Random inspection report
Care homes for older people
Name: Address: Swimbridge House Nursing Home Swimbridge Welcombe Lane Barnstaple Devon EX32 0QT two star good service 14/10/2008 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Joanne Walsh Date: 0 1 1 0 2 0 0 9 Information about the care home
Name of care home: Address: Swimbridge House Nursing Home Swimbridge Welcombe Lane Barnstaple Devon EX32 0QT 01271830599 01271830107 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Margaret Myers Mrs Jaspreet Singh Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr John Kushmira Singh care home 24 Number of places (if applicable): Under 65 Over 65 24 old age, not falling within any other category Conditions of registration: 0 The maximum number of service users who can be accommodated is 24 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: None Date of last inspection Brief description of the care home Swimbridge House is a modern, detached two-storied purpose built building situated in the rural area of Swimbridge in North Devon, it is registered to provide care with
Care Homes for Older People Page 2 of 10 1 4 1 0 2 0 0 8 Brief description of the care home nursing for up to 24 older people. There is level access throughout the home with a passenger lift to the first floor. Swimbridge House has 20 single bedrooms, most with en-suite facilities, 2 double/shared rooms are available if requested. There is a communal lounge and dining room on the ground floor and access to the garden area. The home has a car park and is set in lovely grounds surrounded by fields and countryside. The home is situated in an area which is not served by public transport and therefore can be accessed by private vehicles only. A pre-school nursery has been opened adjacent to the home in part of the surrounding grounds. The range of fees can be obtained directly from the home. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are not included in the fees. The home also makes a charge if any people need a member of staff to escort them anywhere. Current information about the service, including the CQC inspection reports is available upon request from the manager and displayed in the hallway for those people that may wish to look at it. Care Homes for Older People Page 3 of 10 What we found:
This random inspection took place during a week day in September and was completed as a result of a safeguarding issue raised. The North Devon District Hospital had admitted a person from Swimbridge Nursing home who presented with dehydration, pressure sores, and a broken skin area where the their nails had contracted into the palm.This person also appeared to be extremely constipated. We are unable to comment on the outcome of this investigation at this present time as it is still ongoing. We wanted to assure ourselves that other people were not at risk and that personal and health care needs were being met for individuals. As part of the safeguarding process a social worker from the safeguarding investigating team and a community nurse also reviewed 5 peoples records in some detail. We spent time talking to the registered manager, the registered provider and all of the care staff(5) and nurse on duty that day. We case tracked two people with complex needs. This means we looked at the plans of care, medication records and any other information about the individual. We spoke to staff about how they met the needs of these two people, and where possible we spoke to the individual. We also observed care practice, particularly during the lunchtime period. As this was not a key inspection we did not look at all the key standards, but concentrated on looking at the outcomes for people in terms of whether their personal and health care needs are being well met. During this random inspection we spoke with the registered manager and nurse and decided to case track two people with complex needs. We looked at one person who is nursed in bed and who came to the home with a pressure area and the other person has communication difficulties and some behavior that challenges the service. We found that the two plans for care we looked at gave reasonably good basic information about the persons personal and health care needs. For the individual nursed in bed we saw that there was a wound care plan in place, including what dressing is being used. This is not the case for all plans reviewed. We spoke with the community nurse who was reviewing some people at the home and she confirmed that in order for plans to work effectively they need to include more detail about exactly how the nurses are treating a wound, what dressings and creams are being applied and the appearance of the wound, and whether it is improving or otherwise. The plans we looked at contained a pressure damage risk assessment (medley score), a Barthel functional ability assessment, nutritional assessment and a moving and handling risk assessment. They did not contain a risk assessment or agreement for the use of bed rails and yet for both these individuals they were in use. In speaking to the home following the inspection, they maintain they do have these but they were not included in the main plan of care. All risk assessments should be readily available as they form part of the overall plan of care and staff need to be able to refer to these to help minimise any identified risks. One persons plan also had a feeding regime as they were being fed for some of the time via a peg. The investigating team also found that where a person may have an issue with constipation or other bowel related problems, care plans did not contain enough
Care Homes for Older People Page 4 of 10 information to show what actions staff need to take to monitor this and what treatment should be considered. We saw that accidents had been recorded with the exact details of how injuries had occurred and in talking to staff they were aware of one individual being prone to losing nails due to a fungal infection and poor circulation. The medication records appeared well organised, with hand written entries double signed to help prevent errors. One person we case tracked said that they were prescribed movacol in their plan of care, but in fact on the medication charts they had been prescribed something else for constipation. This appeared to be working to good effect as their daily record plans in the bedroom showed that they were now having regular bowel actions. The home has 22 beds and normally runs at almost full capacity. The staffing levels appear sufficient for the number and needs of the current people living there. They normally have 4 carers during the morning shift, 3 or 4 during the pm shift, with a nurse on duty, and one nurse and one night carer as waking night staff. They also have a chef and one domestic staff each day. We discussed whether the staffing levels have fallen below these levels at any time and the registered provider said that if the occupancy falls below a certain level they do look to reduce by one carer, but this is infrequent and was not the case during the incident that the safeguarding issue arose. They did say that the trained nurse staff have fluctuated, in that they had some nurses resign at short notice and then needed to get in agency nurses to cover shifts, and this lack of nurse consistency may have contributed to minor lapses in consistency of care for people. The registered providers maintain that overall standards have not fallen below expected outcomes. The registered manager is not nurse trained but the home does have a clinical lead nurse, who works additional to the staffing rota. One relative and several of the people living at the home commented on how the home lacked a matron, and his was fed back to the registered manager and provider, who agreed that they may not be used to the term clinical lead. They may look at using the term matron to that everyone is familiar with their role. What the care home does well:
Swimbridge Nursing Home provides people with a purpose built, clean safe and homely environment. They have tried to provide a number of small seating areas instead of one large lounge and one large dinning area. This appears to work well and people appeared comfortable and secure in their surroundings. Two requirements made during the last inspection have been actioned to ensure that the environment is safe. These include fitting electronic door openers that are linked to the fire alarm system and fitting window restrictors to windows above ground floor level. Plans of care have been developed for each individual and they give basic details of what the persons care and support needs are. Since the safeguarding issue, the registered manager and provider have reinstated a daily personal care plan in each room, that care staff need to sigh to say what care and support has been provided for each person. This also records if needed, when the individual has had a bowel motion, which helps to
Care Homes for Older People Page 5 of 10 determine more easily if their is a constipation problem, as this information can be seen at a glance. Care staff know and understand the needs of people they support, and appear to have good training and support to enable them to do their job well. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 17 Plans of care need to contain 30/10/2009 clear instructions to staff as to how to monitor bowels and what treatments are needed where bowel care is an issue to ensure a consistent approach is given at all times 2 7 17 All wound care plans need to 30/10/2009 give clear instructions as to what treatment and dressings are being used to ensure a consistent approach is given at all times. 3 7 17 Risk assessments relating to the use of bed rails must be available as part of the persons care plan To ensure that staff understand the risks and take any actions to minimise the risks 30/10/2009 Care Homes for Older People Page 8 of 10 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 27 Staffing levels should be kept under review to ensure that the home can meet all needs, including social, leisure and diverse needs. Care Homes for Older People Page 9 of 10 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 10 of 10 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
