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Inspection on 22/06/06 for Swimbridge House Nursing Home

Also see our care home review for Swimbridge House Nursing Home for more information

This inspection was carried out on 22nd June 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Prospective residents` needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. Involvement of other professionals ensures residents receive good health care. There is good promotion of privacy, dignity and respect for residents. Residents have choice and control over there everyday lives where possible. Residents` families and friends are able to remain part of resident`s lives so they benefit from familiar and supportive relationships and are welcome in the home at all times. The environment and facilities are spacious, light and homely. Care staff are an asset to the home and ensure good care is given to residents. Staff are described by residents as "excellent" and "marvellous" and by professionals as "helpful and caring".The manager has the knowledge and experience to ensure the home is run in the best interests of the residents. This includes having good systems that protect residents` financial affairs. The home is generally described by residents as "having a homely atmosphere" and professionals consider it "well run".

What has improved since the last inspection?

A good quality assurance system has been introduced into the home and fairly regular residents` meetings take place. Smaller resident `focus groups` take place with a particular subject discussed such as meals, complaints etc. and any problems/issues that arise are dealt with. The system for resident care planning has been improved with a new care planning system partly introduced which will help to improve the delivery of care. Staff supervision exists for care staff only but this is shortly to be extended to included trained staff. This will ensure that staff`s training and development needs are fully addressed.

What the care home could do better:

During the inspection it was noted that improvements could be made in the following areas. Care planning records need to be reviewed regularly to ensure that best care is being given to residents. Medication administration procedures must be addressed to ensure safe practice. Activities on offer need to be reviewed to ensure that residents` expectations and individual preferences are met (this is an outstanding requirement from the last three inspections). Food provided is balanced and nutritious but residents would benefit from knowing what food is to be served and being able to choose their main meal. Recruitment procedures must always be followed to ensure that residents are protected (this is an outstanding requirement from the last five inspections). Residents should be able to feel that their complaints will be listened to and acted upon. Aspects of record keeping in the home must be kept up to date and accurate to ensure residents are fully protected, including complaints, staff training and resident care records.

CARE HOMES FOR OLDER PEOPLE Swimbridge House Nursing Home Welcombe Lane Swimbridge Barnstaple Devon EX32 0QT Lead Inspector Victoria Stewart Key Unannounced Inspection 22nd June 2006 10:00 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 Swimbridge House Nursing Home DS0000026725.V293491.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. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swimbridge House Nursing Home Address Welcombe Lane Swimbridge Barnstaple Devon EX32 0QT 01271 830599 01271 830107 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) Mr John Kushmira Singh Mrs Margaret Myers Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Notice of Proposal to Grant Registration for staffing/environmental conditions of registration issued 7/11/1998 That Margaret Myers completes NVQ4 in Care and Management and the Registered Manager’s Award by 2005. 23rd November 2005 Date of last inspection Brief Description of the Service: Swimbridge House is a modern and detached two-storied purpose built building situated in the rural area of Swimbridge in North Devon. The home is registered to provide care with nursing to 24 older persons. 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 large grounds and is surrounded by fields and countryside. large car park has been provided. A pre-school nursery has recently been opened adjacent to the home in part of the surrounding grounds. A The cost of care ranges from £425 to £515 per week at the time of inspection. Chiropody, hairdressing, personal toiletry items and newspapers/magazines are additional costs which are not included in the fees. Current information about the service, including the CSCI inspection reports, is displayed in the hall and is available to those that wish to look at them including current and prospective residents, relatives, staff and professionals. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out as part of the planned inspection programme for the year 2006/7 and took 2 days for the inspector, Victoria Stewart, to complete. This actual inspection itself was unannounced, but the home had received prior notification that an inspection would take place within three months. In the last inspection year, Swimbridge House has received its two statutory inspections, plus an additional visit to monitor one specific issue regarding staffing. The home had 21 residents living at the home on the day of inspection and the inspector spoke with seven residents in depth and had lunch with two others. The inspector saw the remaining residents and chatted briefly with several of them, either in the communal areas or in their private rooms. Several of the residents were unable to give their views, or give them in detail, due to a dementia related disability. Prior to the inspection, a number of information surveys were sent out. Five out of ten surveys sent to residents were returned; four out of ten surveys sent to relatives were returned; one out of four surveys sent to communitybased health or social care professionals was returned and five out of eleven surveys sent to staff were returned. This report is written with information gained from the pre-inspection questionnaire completed by the home, by talking with residents, relatives, staff and management, by looking at a selection of records (including resident files, medication records, staff files, training records, quality