Inspection on 03/10/07 for Swimbridge House Nursing Home

This inspection was carried out on 3rd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

Other inspections for this house

Swimbridge House Nursing Home 09/02/10

Swimbridge House Nursing Home 15/10/09

Swimbridge House Nursing Home 01/10/09

Swimbridge House Nursing Home 14/10/08

Swimbridge House Nursing Home 22/06/06

Swimbridge House Nursing Home 23/11/05

Swimbridge House Nursing Home 19/01/05

Swimbridge House Nursing Home 26/08/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swimbridge House Nursing Home Welcombe Lane Swimbridge Barnstaple Devon EX32 0QT Lead Inspector Victoria Stewart 3 rd Unannounced Inspection and 18 October 2007 10:00 th 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.V342611.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.V342611.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.V342611.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. 26th March 2007 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 large car park has been provided. The home is situated in an area, which is not served by public transport and therefore accessed by private vehicles only. A pre-school nursery has been opened adjacent to the home in part of the surrounding grounds. The cost of care ranges from £435 to £540 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. The home also makes a charge of £15.00 per hour if any person needs a member of staff to escort them anywhere. If anyone visiting the home wants to take lunch or dinner with their relative or friend, the home charges an extra cost of £3.00 per person. Current information about the service, including the CSCI inspection reports is available upon request for those people that may wish to look at them. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A total of two days were spent at the home and the CSCI Pharmacist Inspector also attended. At the time of the visit, there were 20 people living at the home with one vacancy. The last key inspection took place on 22 June, 2006. A further random inspection took place on 26 March, 2007 – the purpose of this visit was to monitor the home’s progress to meet the outstanding requirements of the last inspection report, with particular regard to staff recruitment. Several weeks before the inspection took place an Annual Quality Assurance Assessment (AQAA) document, which contains general information about the home and the people living there, was completed by the registered manager of the home and returned to the CSCI. From this information, survey forms were then sent out to residents, relatives and health/social care professionals. Responses were received from 5 residents, 6 relatives and no health/social care professionals. We also spoke with a further 2 relatives and 8 members of staff during our visit to the home. Swimbridge provides nursing care for people with old age and a percentage of those people living at the home do not have the capacity to communicate fully or understand the inspection process. Therefore we spent a considerable amount of time observing the care and attention given to these people by staff. We also looked closely at the care given to three specific people living at the home, looked at a selection of records (including residents’ files, staff files, medication records, staff training records, quality assurance records, health and safety records) and undertook a tour of the premises. All of this evidence has been used and included in this report to help form the judgements and findings of this inspection. On the first day of inspection, the manager was on annual leave and a registered nurse was in charge of the home. The manager was present on the second day of inspection. The outcome of the inspection was discussed with both the registered nurse on the first day and the manager on the second day of inspection before we left the home. What the service does well: Staff working at the home have a kind and caring attitude towards people. People living at the home told us that staff were “very caring and attentive”. Staff ensure that people’s privacy and dignity is respected and people told us that they feel staff listen and act on what they say. Staff are recruited appropriately and receive supervision in their jobs. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 6 Visitors are made welcome in the home and responses from relatives showed that there is a homely, friendly atmosphere in the home. People felt the food was good and that they enjoyed the choice of meals available. The home takes people’s concerns and complaints seriously and records showed that people are listened to, their concerns addressed and any action needed is taken. The home is clean and fresh. Rooms are personalised, well kept and individual. What has improved since the last inspection? What they could do better: 5 requirements have been made/carried forward as a result of this inspection. Two of these required immediate action which the home resolved as soon as they were highlighted. People living at the home must have a detailed plan of care and risk assessments describing how their individual needs are to be met, to help staff to provide consistent and safe care. These people must also have all their medicines that have been prescribed to them and satisfactory records must be kept. The home must regularly monitor its service, facilities and care delivered to people and act as a result of this. People must be made aware that if living at Swimbridge, the opportunities for individual social, recreational and meaningful activities is very limited, unplanned and ad hoc. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Swimbridge House Nursing Home DS0000026725.V342611.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 Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into Swimbridge can be assured that they will receive full information about the home. Those choosing to live there will receive an assessment before they move in to make sure that the home can fully meet their individual needs. EVIDENCE: Surveys received from people living at the home showed that two out of five were asked if they wanted to move into the home and four out of five said that they had received enough information about the home before they moved in. The AQAA states that the home ensures that all families have the information they need to make a choice about the home and are encouraged to visit the home. Five relative surveys confirmed this. The home accepts people who are either privately funded or state funded. The manager visits all people who wish to live at Swimbridge so that they can be assessed to ensure that the home can meet their needs fully. If the person is Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 10 not from the local areas, then as assessment may be done by telephone with an appropriate person. We looked at four people’s care files and these showed that information is gathered before people move into the home. These assessments had been completed appropriately by a health or social services professional. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and care needs of people living at the home are generally met. Further development of the care planning process will ensure that these needs are met in a consistent manner. People living at the home may not always receive all the medicines that are prescribed to them. EVIDENCE: The AQAA states that the home has individual plans of care which address the health and social care needs, which would include gathering information of their past history, social interests and family relationships. We looked at the care files of three people living at the home. Three of these contained care plans and some risk assessments. One person who had been living at the home for approximately two weeks did not have a plan of care at all. This person had been admitted to the home from hospital and was in an extremely frail condition, was unable to do anything for themselves and therefore relied on the nursing/care staff to look after them Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 12 totally. An assessment had been completed by health/care professionals and a discharge letter written by the hospital staff. Both of these documents assessed this person as being in need of much nursing care and attention and highlighted their problems. No risk assessments at all had been completed on this person, but a daily record of care had been completed. Staff looking after this person were therefore relying on their own individual experience, skills and knowledge to look after this person. We spoke with the member of care staff looking after this person and he/she explained the care they were giving and gave a clear and detailed history of what this person was like when they first came to live at Swimbridge, how they had improved and how their care had now changed from two weeks ago. This member of staff also had good knowledge of this person as an individual, their family contacts and their interests. He/she commented that he/she did read the care plans and understood how important they are to make sure that people are looked after properly. He/she said this he/she felt it was particularly important as the home was using staff from an agency that did not know the people living at the home and would need to use the care plan to help them. On the first day of inspection, out of the four care staff on duty in the morning, two were experienced, one was a new member of staff and one was from an agency. An immediate requirement was made for the home to complete a plan of care for this person. We saw that the care files in the home are complex, not easy to use and some of the information was repeated. This has the possibility of making staff not want to use them or complete them properly. They do not plan care for an individual person and focus mainly on the care tasks that are to be performed on each person. None of the care files contained information about a person’s previous life, social interests or hobbies. The home has a workbook which the staff use to complete their duties. This refers to the people living in the home as ‘numbers’ and resident’s doors to their rooms are also numbers. We talked to one member of staff who was aware of their duties they had to perform, but had no idea about actual the person he/she was looking after, for example their family, past history, interests etc. The care staff use a separate set of files which tells then what time a person likes to get up, go to bed etc and these held useful information. We saw that residents were treated with respect and dignity from staff and that staff addressed residents in the way in which they wanted. We also heard very good staff-people interactions when the member of staff was unaware we were present. On arrival we found that the medicines trolley was in the manager’s office. Attached to the trolley was an open plastic box containing prescribed eye drops and inhalers. We were told that the office door is closed when no one is present however we observed a person living at the home entering the office Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 13 to look for something whilst the member of staff was elsewhere administering medicines. We found that for one person a GP had visited and prescribed medicines 13 days previously and, although a hand written medication administration record (MAR) chart had been made, no medicine had been obtained for this person. This chart only had one signature and was not dated. A record was found to indicate that the home had chased the supply of these medicines after 5 days but not subsequently. An immediate requirement was made for the home to obtain a supply of this medicine. We found that the home record the receipt of the monthly medicines in to the home, however when medicines are received at other times the quantity received and the date of receipt are mostly not recorded. This means that it is not possible to audit if people are receiving medicines as prescribed or the quantities of medicines in the home. We found that for some people prescribed medicines to be administered with a variable dose the actual dose administered is not recorded either on the MAR or in the daily records. We found that although a dedicated medicines fridge is provided that not all medicines requiring refrigeration were stored appropriately. Also the home only monitor the current temperature of the fridge and so are unable to demonstrate that the medicines are stored within the temperature range as specified by the manufacturers. We found some date expired sterile products, and also that nutritional supplements are not stored appropriately. There were also some opened and unlabelled tubes of cream that we were told were used as homely remedies, however these items were not on the list of medicines included in the homely remedies policy. