Inspection on 18/09/06 for Swinton Lodge

This inspection was carried out on 18th September 2006.

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

Swinton Lodge 08/09/09

Swinton Lodge 10/09/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT Lead Inspector Mike Hamstead Key Unannounced Inspection 18th September 2006 07:15 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.V308761.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. Swinton Lodge DS0000003090.V308761.R01.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 NONE NONE 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 ** Post Vacant *** Care Home 63 Category(ies) of Dementia - over 65 years of age (35), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (35), Old age, not falling within any other category (28) Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 28 Beds in the Windsor unit for Old Age (OP), Dementia - over 65 years of age (DE[E]) and Mental Disorder - over 65 years of age (MD[E]) 28 Beds in the Spencer Unit for Old Age (OP) 7 Beds in the Royal Unit for Dementia - over 65 years of age (DE[E]) Manager to undertake the Registered Manager NVQ level 4 award by 2005 A condition of registration is that one named resident under the age of 65 be allowed to reside at the home. One respite bed to accommodate service users with residential/nursing care, between the ages of 55 and 65. One respite bed to accommodate service users with EMI residential/nursing care, between the ages of 55 and 65. 20th December 2005 Date of last inspection Brief Description of the Service: Swinton Lodge was purpose built in 1989, and is registered as a Care Home for Older People with nursing for 63 beds. It stands in its own grounds and is situated at the end of a cul-de-sac close to a local housing complex, but is close to local amenities and public transport. It is a two story building, divided into three separate units. Two of the units, Windsor and Royal, cater for Older People with dementia and mental disorder, but the Royal Unit is currently not being used due to a shortage of admissions. The third unit the Spencer unit accommodates Older People with varying needs including nursing needs. All bedrooms have en-suite facilities, with 59 single bedrooms and 2 double bedrooms. Each unit has a communal lounge and dining room, with tea and snack making areas in two of these. Bathing facilities include specialist baths, showers and hoist attachments for ease of users. There is also a shaft lift. The home offers physiotherapy and a relaxation room. The range of fees is currently £329:00 to £430:00 per week, effective from April 2006. Additional charges are made for hairdressing, private chiropody, and newspapers. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 5 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.V308761.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection methodology consisted of bringing together the cumulative information and evidence received at CSCI, available to the inspector since the last inspection in December 2005, interviews with the people who use the service where possible, and discussions with the administration manager, deputy care manager, visiting line manager and staff on duty. It also included an examination of the homes records, and a tour of the accommodation. There were 40 permanent residents accommodated at this inspection, and 3 residents in hospital. The inspection was commenced at 07:15 and finished at 15:15 and the inspector is grateful to all the residents, the nursing staff, and all who took part in this inspection. What the service does well: What has improved since the last inspection? Some aspects of care plan recording have improved. The home has sought specialist advice on the use of a restrictive type of seating for a resident. The number and variety of external activities has improved. The frequency of staff supervision and appraisal has improved. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 7 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. Swinton Lodge DS0000003090.V308761.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 Swinton Lodge DS0000003090.V308761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. All residents receive a thorough assessment of their needs. EVIDENCE: Residents are being admitted following a full assessment, and a sample of residents files examined confirmed this fact. This includes a combination of information obtained via residents being referred through Care Management arrangements, and evidence of the homes own assessment documentation that meets this standard. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 10 Care and ancillary staff are currently undertaking statutory training and NVQ training, to demonstrate the homes capacity to meet the assessed needs of residents. Care staff have had other training sessions on issues such as violence and aggression and nutrition and health, and training packs have been obtained on epilepsy. Further training on equality and diversity is being considered by the acting care manager. The home is not registered for Intermediate care. Swinton Lodge DS0000003090.V308761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. There is a need for a more rigorous approach to recording on resident’s assessments and care plan documentation. EVIDENCE: The plans of care for residents in both units, are completed by a named nurse and by care staff, and should be reviewed on a monthly basis, and where possible drawn up with the resident/representative as required by this standard. A number of plans of care were examined that are now part of a new Spandex system of care documentation that has recently been introduced, and it was found that the initial assessment documentation is not being signed by the nurse completing the document, and in addition the care plans examined were not being reviewed on a monthly basis as required. The social needs and activities undertaken by residents are now recorded within the new system and this contributes to the overall care management system for residents. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 12 The inspector was informed that the home is once again reviewing its care management documentation system, in order to provide the best possible care to residents. There are two residents who have mental health problems, who are visited by CPN’s, and one had received a recent visit to review his financial situation. There was evidence to indicate that access to all primary health care facilities for residents has improved but there are still some residents who have been in good health, who have not been seen by the GP for over 2 years, contravening the need for an annual review, and who also have not had their medication reviewed during this time. It was mentioned that the acting care manager should pursue this matter with the various GP practices, and Primary Care Trust to safeguard the welfare of residents. The home has negotiated a reduced cost for private chiropody for residents, because of the difficulties of obtaining NHS facilities, and the home is clearly doing all it can to promote and maintain the health of residents but clearly under difficult circumstances. The Inspector sampled the MAR sheets in the Windsor and Spencer Units, and found these to be satisfactory, and checked the controlled drugs register in the Windsor Unit that was also satisfactory. The home does not have any residents who self-medicate. There were many examples of resident’s dignity being maintained throughout the day, and care staff always addressed residents in a polite and friendly manner. Personal hygiene was provided to residents with respect and dignity. Many residents in the home display dementia related confused behaviour, and there were examples of staff treating them in a sensitive and dignified way, assisting them where required. Swinton Lodge DS0000003090.V308761.