assurance records and by undertaking a tour of the home. Finally the outcome of the inspection was discussed, fed back and agreed with the registered provider and manager prior to the inspector leaving the home. What the service does well: Prospective residents’ needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. Involvement of other professionals ensures residents receive good health care. There is good promotion of privacy, dignity and respect for residents. Residents have choice and control over there everyday lives where possible. Residents’ families and friends are able to remain part of resident’s lives so they benefit from familiar and supportive relationships and are welcome in the home at all times. The environment and facilities are spacious, light and homely. Care staff are an asset to the home and ensure good care is given to residents. Staff are described by residents as “excellent” and “marvellous” and by professionals as “helpful and caring”. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 6 The manager has the knowledge and experience to ensure the home is run in the best interests of the residents. This includes having good systems that protect residents’ financial affairs. The home is generally described by residents as “having a homely atmosphere” and professionals consider it “well run”. What has improved since the last inspection? 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. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 7 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 Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 8 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&6 Quality is this outcome area is good. This judgement has been made with available evidence including a visit to the service There is a good admission process at the home, meaning that residents can generally be assured that the home can meet their needs EVIDENCE: Four resident files were looked at. All of these files contained a pre-admission assessment which had been carried out either by a representative of the home and/or a social and health care professional. The care files included relevant information gained by the home to enable them to complete a provisional plan of care when admitted. One visitor told the inspector that the recent admission of their relative to the home had been well managed and that Swimbridge had been chosen on advice from a professional and information written in the CSCI’s inspection reports. Five out of five resident surveys completed said that they had received enough information about the home before deciding to move in. Trial visits are encouraged if possible. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 9 During the inspection, the inspector noted that the home is in the process of finding a more suitable establishment for one resident. This is due to the fact that staff at the home feel they can no longer meet this resident’s full needs properly. The home has contacted, and is working with, the appropriate professionals to ensure that a more suitable home is found, for example a social worker and occupational therapist. The home has arranged to have preadmission assessments carried out by several other care homes in the area, with the resident kept fully aware of what is happening and being involved in the process. This was confirmed by the social worker that was visiting this resident on the day of inspection. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service Care planning is adequate but will be improved when the new care planning system is fully introduced into the home Residents’ benefit from staff that treat them with respect, privacy and dignity at all times The systems relating to medication are generally well managed but some areas of poor practice need addressing EVIDENCE: Four resident care files were looked at. These identified some aspects of health and personal care needs identified and planned for but gaps were noted in some areas of care plans with relevant information missing, for example social needs and evidence of resident involvement in care planning. All four files looked had not been reviewed for several months. However, it was noted that the home is in the middle of transferring to a new care planning system for residents. The inspector looked at one of these files and believes that Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 11 when these are fully introduced into the home, they will provide a very good comprehensive record of care if completed appropriately. Five resident surveys said that they received the care and support they need. One resident spoken with said that their care was “as good as you can get” and another said that she feels “looked after”. Residents’ needs appeared to be being met during the inspection, with the exception of one resident (see NMS 3). However, the inspector noted that some finer details of personal care could be improved, for example one resident had sticky eyes and more than one resident was noted to have a dirty mouth/teeth. This was discussed with the manager who said that oral hygiene had been previously identified as a training need for staff and had already been planned for. The home liaises with other social and health care professionals when needed, for example GPs, nurse specialists and occupational therapists. One professional survey said that the staff were “helpful, caring” and that Swimbridge is a “well run home”. The home provides specialist equipment when needed to prevent skin deterioration, for example pressure relieving mattresses and cushions. The home also has two lifting hoists to ensure safe handling procedures are maintained and other aids such as zimmer frames, grab rails and wheelchairs. One resident had a specific chair and commode for her own use, which was different to the general ones used in the home. Staff interviews demonstrated that staff have a good awareness of how to treat residents with privacy and dignity. This practice was observed during the inspection at all times and residents spoken with confirmed that staff always knock on doors before entering their private rooms, ensure that their privacy is maintained when carrying out personal care and that their preferred name of address is used. The medication procedures in the home were looked at. The Medicine Administration Record (MAR) chart was generally well kept, with medicines checked into stock and recorded properly. The systems for controlled drug recording, storage and administration were checked and satisfactory. The home has had a recent review by the Boots pharmacist and the inspector noted that the recommendations made following that visit had been acted upon by the home. One resident self medicates but the records relating to this assessment of this process could not be found. Creams and eye medication kept in residents’ bedrooms did not have an opening or discard by date, which could alter the medication strength if not monitored. When the inspector arrived at the home, the medicine trolley was found unlocked in the upstairs medicine room, with the keys left in it. The inspector also noted that there were five pots of unnamed medicine put out in the medicine trolley. This unsafe practice was discussed with the nurse administering the medication at the time and the nurse explained that she had responded to a resident’s needs and did not make a habit of this bad practice. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 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): 12,13,14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Residents are generally able to exercise choice in their day-to-day lives The provision of social activities is limited meaning that residents’ social needs and expectations may not always met The home provides a welcoming and friendly approach at all times when relatives and friends visit residents Residents have the benefit of meals that are both home made and nutritious but are not routinely offered a choice of main meal EVIDENCE: Several residents told the inspector that they liked to stay in their rooms all day and their meals are served there. The inspector also spoke with one resident likes to have her curtains drawn all day and another liked to go back to bed after breakfast and lie in until lunchtime. Residents confirmed in their surveys that activities are only sometimes organised that they can take part in. However, the residents who choose to Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 13 stay in their rooms did not wish to participate in activities at all. Staff confirmed in their interviews that the homes approach to activity organising was poor and comments such as “what activities”; “activities are not organised” and “I would like to change the activities” were gained, although one member of staff said, “Matron has tried really hard”. Staff felt that the lack of activities was due to the fact that the home has a lack of staff available to undertake this, i.e. care staff perform it as part of their duties. Entertainers are invited into the home about twice a year. The home’s lack of ability to meet the social, cultural, and recreational interests of residents has been noted in the last three inspections with little progress made to meet them. One resident does have his vegetable patch, which he tends to daily. The home encourages residents to maintain contact with family and friends in the home and one relative said that he visits at different times of the day and is always made to feel welcome by staff. Visitors are able to take part in meals if they wish for which a nominal charge is made. The home provides homemade cooking by a cook that has worked at the home for several years. Five out of five residents commented in their surveys that they either always or usually liked the food. On the day of inspection, the inspector asked the residents who were waiting for lunch to be served what they were having and they all said that they did not know. The menu is not routinely displayed at lunchtime. Whilst there is one main set meal a day, it was clear that if a resident disliked this, an alternative would be found. The cook is aware of residents’ likes and dislikes. The inspector saw that residents were being asked for their choice of food for their light supper. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 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 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service Residents have access to a good complaints procedure, but better recording is needed so that there are always clear outcomes for residents Residents are protected from abuse by staff, most of who understand the principles of adult protection and are aware of the procedures to take EVIDENCE: The manager told the inspector that all staff had received in-house training in the Protection of Vulnerable Adults, although records to confirm this were unable to be found. The manager said she carried out this training over two afternoons and two evenings in order to deliver the training to all staff. The inspector was shown the tools used for the training and the ways in which different issues of adult abuse were discussed. Four staff surveys and three out of five staff spoken with confirmed that they were aware of adult protection procedures. The home displays its complaints procedure in the entrance hall and the manager said that she goes through this with newly admitted residents and their relatives. Five out of five resident surveys and three out of three relatives surveys confirmed that they knew who to speak to if they were not happy. One professional survey stated “I have no concerns about the home”. One relative confirmed verbally he knew how to make a complaint if needed. The complaints book was looked at. There was only one complaint noted since Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 15 the last inspection took place and its outcome was detailed. However, after speaking with one resident, it became apparent that other complaints had been raised but not recorded and held on file, except for being inappropriately and briefly mentioned in the daily care records. This was discussed with the manager. Swimbridge House Nursing Home DS0000026725.V293491.