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The friendly atmosphere helps people and their friends/relatives feel welcome and at home. Residents’ benefit from a diet that is good but there is a limited programme of meaningful activities which residents can participate in. EVIDENCE: Staff and relatives confirmed that visits are welcome at any time and those visiting are made to feel welcome with beverages offered. One commented, “always offered refreshments when visiting”. Four relatives felt that the person living at the home was “usually” supported to live as they choose and one relative said they were “sometimes”. Four residents said that they can do what they want to do and one said they could not. The AQAA says that the routines in the home are flexible and one to one activities are offered for the people living there. The home has a supply of newspapers, magazines, painting and drawing equipment, a computer and library books. The AQAA and the home’s statement of purpose say that outings are arranged and that the home ‘maximises intellectual, emotional, and social capacity”. The most recent outing to be arranged by the home was to see a pantomime in December 2006. The manager said that she ensures activities are individual and does this by talking to the people who live there, Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 15 by helping them to read and write, by watching television, having their hair done, attending a church service or having a discussion. No member of staff is employed to do activities but it happens to be whoever is on duty in the afternoon. Staff said that activities do not always happen as they are too busy and comments from residents when they were asked about activities were “TV – source of all entertainment” and “options are very limited”. On the two days of inspection, we saw that very little stimulation or activities were offered to people. One person had the use of a computer and when asked if he liked it, commented that there was nothing else to do and he spent most of his time on it. Another person has a toy dog which the home had bought for her and she liked to keep it close and one other person likes to grow vegetables – however, he commented that he has been waiting a long time for the home to purchase some topsoil for the vegetable/flower beds as he cannot grow the vegetables without this. Wherever possible residents or their families take responsibility for their finances and valuables. In order that residents feel ‘at home’ they are encouraged to bring with them items of sentimental value, such as pictures, ornaments and in some instances, items of furniture. These are used to personalise bedrooms and thereby give residents a sense of ownership of their rooms and immediate environment. During the inspection we saw residents having both their breakfast and their lunch. Care staff give out the breakfast whilst the cook concentrates on preparing lunch and tea. The cook has worked at the home for many years and people were very complimentary of the food served. Two visiting relatives were sharing lunch. No actual choice of food is offered, however the cook knew when some people did not like the food choice and prepared an alternative meal. The AQAA states that afternoon staff record teatime orders in a book. However, staff said this does not always happen and no records are kept of the type of food served at teatime. One complaint received by the home was in relation to a person not receiving the food they wanted at teatime by a member of staff. The manager had dealt this with. The kitchen is well stocked, clean and tidy. The home follows the principles of Safer Food, Better Business. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good complaints procedure where people can be confident that their concerns will be listened to. Adequate procedures are in place to ensure that people are protected from abuse. EVIDENCE: The AQAA states that all complaints and concerns are dealt with as soon as possible and are welcomed as an opportunity to improve the service. We saw that the complaints procedure is displayed in the home. Resident surveys stated that they knew how to make a complaint and one commented “there are no complaints to make up to now”. All residents and relatives confirmed that they knew who to speak to if they were not happy and knew how to make a complaint. We received no complaints about the service and many positive comments were received, for example “I have never been concerned ”, “never had to have a concern” and “I have never had any complaints about the care of XXX”. We looked at the complaints file and saw that six complaints had been received since the last inspection. All of these complaints, which covered relatively minor issues, had been investigated and appropriate action taken if required. Staff surveys and conversations showed that the majority of staff are aware of adult protection procedures. The AQAA and staff training files confirmed that Protection of Vulnerable Adult training took place in August and September 2007. All new staff to the home have training provided by the manager which Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 17 includes watching the Safeguarding Adults video, recognising the signs of abuse and being aware of the correct procedures to take. Formal training is then arranged at a later date. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a clean and homely environment, which is suitable for their needs. EVIDENCE: Both resident and relative surveys stated that the home is always fresh and clean and comments included “the home has a warm and friendly atmosphere” and “always clean and tidy”. We had a tour of the premises including private rooms, communal areas, laundry and the kitchen. We saw that Swimbridge was fresh and clean with one cleaner busy on duty. The home has an 8-person shaft lift which enable residents and relatives to access all areas. People are able to have a telephone and/or television in their private rooms. Private rooms are decorated and furnished with some sentimental and personal items brought from their homes. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 19 The home has an outdoor area where people can sit if they wish, and this is easily accessible from the lounge/dining room areas. The laundry area is sufficient for the number of people living at the home. Care staff undertake laundry duties in their daily routine. We saw that laundry was being washed at the correct temperatures to ensure it is cleaned properly. The home is fitted with temperature regulators on the hot water systems to ensure that people are protected from burns from water that may be too hot. