete confidence in the staff, they are brilliant”
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 10 During the day of the inspection a service user was admitted to the home and there was the opportunity to speak with the person and his relative. It was evident that a thorough and appropriate pre admission assessment had been carried out by the manager and there had been consultations with the service user, the service users’ social worker and family members, thereby demonstrating that as much information as possible is gathered, to help provide the correct level of care to meet individuals needs. Swillbrook House DS0000066401.V291936.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome group is – ‘Good’ Service users’ health care needs are adequately met, but documentation needs to fully demonstrate this. Medication procedures are satisfactory, thereby safeguarding service users. Service users are treated courteously, respectfully and with dignity. EVIDENCE: Service users’ care plans were examined and were found to be up to date, containing information with guidance on how to provide individual personal care and how to meet a person’s health care needs, however as already mentioned there is a need for the information to be more detailed. This would help ensure that individuals’ health care needs are being fully met. The inspection coincided with a visit from a District nurse, (clinical nurse manager) who had come to attend to a service users’ medical needs, the
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 12 treatment took place in the person’s bedroom, demonstrating that individuals are treated in privacy, to ensure dignity and respect. In discussion with the nurse manager, she said, “I have been attending to different people at Swillbrook for over 4 years and they really do care for people” “The home has improved so much over the last few months” and “the staff appear to be so much happier, which has positive effects for the service users” Medication procedures and records were examined and found to be satisfactory, with staff being appropriately trained in the storage, administration and recording of medicines. ‘Boots’ pharmacy carries out an annual examination of medication procedures within the home, helping to ensure that correct procedures are maintained, for the benefit of the service users. GP’s hold regular medication reviews for service users, which also helps to guarantee that correct medicines and dosages are administered to individuals, in order to safeguard, promote and maintain their health. Some staff members were observed speaking to service users in a polite, courteous and respectful manner. One person said, “When I came to live here I was asked what would I like to be called?” Indicating that people are addressed in the name they prefer. Swillbrook House DS0000066401.V291936.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 The quality in this outcome group is – ‘Good’ Leisure and recreational activities need to increase, in order to provide more interest, motivation and stimulation for service users Good contact is encouraged and maintained with family and friends. Meals are nutritious, with a balanced and wholesome diet being provided. EVIDENCE: As already mentioned there is a need to improve the leisure and recreational planning within the home, in order to provide varied interests and activities. This will help motivate and stimulate service users. There was evidence that various religious services take place within the home, with ministers from different denominations visiting and service users are enabled to attend if they choose. The service users and relatives spoken to all commented that everything possible is done, in order for people to retain relationships with family and friends. Relatives commented that they are welcome to visit at any time and
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 14 the staff, always give them information on the health and wellbeing of their relative. During the inspection it was observed that there was a good rapport between staff and visiting relatives. The inspector was informed that a service users committee / group was planned, this would help ensure that people play an active part in the decisions and choices that are made concerning their welfare. It was also evident that a keyworker system (service users are allocated a named care worker) is in the process of being introduced. This would also give service users the added confidence that they (and supported if necessary) have control over their lives and are helped to make their own choices. There was a choice of menus available, which were seen to be nutritious, varied and appetising. There was the opportunity to have lunch with the service users, who were observed expressing their own choices about what to eat. Staff were observed supporting less able service users in a calm, relaxed atmosphere, with sensitivity and gentleness, thereby reducing any embarrassment that service users may feel. Some of the service users chose to have their meals in their own rooms, which demonstrated that mealtimes are flexible and service users’ wishes and choices are catered for. Some comments form service users regarding the meals were quite positive including: “the meals are always really good” “there’s always enough to eat, the cook is very good” and we have a good choice of meals” Swillbrook House DS0000066401.V291936.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome group is – ‘Adequate’ Thorough and satisfactory protection procedures for service users are in place. EVIDENCE: The home had a comprehensive complaints policy and procedure in place, regarding complaints and the protection of vulnerable adults. The inspector spoke with some service users and they knew whom they could speak to in the home if they had a complaint. They were also aware that the social worker and the inspector for CSCI (Commission for Social Care Inspection) could be contacted if they chose to do so. There was a thorough policy in place to deal with a suspicion or allegation of abuse. The inspector spoke with staff members and who were aware of the procedures to follow and would be confident in the process. A member of staff had not received criminal records check (CRB) clearance. (See staffing section) Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 16 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 and 26 Quality in this outcome group is – ‘Adequate’ Some very good refurbishment has been completed. The improvement programme needs to continue, in order to further improve the standards for the service users. EVIDENCE: The previous inspection report highlighted a number of areas within the home that needed some attention either with redecoration, replacement or repair of specific items. It was evident that a number of the issues raised have been addressed with some of the service users bedrooms being redecorated to a high standard, with all bedrooms reflecting service users own individuality, containing their personal belongings, helping to give people a sense of belonging and ownership. The ground floor bathroom has been completely refurbished to a high standard and the grounds have had extensive work carried out.