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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the benefit of living in a home that is safe, well maintained and homely EVIDENCE: The home appeared generally clean and tidy, with the exception of a ground floor bathroom. This was being used as a storage area for unused furniture for example commodes and wheelchairs, which would make the bathroom unable and unpleasant to be used for residents if required. Residents had personalised their bedrooms with sentimental and private possessions. One resident had brought several items of treasured furniture to her room. The inspector found it difficult at times to visit certain residents in private rooms as not all these rooms had either a number or the identity of the resident living in that particular room. This could be especially confusing for Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 17 residents with a dementia related illness and new visitors/relatives/friends to the home. Direct access can be gained to the garden from the ground floor. The grounds of the home were being developed and flowerbeds planted when the inspector arrived. There are outdoor patio areas with outdoor furniture for residents to sit one where they can enjoy the peace and surrounding wildlife if desired. The home has an eight person lift which enables access all areas of the home. The home does have two shared rooms if necessary, but currently all rooms are occupied by a single resident. The inspector noted that residents and visitors would benefit if some of the carpets in the home were cleaned. One private room also had an offensive smell of urine. This was discussed with the manager. Swimbridge House Nursing Home DS0000026725.V293491.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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service The recruitment procedures for the employment of staff are not always robust enough to protect the residents living at the home Residents benefit from a happy, caring and permanent staff group. However, the deployment, type and number of staff available may not always be sufficient enough to fully meet the needs and preferences of the residents EVIDENCE: The home is encouraging care staff to undertake NVQ training and currently 40 of care staff have achieved this qualification at either level 2 or 3. Two senior members of care staff regularly attend training on a Thursday. Staff and management reported that this day could therefore be a problem to manage. The inspection was carried out on a Thursday and the inspector noted that two agency staff members were part of the care staff team. There are currently some staff vacancies at the home and records show that regular agency staff have been needed to cover shortfalls in staff. One resident commented that the frequent use of agency staff means that she has to tell them what to do for her to meet her care needs. An extra member of care staff is employed on a Wednesday morning and staff reported that when this happens, staff feel less pressurised and are able to care for residents better. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 19 Care staff currently have to do household duties as well as care work, which could potentially take them away from caring for the residents as well as they could. These duties include clearing and washing dishes after meals, doing the laundry and carrying out resident activities. The homes does employ domestic staff but there has been a vacancy for this work which has just been resolved with a new cleaner being employed. One member of staff, who covers the cook’s day off, has been doing domestic duties before she commences her cooking duties to cover the shortfall in domestic staff. When the inspector arrived at the home, she noted that this member of staff had to leave her vacuuming duties to give one resident her breakfast as the care staff were in the middle of getting other residents up. Typical staff comments were that if they could change the home in any way it would be “more cleaning staff and staff to help with the laundry. At present care staff do laundry”. Staff reported in their surveys and in interviews that they felt that residents had to wait long periods at times for attention. Two residents commented in their surveys that this can also be a problem, but three said that staff are available when they are needed. Care staff reported feeling a low morale within the staff group and comments such as “better team work”, “all staff should work as a team” and “we could do better at team working”. In their interviews, care staff reported that on occasions they felt that “residents having to wait longer than usual” for attention and that on occasions did not feel supported or guided by certain trained staff. The manager had noted this staffing issue before the inspection and is organising a ‘team building’ event for the home. Staff reported that they think regular staff meetings would be useful and do not know why the manager does not organise them. The manager said meetings such as these were not held regularly and that she was not sure if staff would attend or the usefulness of them. However, staff commented that, despite this lack of staff moral, they still “like the home”, “like the job” and is a “happy, homely home, where everything is done to allow them (the residents) to treat it as such”. Residents were very complimentary of the staff and written and verbal comments such as “smiley, cheerful staff”, “excellent staff” and “marvellous staff” were made. The home now employs one trained member of staff and one care member of staff to work during the night. Staff felt that this was adequate. Four staff recruitment files were looked at and the inspector found that though the files contained most of the information required, there were some records missing, for example two files had only one reference instead of the two required and written confirmation of Personal Identity Numbers (PIN) from the nurse’s regulatory body were missing. The home’s lack of ability to ensure a robust recruitment procedure and hold the relevant staff records has been noted in the last five inspections with some progress made to meet them. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 20 Staff had undertaken mandatory training since the last inspection and an induction programme has been established. However, the records selected to look at were not completed or signed to confirm the induction had taken place. Swimbridge House Nursing Home DS0000026725.V293491.