CARE HOMES FOR OLDER PEOPLE
Swimbridge House Nursing Home Welcombe Lane Swimbridge Barnstaple Devon EX32 0QT Lead Inspector
Dee McEvoy Announced Inspection 23rd November 2005 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.V249849.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 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.V249849.R01.S.doc Version 5.0 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. 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. A car park and turning area have been provided. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection was the second inspection of the current year and took the inspector one day to complete. National Minimum Standards, which have been met at the previous inspection on 19 May 2005, were not inspected on this occasion. This inspection focussed on key National Minimum Standards, which had not been inspected at the previous inspection or those, which were the subject of previous requirements and/or recommendations There were 21 residents living at the home, and one person had been admitted for respite care. The inspector spoke with six residents in some depth as well as meeting others around the home. 12 residents and 10 relatives/visitors returned CSCI comment cards. One relative was spoken with during the inspection. The registered manager, provider and several staff members contributed to the inspection. The inspector toured the premises and inspected a number of records including residents’ assessments and care plans, records relating to recruitment and training and a pre-inspection questionnaire. Finally, the outcome of the inspection was discussed with the provider and registered manager. What the service does well: What has improved since the last inspection?
Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 6 The storage of medicines requiring refrigeration has improved. In order to ensure that residents are consulted about activities, and their needs and preferences are understood and planned for in this area, a monthly ‘focus group’ has been established. Relatives are also encouraged to attend. Redecoration and refurbishment continues in areas around the home including individual bedrooms, to ensure that a pleasant environment is maintained for residents. Quality assurance systems are developing, regular residents’ meetings and a care-planning audit have been undertaken to look at areas of improvement. This work is to be evaluated and the findings made available to the residents, relatives and CSCI. 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.V249849.R01.S.doc Version 5.0 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.V249849.R01.S.doc Version 5.0 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 This standard was met at the previous inspection EVIDENCE: Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 9 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&9 Residents’ health and personal care needs are identified and met by staff that have the right approach towards them, however some assessments lack sufficient detail in order to ensure the safety of the residents while promoting independence where possible. Medication systems are generally good. However, some aspects of practice do not ensure safe administration. EVIDENCE: Most residents felt that staff had a good understanding of their needs, all spoken with or responding with comment cards felt well cared for, and said that staff treated them with respect. Five care plans were looked at and residents were case tracked. Records identify aspects of health and personal care needs, and a number of social needs were also recorded. However, the social needs recorded for one resident did not reflect the needs identified by the resident or their relative. Records of wound care were generally good and the home is planning to implement the new diabetes care plan developed by the local PCT. Evaluations/reviews of care were often brief, not showing whether care had been appropriate or successful in meeting residents’ needs, many entries said “No change” for some months.
Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 10 Manual handling plans and other risk assessments were present but not all had been completed, for example, weights, mental states and environmental issues were blank in some cases, not reflecting residents’ abilities. The inspector was told that the home did not have weighing scales suitable for all residents. The storage of medicines requiring refrigeration has improved since the last inspection. A new medicines fridge has been purchased and temperatures had been regularly monitored. Medication records were checked. Hand written entries were noted on the Medicine Administration Records (MAR) charts; these had not been signed or dated. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 11 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, 14 & 15 Although improving, social activities do not fully meet individual residents’ needs, expectations or preferences. Residents enjoy meals, which are nutritious and appealing, taking into account, the likes and dislikes of individuals. EVIDENCE: Since the last inspection an activities care plan is being used to identify residents’ level of ability and potential activities enjoyed by them. The home is encouraging residents and relatives to assist with the completion of social histories to further develop interests and hobbies. Three residents said they had enjoyed a recent visit from a theatre company, others said they enjoyed the church service held at the home. This is commendable, but several comments made by residents and one relative showed that improvement in this area was crucial if individual needs were to be met. One resident with sensory impairment felt that some of the group activities provided, for example bingo and films, were not appropriate for them; other residents with cognitive impairment would also find these activities difficult to engage with. Where one-to-one activities had been identified a resident and relative told the inspector, “I understand I can’t have individual attention” and “ Staff don’t have the time”. The relative felt that, “Residents need something useful and satisfying to do.” On the morning of the inspection 5 residents were in the sitting room watching cartoons; the manager told the inspector they were
Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 12 waiting for a daytime programme, which they usually enjoyed. Two residents were dozing in their chairs. During a period of an hour, staff were seen to pass through the sitting room, but little social contact was observed between residents and staff during the morning. Three or four residents played bingo in the afternoon with one staff member. Two residents were happy to stay in their rooms, reading and watch TV and were not interested in group activities but one said it would be nice to have some time with the staff to chat. Two other residents said they would like an occasional trip out. The majority of residents were very happy with the food provided, comments included, “The food is lovely” and “I am happy with food”. Residents told the inspector that alternatives were provided if they did not like or want the main dish. Menus were varied, providing a fairly balanced diet. The home has an experienced cook, who is aware of individual needs, and preferences. The inspector enjoyed lunch with the residents. Staff were on hand to provide assistance where needed. Several residents preferred to eat in their rooms, which was facilitate by staff. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 13 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 The home has a satisfactory complaints system, with evidence that residents feel their concerns would be listened to. Staff understand the principles of adult protection and this protects residents from abuse. EVIDENCE: The home has a comprehensive complaints procedure in place; a copy of the procedure is displayed in the entrance hall and complaints were the subject of a recent focus group to ensure residents were aware. Residents spoken with had no complaints but were aware of whom to speak with if they were unhappy. All but two relatives were aware of the complaints procedure; none of the relatives responding had made a complaint. A record of the most recent complaints was inspected. The complaints record detailed the action taken and the outcome. The inspector also saw several thank you cards and letters of appreciation sent to the staff. Staff spoken with had undertaken adult protection training, and were aware of their personal responsibilities with regards to reporting any concerns or incidents. Residents spoken with and those responding with comment cards said they felt safe at the home. With the exception of one incidence, where bed rails are used a risk assessment is completed and consent sought from the resident. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 14 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 The standard of the environment within this home is good, providing residents with an attractive, clean and comfortable place to live. EVIDENCE: The home appeared well maintained generally, both internally and externally. Residents liked the accommodation, including their bedrooms. Several bedrooms have been redecorated and new carpets fitted; the lounge and dining room have also been redecorated and were bright, clean and warm. The home was clean and free from offensive odours, and residents confirmed that this was usual. The sluice areas were clean, and the laundry was tidy and organised, although a washing machine was out of order and waiting to be repaired. Gloves and aprons are available, and communal toilets have liquid soap and paper towels at hand. The staff training plan and the pre-inspection questionnaire showed that infection control training had been planned for November. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 15 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 The deployment and number of staff available is not always sufficient to meet the needs and preferences of the residents in a timely way. Recruitment systems are failing to fully protect residents. Areas of staff training need development to ensure that staff have the skills to meet the residents’ needs EVIDENCE: The residents were positive about the staff team; all felt well cared for and many said staff were “kind” and “lovely” but three residents said the home sometimes appeared short of staff. One resident told the inspector, “They (the staff) are always busy.” Two relatives responding with comment cards felt that sufficient number of staff were not always available. Three residents, one relative and one staff member said that they would like more one to one time, to peruse interests and “do little things” such as chatting, reading and assisting with correspondence. The number of staff available for each shift has not changed since the last inspection. The pre-inspection questionnaire shows that all residents require assistance with personal care, that 5 have a dementia type illness, 8 are wheelchair users and that at least 5 or 6 require two staff to undertake their care. On the morning of the inspection, the inspector was unable to interview staff as they were busy with various care-related duties. The off duty showed that the manager and some staff were working excessive hours; over 60 hours were recorded for one week for two members of staff. This was discussed with the manager.
Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 16 Four staff recruitment files were examined; the necessary documents were not available in all files. One file contained a CRB from a previous employer; the manager was reminded that CRBs are not transferable. Two other files, for overseas staff did not contain the necessary CBR checks. The recruitment for agency staff was discussed. The home is not currently obtaining the required information about individual agency staff. Staff are encouraged and supported to achieve NVQ; four care staff currently hold NVQ 2 or above. The home will need to develop a strategy to increase this number. A basic training plan has been developed since the last inspection and a staff questionnaire has identified areas of learning which will help to develop the training programme further. Training currently focuses on mandatory training such as fire safety and manual handling but also needs to reflect the needs and conditions of the residents. All new staff receive induction, which is supervised by a senior nurse. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 17 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 & 38 Residents and staff benefit from the open and friendly approach of the Manager. Residents’ involvement in the running of the home is encouraged, with evidence that their views are sought. However, formal review of the quality of care is less well addressed. The health and safety of residents is in the main protected by the Home’s systems but without regular updates of mandatory training, safe working practices are at risk. EVIDENCE: Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 18 The manager is hard working, with a ‘hands-on’ approach. The manager is a Registered General Nurse and is undertaking the Registered Manager’s Award, which she hopes to complete in February 2006. The duty rota shows that the manager has very little supernumerary time to address the routine administration and operation of the home, for example staff recruitment, training and supervision and quality assurance initiatives. It is noted that some of these duties have been delegated to a senior nurse, but these are issues identified as needing improvement. Residents and staff expressed their confidence in the manager and said that she was easy to talk to. A quality assurance system has been implemented since the last inspection and includes regular residents’ and relatives meetings and an internal audit of care planning has been completed. The home has plans to implement the Essence of Care tool. An evaluation of the quality of care has not been completed and made available to residents, relatives or CSCI. The manager uses a training matrix to identify where mandatory training is needed for staff; it was noted that several staff required up dates in fire safety, manual handling and health and safety. Accidents are well recorded. The first floor windows are not restricted; the manager has completed individual risk assessments for residents on the first floor as required at previous inspections. Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 1 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X X X 1 Swimbridge House Nursing Home DS0000026725.V249849.R01.S.doc Version 5.0 Page 20 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 OP12 Regulation 16 (2) (m) Requirement The registered person shall 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 not met) 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 uses. (This is regarding adequate staffing levels in relation to residents’ dependency levels & needs.) 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
DS0000026725.V249849.R01.S.doc Timescale for action 15/02/06 2 OP27 18(1)(a) 18/01/06 3 OP29 19 (1) b Sch 2 1-7 18/01/06 Swimbridge House Nursing Home Version 5.0 Page 21 4 OP33 24 5 OP38 13 (4) documents specified in paragraphs 1 to 7 of Schedule 2.This refers to references (Previous timescales of 29/9/04, 16/3/05 & 14/6/05 not met) The registered person shall 15/02/06 establish & maintain a system for reviewing and improving the quality of care, including the quality of nursing, consulting residents & their representatives. And you must supply a copy of these reviews to the Commission, and make a copy available to residents. The registered person shall make 15/02/06 suitable arrangements for the training of staff in first aid. The registered person shall make 15/02/06 suitable arrangements to provide a safe system for moving and handling residents. (This relates to staff training needs.) Staff receive training appropriate to the work they are to perform (This relates to fire safety, infection control and food hygiene training) 15/02/06 6 OP38 13 (5) 7 OP38 18 (1) (c) (i) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations It is recommended that 1.) All care plans include social care needs and contain adequately detailed information, to ensure that staff know what action to take to meet individual residents’ needs and expectations in relation to interests, hobbies and activities. 2.) That reviews are monthly, include residents (or their
DS0000026725.V249849.R01.S.doc Version 5.0 Page 22 Swimbridge House Nursing Home 2 3 4 5 6 OP9 OP18 OP28 OP30 OP31 representatives) where possible, and reflect changing needs. 3.) That manual handling and assessments 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 the use of bedrails be risk assessed and consent sought from residents. It is recommended that the home develop a strategy for ensuring that 50 of care staff achieve NVQ 2 or above. Staff training should include issues specific to residents’ needs. 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.V249849.R01.S.doc Version 5.0 Page 23 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
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