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of staff on duty are sufficient to meet the needs of the people living at this home. People living at the home are protected by the home’s satisfactory recruitment procedure. New staff undergo comprehensive induction training. EVIDENCE: People and their relatives were very complimentary of the staff employed at the home – comments included “the staff are always very caring and attentive”, “we found the staff at Swimbridge very friendly and very caring” and “the girls are all very friendly and caring at all times”. There were 21 people living in the home on the day of inspection, with one vacancy. The home as a registered nurse in charge on each shift who is assisted by 4 care staff from 8am-2pm, 3 care staff from 2pm-8pm and 1 care staff 8pm-8am night duty. The home has had some shortfalls in staff recently and the home has employed agency staff to cover the home. On the first day of inspection, both on the morning and the afternoon shift had one member of care staff on duty from an agency. The AQAA confirmed that, at the time of writing, qualified nursing staff had covered 26 shifts and care staff had covered 43 shifts, both supplied by a local agency. The home believes that “we use agency staff till the right person comes along” and therefore ensures the most appropriate people are employed at the home. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 21 The AQAA states that 8 members of staff have left in the last 12 months. People and their relatives commented that this had sometimes had an effect on the people living there, for example “Staff quality could improve”, “sometimes the change of staff upset him/her” and “8 experienced staff have left within the last 12 months” The home has a core of staff who have worked at the home for some time and are committed individuals who care about the residents. This is supplemented with newly recruited employees and the staff team reported higher morale than at the last inspection. We looked at the files of two members of care/domestic staff and a qualified nurse. These files showed that most of the right checks were in place before they started work. Training has improved in the home and records demonstrated this. New staff in the home undertake a 12-week induction programme obtained from the Residential and Care Home resources. One member of newly employed staff confirmed they had a copy of this and were working through it. With the exception of two, all members of care staff have completed, almost completed or beginning NVQ level 2 training in care which will give them the skills to do their jobs properly. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is good communication between staff, residents and management with good attention to health and safety procedures. There are limited arrangements in place which allow people to be involved in the running of the home and their views sought. EVIDENCE: The registered manager is a qualified general nurse with a formal qualification in management - the Registered Manager’s Award. She has worked at the home for several years and ensures an open and transparent atmosphere it maintained. Staff and relatives confirmed this. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 23 On the first day of inspection, the manager was on annual leave and the qualified nurse assisted the inspectors. The AQAA states that the home has a “good quality assurance system to monitor the services”. However, when we looked at this document it was sent to people living at the home in January 2006 and no audit had been done since. The home holds ‘focus group meetings’ which the manager considers to be part of the activities of the home. These are small meetings which encourage the participation of people living at the home and their relatives. The AQAA states that they are held “at least 3 monthly and more often if a topic needs to be discussed”. Topics discussed are stated to be menu planning, activities, complaints, laundry, environment, cleanliness, making choices and taking risks. However, records showed that the last discussion was on ‘equality and diversity’, which took place in September 2007 and the one previous to that on ‘taking risks’ was March 2007. Previous to that one took place in October 2006. The manager states told us that she talks to the people weekly to see if they have any problems. Qualified nurse meetings have recently begun and the last one was held in June 2007 when care planning systems were discussed. The last care staff meeting was held “a couple of years ago” and are not routinely held. Staff commented that they would find these useful if they were offered. The manager has begun formal supervision for all staff, with the exception of night staff and is continuing this on a rolling programme. The home encourages relatives to look after people’s private monies and does not hold any at the home. The accident book was looked at and we saw that one person had had a large amount of falls recorded. The home was now auditing these and had called in a specialist professional for advice. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 25 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 You must ensure that each person living in the home has a comprehensive care plan and risk assessments made based on their assessment of need. This must be regularly reviewed. Immediate requirement made. This is an outstanding requirement from the last report with timescale of 26/03/07 not met. You must have in place a safe system to ensure the timely provision of prescribed medicines. Immediate requirement made. To prevent unauthorised access to medicines they must be kept secure at all times. To ensure that it is possible to audit the administration of medicines a record must be made of the date of receipt and the quantity received for all medicines received into the home. Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 26 Timescale for action 03/10/07 2. OP9 13(2) 03/10/07 3. OP9 13 (2) 03/01/08 You must have in place a system to ensure that date expired products are removed from use promptly. 4. OP12 16 (2) (m) Social, recreational and community activities are strictly limited and do not provide meaningful stimulation or reflect individual interests for the people that live there. Information held on the statement of purpose and other relevant documents needs amending to reflect this deficit and people can then choose whether they wish to live in the home or not. This is an outstanding requirement from previous reports with timescales of 13/4/05, 11/8/05 and 15/02/06 and 26.3.07. Little has been done to meet this regulation. 18/12/07 5. OP33 24 (1) (2) (3) You must ensure that the 18/01/08 services, facilities and care provided by the home are regularly reviewed and shall include both people living at the home and their friends/relatives. A copy of this review must be available for the Commission and for people and their friends/relatives to look at. 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 Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 27 1. OP9 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 2. OP27 Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swimbridge House Nursing Home DS0000026725.V342611.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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