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,35,37 and 38. Quality in this outcome area is good overall. This judgement has been made using available evidence including a visit to the service The home has developed a good system to monitor the quality of service offered at the home which means that residents are involved in this process Record keeping in the home is adequate, but improvements would mean that residents are fully safeguarded Staff generally receive clear leadership and guidance to ensure that residents receive quality care in a safe environment EVIDENCE: The registered manager is a Registered General Nurse and has almost completed the Registered Manager’s award. She has many years experience in the health service and private care sector and has worked at Swimbridge for Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 22 several years, before and during her appointment as registered manager. A deputy manager has been appointed to help her manage the home. Staff surveys and interviews indicated that staff generally felt well-supported y the manager and trained nursing staff. However, this can sometimes be compromised if trained nursing staff are not always readily available for advice, help or guidance or when not working directly alongside care staff. The home has in the last six months (January 2006) formulated a good quality assurance (QA) form which has identified the home’s strengths and weaknesses. This form had been evaluated and an audit produced in a formal report. As part of the QA process, the manager holds small ‘focus groups’ with residents when a specific topic is chosen, discussed and any issued resolved for example, laundry, complaints and food. This is supplemented with residents’ views of certain parts of the service offered written in individual questionnaires. The home has begun a formal system for care staff supervision and this is soon to be extended to include trained staff by offering either individual or group sessions. The records relating to fire training, equipment and maintenance were chosen to be looked at and these were satisfactory ensuring that residents are safe. Fire training continues in accordance with the requirements and all tests/servicing of equipment was up to date. The fire service made a visit to the home last year and all the recommendations that were made following that visit have been actionned. The last fire risk assessment was done recently. Staff continue to be trained in first aid awareness carried out by the deputy manager. Three members of staff have recently undertaken the professionally run recognised first-aid course. Whilst the manager confirmed that all necessary training had been undertaken and staff confirmed this in interviews, it is difficult to check the training records, as the system is poorly organised and difficult to follow. This was discussed with the manager and advice given on how to resolve this issue. There are other records in the home which need more stringent recording (see individual NMS). The home does not keep any pocket monies relating to residents. Friends and relatives are encouraged to do this if the resident themselves are unable to do it. Monthly bills are sent out for extras involved for example newspapers, chiropody and hairdressing. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 23 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 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 24 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 (1)(2) a,b Requirement The registered person shall after consultation with the service user prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. The registered person shall make the service user’s plan available to the service user and keep the service user’s plan under review. With regard to: • Ensuring that the service users’ care plans are regularly reviewed • Ensuring that service users’ care plans contain all the information required Timescale for action 22/09/06 Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 25 2. OP9 13 (2) 3. OP12 16 (2) (m) The registered person shall make 23/07/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. With regard to: • Ensuring that all creams, ointments and potions given to residents have either an opening date or discard date written on them • Ensuring that the medicine trolley is kept secure at all time • Ensuring that unnamed medication is not ‘potted up’ for resident use The registered person shall 23/10/06 having regard to the needs of the service users consult service users about their interests, and make arrangements to enable them to engage in local, social and community activities. (Previous timescale of 13/4/05, 11/8/05 and 15/02/06 not met) With regard to: • Developing a programme of recreational activities to suit individual residents’ varied needs Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 26 4. OP27 18(1)(a) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service userensure that at all times suitable, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service users. With regard to: • Ensuring that adequate staffing levels are maintained in relation to residents’ dependency levels & needs and are monitored and adjusted accordingly The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. (Previous timescales of 29/09/04, 16/03/05, 14/06/05 and 18/01/06 and 07/04/06 not met). With regard to: • Ensuring that each member of staff employed by the home has the following information held on their file: proof of identity, copy of birth certificate and/or passport, two written references, Criminal Records Bureau check and copies of any qualifications (including confirmation of nurse registration). 23/07/06 5. OP29 19,1-4 Sch2 1-7 23/08/06 Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 27 6. OP37 17 (1)(2)(3) Schedule 4 The registered person shall maintain in the care home the records specified in Schedule 4. With regard to: • Ensuring that the complaints record is up to date and includes both formal complaints and concerns. • Ensuring that all records relating to staff training are up to date and include names of those attended and the dates on which the training was delivered. • Ensuring that service users’ care records are regularly reviewed 23/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP9 OP27 OP27 OP31 Good Practice Recommendations It is recommended that hand-written entries on medication administration sheets are dated and signed by two staff, to verify the accuracy of the entries It is recommended that regular staff meetings be held to allow staff to voice their opinions It is recommended that designated staff are employed solely to carry out laundry duties during the day It is recommended that the manager have designated supernumerary time to attend to the routine administration and operation of the home. Swimbridge House Nursing Home DS0000026725.V293491.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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