Inspection on 10/09/08 for Swinton Lodge

This inspection was carried out on 10th September 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Swinton Lodge 08/09/09

Swinton Lodge 18/09/06

Swinton Lodge 20/12/05

Swinton Lodge 04/07/05

Swinton Lodge 12/10/04

Swinton Lodge 08/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT Lead Inspector Christine Rolt Key Unannounced Inspection 10th September 2008 09:30 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 Swinton Lodge DS0000003090.V371339.R02.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. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swinton Lodge Address Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT 01709 586704 01709 578172 wendy.panther@hotmail.co.uk 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) Absolute Care Homes (Swinton) Limited Manager post vacant Care Home 63 Category(ies) of Dementia (35), Mental disorder, excluding registration, with number learning disability or dementia (35), Old age, of places not falling within any other category (28) Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N, to service users of the following gender; Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP; Dementia - Code DE and Mental Disorder - Code MD The maximum number of service users who can be accommodated is: 63 18th September 2006 2. Date of last inspection Brief Description of the Service: Swinton Lodge is at the end of a cul-de-sac in a residential area of Swinton. It is near to shops and other local amenities. It is on a bus route and is also close to the local train station, which provides services to Sheffield, Doncaster and Leeds. The home is a two story building served by a passenger lift and stairs. There are three separate units with their own lounges, dining rooms, bathrooms and lavatories. All bedrooms have en-suite lavatories. The fees ranged from £353.00 to £464.00 plus funded nursing care. Addition charges were made for hairdressing, chiropody, toiletries, newspapers and outings. The acting manager supplied this information during the site visit. The registered person makes information about the service available to residents and their families via the Statement of Purpose and the Service User Guide. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate quality outcomes. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. This was a key inspection and comprised information already received from or about the home and a site visit. The site visit was from 9.30 am to 6:00 pm. The acting manager completed an Annual Quality Assurance Assessment (AQAA) before the site visit. This document gave her the opportunity to tell us what the home did well, what had improved and what they were working on to improve. Various aspects of the service were then checked during the site visit. Care practices were observed, a sample of records was examined, a partial inspection of the building was carried out and service provision was discussed with the acting manager. The majority of people living at the home were seen throughout the day and several were chatted to. Two visitors were asked for their opinions and a third visitor completed a questionnaire. The care provided for three people was checked against their records to determine if their individual needs were being met. Questionnaires were sent to ten people living in the home and five were returned and nine were sent to relatives and two were returned. All information, opinions and comments were considered for inclusion in this report. The inspector wishes to thank people living at the home, visitors, the staff and the manager for their assistance and co-operation. What the service does well: The home has a good recruitment process. The system was robust and the recruitment files contained all the relevant documentation. People living in the home were included on the interview panel. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 6 The home tried to maintain continuity of care by keeping a full complement of staff and using bank staff where there were shortages. Their use of agency staff was minimal. Staff training was good with structured induction training, and good skills training. Some staff were to undertake Dementia Care Mapping to increase their awareness of people with dementia. All staff were on a rolling programme to update their mandatory health and safety training. 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. The summary of this inspection report can be made available in other formats on request. Swinton Lodge DS0000003090.V371339.R02.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 Swinton Lodge DS0000003090.V371339.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People using this service had their needs assessed to ensure that their needs could be met but improvements could be made. This home does not provide intermediate care. EVIDENCE: People said that this home was chosen because the home was “familiar”, “convenient”, staff were helpful and the home was clean. Information in the Annual Quality Assurance Assessment (AQAA) stated that improved pre admission assessments were being used. Assessments seen on the three files that were checked provided information of people’s needs but Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 9 the information could be more person centred e.g. including people’s likes, dislikes, choices and preferences. This will help promote people’s independence and help them stay more in control of their care. During the site visit, people were asked whether they had been asked about personal choices regarding baths and showers, food preferences, etc. They could not remember being asked and one person gave an example of how this could be improved to meet her mother’s wishes. The benefit of considering and recording the choices and preferences of people living in the home was discussed with the manager. Swinton Lodge DS0000003090.V371339.