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 17 Some of the service users were sitting in the patio area, which had been newly furnished with a good quality solid wooden garden table, chairs and a bench. Some of the service users commented: “the gardens are lovely now” and “a lot of work has been done in the last few months, they have worked really hard” The home was clean and hygienic with appropriate laundry and washing facilities provided to help ensure that the risk of infection is managed and controlled. Training in the control of infection had been provided to staff, in order to promote a clean and safe environment for service users and staff. There are still some areas that are in need of attention, including: carpets needing to be repaired or replaced, in some areas there is a trip hazard, some bedroom floors are uneven, one of the bathrooms has very poor lighting and there is a need to provide more ramps and improve walking areas outside (more level) for wheelchair users and for people with mobility problems. However, it is apparent that the new provider is committed to improving the environment for the people who live at Swillbrook House. Feedback was given to the registered manager following the inspection and an assurance was given that the items identified, needing attention would be addressed as soon as possible. Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 18 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 group is – ‘Poor’ Staffing levels are adequate to meet the service users needs. Recruitment checks (CRB) have not been sufficiently followed through; this could possibly leave vulnerable people at risk. EVIDENCE: Staff files, rotas and training records that were examined, highlighted that there was a mixture of suitably skilled staff with sufficient staffing levels employed in the home. In observation and discussion with staff members, there was a clear indication that staff work together to meet the needs of the service users. The home employs a number of qualified overseas staff; records examined provided evidence that checks are carried out prior to an offer of employment, although one staff member still requires a Criminal Records Check (CRB) to be carried out in this country. (The person does have clearance from her country of origin) A previous inspection report (April 2005) also highlighted the shortfalls in the recruitment process and the registered manager was informed again of this requirement. Staff spoken to said, “Things are a lot better now since the new ownership, they are nice people to work for and things are getting done” and another member of staff said, “I have worked here for over ten years and I have never known it to be so good, it is a pleasure to come to work”.
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 19 Training records showed that staff had received mandatory training in moving and handling, fire safety, first aid, food hygiene, and recently staff had received training in the control of infection. This helps to demonstrate that the provider is committed to ensuring that staff are suitably trained to care and support vulnerable adults. Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 20 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, 33, 35 and 38 The quality in this outcome group is – ‘Adequate’ The home is well managed and organised, ensuring as much as possible that service users receive a good quality service, however, there are still some environmental issues to be addressed and some concerns regarding protection issues with the recruitment process. EVIDENCE: The manager has a number of years experience in care work and has managed Swillbrook House for the past four years. She has relevant qualifications for the post of registered manager and is presently studying for the ‘Registered Managers Award’. Swillbrook House has the ‘Investors in People Award’, which is an independent quality assurance-monitoring organisation and recently service users were encouraged to complete evaluation questionnaires, entitled ‘Service Users
Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 21 Satisfaction Questionnaires’, these were inspected and found to be mostly positive, with just one or two comments from service users suggesting more activities and days out. The manager informed the inspector that the questionnaires would be taken seriously. The staff who were spoken to also indicated that their views were listened to and one said, “We feel that we are included more than we used to be”. This helps to demonstrate that service users and staff are consulted regarding their opinions and concerns and knowing they are taken seriously. All staff have received relevant and appropriate training, including: moving and handling, first aid and infection control. Health and safety certificates were inspected and found to be up to date and in order, helping to demonstrate that service users and staff are safeguarded as much as possible, by ensuring that equipment and utility services are regularly inspected. As already mentioned there are still some repairs, redecoration and wheelchair access improvements to be completed, in order to further promote the health and safety standards for service users. Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 22 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 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 23 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 OP7 Regulation 15 Requirement Service users care plans must be developed further to provide greater detail. The leisure and recreational activities for service users need to be improved. All staff need to have a criminal records bureau (CRB) check and clearance before starting employment. All areas of the home must be maintained and decorated to an acceptable standard. (Ongoing refurbishment programme) The worn carpets must be replaced (Previous timescales of April 2005 and October 2005 not met) Timescale for action 31/08/06 2 3 OP12 OP18 16 (m) (n) 19 schedule 2 (1 – 7) 23 31/08/06 31/08/06 4 OP19 31/12/06 5 OP19 23 30/09/06 Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 24 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 Swillbrook House DS0000066401.V291936.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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