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were treated with respect. Medication recording procedures were not met. Care and health needs were partially met. EVIDENCE: People living in the home looked well cared for, clean and appropriately dressed. They said they were happy living in the home. Staff were observed treating people with respect and kindness, and interactions were good. People said that they were treated with respect and dignity. A comment received was, “They seem to be very caring towards the patients.” Three care plans were checked in detail. They provided information of how each person’s needs should be met but there were also unnecessary records Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 11 where there were no identified needs e.g. maintaining body temperature and breathing difficulties, or repetitive records of general information e.g. information on administering medication. Therefore the system could be streamlined to help staff to focus on people’s identified needs and wishes. Daily records were made only once per day and provided general information that did not always relate to the care plans and did not show how each person spent their day. There was very little information of social needs being met, participation in group activities or 1 to 1 interactions throughout the day. The need for more specific information related to the person’s health and social needs and more frequent recording was discussed with the manager who agreed that this was an area for improvement. Files contained a form for listing people’s personal property. One of these was blank. Where the inventories were recorded, there was insufficient detail to enable identification if the items went missing. Each file contained a medical intervention sheet to record visits or communications with health professionals. There was a lack of consistency in how the information was recorded. On one file the medical intervention sheet stated that blood tests were to be arranged but there was no further information to confirm that these tests had been done or the outcome. Care plans were kept under review and updated as necessary. They were done in consultation with the relevant person but from the information recorded, it was not always clear whether the person understood what this meant. It was recommended that people’s representatives might need to be considered for consultation during reviews to ensure that people’s needs and wishes were being met. Relatives of people with dementia said that they would like to be kept informed. Files contained a range of risk assessments and monitoring systems. (Also see section on Environment). The manager said that accidents were recorded and a monthly accident analysis sheet was completed to determine any patterns of accidents. It was also suggested that 72-hour monitoring charts be implemented to closely monitor people who had had accidents or falls where there were no apparent injuries at the time of the incidents. The home’s system for dealing with medication was checked. The medication had not been booked in, checked and signed as being received on the Medication Administration Record (MAR) charts. Loose medication such as paracetamol that was prescribed to be given ‘as and when required’ was not carried forward onto the most recent MAR chart either. Therefore there was no record of the quantities of medication available for each person. For three days the designated staff were dealing with people’s medications but no one had taken responsibility for booking in or carrying forward the medication and Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 12 this brought into question staff’s competency for dealing with medication. This was discussed with a senior manager shortly after the site visit. An immediate requirement was issued for a stock check of all medications to be undertaken and recorded within 48 hours to verify the quantities of medication available to each person and thereby facilitate auditing. One medication on the MAR chart gave a warning that the information leaflet must be read. There was no leaflet available. The instructions for giving this medication are specific of how and when to be given including the body position. This information must be available to ensure that staff follow the instructions. Two people were being given Haloperidol medication on an ‘as and when’ basis instead of the prescribed daily dosages. Staff felt that they were doing this for the right reasons, but this should have been discussed with the prescriber, i.e. the GP, and more frequent reviews of medication should be arranged with the prescriber if there are concerns. Medication that required refrigeration was kept in a medication refrigerator but the thermometer indicated that this was above the prescribed limits. There was no monitoring of the temperature. A sheet was available that said that the temperature must be recorded daily but no entries had been made since May. The medication room had a sink for staff to wash their hands but the soap and paper towel dispensers were empty and there was no soap or towel available. The home needs to review the staff’s medication training and competency to ensure that staff follow safe medication practices. All of the above were discussed with the acting manager during the site visit and also with a senior manager shortly afterwards. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were generally satisfied with their lifestyles in the home but improvements could be made. EVIDENCE: According to information in the AQAA, the home had two activities coordinators. On the day of the site visit, the manager said that both coordinators were off work. Two members of staff were assisting with one to one activities with two or the people in the dementia unit. There were no activity programmes displayed on any of the units to inform people of any group activities. The benefit of an activities programme and better information on care plans and records was discussed with the manager. Information in care plans was sparse. (See also section on Health and Personal Care). The manager said that people who were capable could use community facilities. The AQAA provided information of outings, themed events, church Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 14 services and entertainers coming into the home. People in the dementia unit had access to a secure garden area with paths and seating. Visitors were welcomed and several were seen throughout the day. People were asked about the meals. One person considered that the meals were “lovely” and that there were choices. Another person considered that improvements could be made especially with the teatime sandwiches, which always seemed to be the same fillings. A third person commented that staff were very good at mealtimes and stated, “I have been there at meal times and they help to feed the ones that cannot feed themselves.” There were no menus available on any of the units. The manager said that staff asked people what they wanted for their meals. The provision of menu boards would give people time to plan what they wished to eat and also remind them of any meals that they had ordered. Various methods and formats to help people with dementia were discussed including large menu boards with written and pictorial information and also for staff to show people the meal choices. The teatime meal was observed on the residential unit. There was a selection of sandwiches on white and brown bread with four different fillings. The hot option was tinned spaghetti in tomato sauce with bread and butter. It was suggested to staff that people might prefer the spaghetti on toast if there was a toaster available. There was no toaster on display but staff said that this was in the cupboard. The option of toast was not offered. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People felt they were listened to and protected. EVIDENCE: Information in the AQAA stated that the complaints procedure was displayed and was also included in copies of the service user guide that were given to all people living in the home. People said that they were confident in the complaints process and would tell either the manager or the senior member of staff if they had concerns. The manager dealt appropriately with all complaints and allegations. including ancillary staff had undertaken adult safeguarding training. All staff Swinton Lodge DS0000003090.V371339.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People lived in a fairly clean and pleasant environment but maintenance and safety could improve. EVIDENCE: The home was generally clean and there were no offensive odours. asked about the environment, people said, “Pleasant smells” and “The home is well looked after” When Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 17 However, the corridor carpet was dirty and was lifting in parts. The lounge carpet on the dementia unit was badly stained. This does not respect people’s dignity and can create tripping hazards. A partial inspection of the building including four bedrooms revealed that some people’s health and safety, comfort and dignity needs were not met. • • • • • • • • • • • Beds were against bedroom walls in all four bedrooms. The manager could not verify that risk assessments had been carried out to ensure that risks to people and staff were minimised. A damaged plastic light switch in a bedroom No bedside table in one bedroom Caustic denture cleaning tablets on display in an unlocked bedroom. An unstable wardrobe that needed to be risk assessed. An overbed light that was not working A bedroom ceiling light with no shade No mirror in one bedroom and no explanation for this on the care plan Trailing wires from a sensor mat in one bedroom. Two bedrooms without lockable facilities No shelves above sinks for toiletries All of the above could have been rectified if the home had an environment monitoring check as part of its quality assurance. In addition to the above, the dementia unit would benefit from redecoration and signage to orientate people to their environment. Pictorial signs and visual stimuli would help orientate them to time and place and would help promote people’s dignity and independence. Ways of achieving this were discussed with the manager during the site visit and also with a senior manager after the site visit. Bedrooms were individualised with people’s own personal belongings. person commented that the bed linen was changed every day. One Swinton Lodge DS0000003090.V371339.R02.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People were cared for by a well trained and dedicated staff team. EVIDENCE: Information in the AQAA stated that the service was staffed “to the needs of our residents”. To provide continuity of care, bank staff were used flexibly and the home tried not to use agency staff wherever possible. There were sufficient staff on duty at the time of this inspection. People considered that the staff were good. “Good staff” “Lovely staff” “Looked after by very nice care workers” All new staff undertook structured induction training and over 50 of care staff had achieved NVQ Level 2 or above in care. Skills training was promoted and the manager supplied a list of all training undertaken within the last year. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 19 Some staff were to undertake Dementia Care Mapping to help meet the needs of people with dementia. Four staff recruitment files were checked and all contained the relevant documentation. People living in the home were encouraged to participate in the recruitment process and were included on the interview panel. One person said that he enjoyed this role. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Improvements could be made to ensure that the home is run in the best interests of people living in the home. EVIDENCE: The home did not have a registered manager and the acting manager had resigned and was due to leave shortly. Because the home had no registered manager, this standard has not been scored. After the site visit the acting manager informed the CSCI that a new manager had been appointed and was due to take over mid October. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 21 The home had safe storage for money held on behalf of people living in the home and records of accounts were kept. The money for three people was checked against the records. In two cases, the cash tallied with the records but in the third case, there was a £10 discrepancy. The manager agreed to take action on this. The manager said that the home had a quality assurance monitoring system. However, based on the discrepancies found, the quality assurances system had not identified problems e.g. care plans, medication, finance and environment. To ensure that people’s dignity, health and welfare are protected, the quality assurance system must improve. Records and certificates were available to verify that service and maintenance checks were carried out and a sample of these was checked during the site visit. However, the certificate for the passenger lift did not verify that it was compliant with the Lifting Operations and Lifting Equipment Regulations (LOLER). This was discussed with the manager during the inspection. Staff undertook mandatory health and safety training. Refresher training was available on a regular basis, which is good practice. A copy of the staff training matrix was seen during the site visit. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 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 N/A X 2 X 2 X X 3 Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 12, 15 Requirement Information in care plans must be: a. Relevant to the person’s identified needs, for example, daily records must verify that identified care needs have been met b. Individualised to include information of how each person has spent their day. Information in care plans that relates to people’s health needs must be up to date to ensure that needs have been met e.g. information of health visits and outcomes. To keep people safe from medication errors staff must follow safe practices when dealing with people’s medication. This includes: a. Ensuring the necessary information, i.e. specific instruction leaflet, is available as required b. Consulting the prescriber before prescriptions are changed c. Ensuring that medication DS0000003090.V371339.R02.S.doc Timescale for action 05/11/08 2 OP8 12 05/11/08 3 OP9 13 15/10/08 Swinton Lodge Version 5.2 Page 24 4 OP9 13 5 OP9 13 6 OP19 13 7 OP19 13 8 9 OP26 OP33 23 24 that requires refrigeration is kept at the correct temperature, monitored and recorded. d. Ensuring satisfactory record keeping. A full check of all medications held within the home must be carried out to verify the amounts of stocks held and this must be verified by up to date records of medications to ensure that people living in the home are not put at unnecessary risks. An immediate requirement was issued. The competency of staff who deal with medication must be assessed and medication training undertaken as considered necessary to ensure that people are safe from medication errors. Nursing staff must also act according to guidance from the NMC e.g. guidelines for the administration of medication. To ensure that there are no unnecessary risks to people living or working in the home, risk assessments must be carried out and the risks minimised, e.g. beds against walls and unstable bedroom furniture Health and safety checks must be carried out and action taken to minimise risks, e.g. trailing wires, broken light switch, caustic denture cleaning tablets on display. Carpets must be kept clean and in good condition The quality assurance monitoring system must improve to better protect people’s health, safety and dignity, and include: a. Environmental audits and DS0000003090.V371339.R02.S.doc 12/10/08 15/10/08 15/10/08 15/10/08 05/11/08 05/11/08 Swinton Lodge Version 5.2 Page 25 10 OP35 17 checks to highlight missing, faulty and damaged furniture, furnishings and equipment. b. Medication procedures and checks c. Regular audits of money held on behalf of people living in the home. d. Audits of care plans and records to ensure the information is up to date and relevant to the persons. The system for looking after 15/10/08 money held on behalf of people living in the home must be robust 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 5 Refer to Standard OP3 OP7 OP7 OP7 OP8 Good Practice Recommendations The inclusion of people’s choices, preferences, likes and dislikes in their assessments and subsequently their care plans would benefit people living in the home. Consider streamlining the information in care plans to ensure focus is on people’s identified needs Inventories should provide sufficient details to enable identification of items Consider inviting people’s representatives for reviews of care plans. The implementation of 72 hr monitoring sheets for accidents and falls would provide a system of close monitoring where there were no apparent injuries at the time of the incident. The Royal Pharmaceutical Society’s guide “The Handling of Medicines in Social Care” would remind staff of the correct procedures for dealing with medication. Consider more frequent reviews of medications with GPs DS0000003090.V371339.R02.S.doc Version 5.2 Page 26 6 7 OP9 OP9 Swinton Lodge 8 9 10 11 OP9 OP12 OP15 OP19 12 13 OP19 OP38 when considered necessary Provide liquid soap and paper towels in the medication room as part of the home’s infection control measures to prevent cross contamination An activity programme would inform people of the activities on offer. Menu boards in various formats would help people to plan what they wished to eat at mealtimes and would also act as a reminder of the meals on offer. People should have lockable facilities, and a range of furniture and equipment for their comfort as listed in the National Minimum Standards unless there are valid reasons for not doing so. Aids to orientation around the dementia unit and to time and place should be seriously considered to help people maintain their independence as far as possible. The registered person should be conversant with current heath and safety and associated regulations to ensure compliance when arranging for the servicing and maintenance of equipment and systems i.e. LOLER. Swinton Lodge DS0000003090.V371339.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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