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. There are opportunities for residents to enjoy social and recreational activities, particularly within the home, and residents meetings are stimulating and provide a useful feedback to staff to form part of the homes quality assurance system. EVIDENCE: A variety of leisure and social activities are provided and residents can choose what to participate in. Choice is also provided at mealtimes and with the other routines of daily living, such as personal and social relationships, and religious observance as defined by this standard. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 14 The interests of residents are recorded at the assessment stage, and then developed via opportunities being made available for stimulation through leisure and recreational activities in and outside the home. Activities are arranged to suit individual needs, preferences and capacities and the system for organising activities has recently changed and involves the activities coordinator now being solely responsible for the activities with residents on the ground floor, and carers being given extra hours to provide activities for residents on the first floor. A notice board inside the main entrance displays current and future activities that are planned and internally a range of activities is provided including, dominoes bingo, baking and games, as well as nail care and a pampering session involving creams and perfumes. The home is hoping to acquire the use of a vehicle that it will share with another home, and there have been trips to Wentworth garden centre and there are trips planned to the coal mining museum in Wakefield, Goldthorpe to watch the King and I, and the Christmas lunch has been booked at the Carlton Park Hotel in Rotherham. It is also hoped to go to the civic theatre in Rotherham to watch a pantomime. The inspector witnessed the activities co-ordinator conducting a reminiscence activity with 5 residents that was interesting and had clearly gained the attention of all residents present and was a good example of how the use of basic resources and materials can provide stimulating entertainment and interest to older people. There are occasional visits from a local Church of England establishment, who provide a service for some residents, but no residents are currently visiting church of their own accord. Residents and their relatives and friends are informed of how to contact external agents (e.g. advocates), who will act in their interests, and there is an information rack inside the main entrance to the home. There are also contact names and numbers for the Alzheimer’s Society on the notice board. No residents have control of their financial affairs at the present time, and a sample of resident’s monies was checked and found to be accurately recorded with receipts available, demonstrating a responsible approach to resident’s finances. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 15 The menus, displayed a good supply of varied and wholesome food, and a cooked breakfast is always available, and hot and cold drinks are available at regular intervals or as requested by residents. It was good to read residents comments from a residents meeting held on the 5th and 6th September 2006 in which many expressed their views on the standard of meals provided, mentioning their likes and dislikes and requesting various foods not already provided that they would like including on the menus. Swinton Lodge DS0000003090.V308761.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, & 18 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. Residents are protected by the homes policies and procedures. EVIDENCE: There is a complaints procedure which specifies how complaints may be made and who will deal with them with an assurance that they will be responded to within a maximum of 28 days. Written information is provided to all residents for referring a complaint to the CSCI at any stage, should the complainant wish to do so. A record is kept of all complaints made and includes details of investigation and any action taken. There have been three complaints received since the last inspection, all satisfactorily dealt with, and one referral to Adult Protection that resulted in the member of staff being dismissed. The home also has a number of letters from the families of residents thanking staff for the care given to them during their stay at the home. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 17 There are procedures for responding to suspicion or evidence of abuse or neglect (including whistle blowing) to ensure the safety and protection of residents, including passing on concerns to the CSCI in accordance with the Public Interest Disclosure Act 1998. Any member of staff identified as being unsuitable to work with vulnerable adults would be referred, in accordance with the Care Standards Act, for inclusion on the Protection of Vulnerable Adults register. Some residents receive ballot papers and postal votes, and staff enable them to participate in the political process if requested to do so. The acting manager is to ensure that all residents are registered for postal votes. The policies and practices of the home ensure that physical and/or verbal aggression by residents is understood and dealt with appropriately, and that physical intervention is used only as a last resort and in accordance with DH guidance eg, de-escalation/breakaway techniques. It is planned that staff training on physical intervention/restraint will be undertaken as soon as a suitable course can be identified. Swinton Lodge DS0000003090.V308761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, & 26 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. Continuing investment is ensuring that the home is maintained in a satisfactory condition. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 19 EVIDENCE: There is an ongoing refurbishment programme that is planned to be completed by Christmas 2006, covering all aspects of the premises, many that need attention and are the inevitable consequences of a group living situation. Laundry facilities are sited so that soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on residents. There is a sluicing facility and, a sluicing disinfector, and washing machines have the specified programming ability to meet disinfection standards. Hand washing facilities are prominently sited in areas where infected material and/or clinical waste is being handled. Swinton Lodge DS0000003090.V308761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, & 30 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. The home benefits from a relatively stable staff team who are aware of the residents needs. EVIDENCE: In accordance with the home’s staffing notice for 63 residents, the staffing complement must be an RMN in the Windsor unit and 4 care staff in the waking day, and an RGN in the Spencer unit and 3 care staff during the waking day. Night-time staffing requirements are for 1 RMN and 1 RGN and 4 care staff to be on duty at all times deployed throughout the three units. The staffing situation found on this inspection was satisfactory with the exception that there wasn’t an RMN on duty, and an RGN was covering the Windsor unit. The home is advertising for an RMN, but this is proving difficult to achieve. The trained nurses however covering the Windsor unit, have some training in dealing with EMI issues. The Royal unit was still closed after refurbishment and there have been no admissions to this unit for some considerable time. There were 40 residents accommodated in the whole home at this inspection. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 21 All the staff spoken to appeared motivated and committed to providing the best possible care, and a number of the longer serving staff repeated that things were now much better in the home, since the new management arrangements have been in place. A random selection of the files of three members of staff employed since the last inspection revealed that the recruitment and selection process was being adhered to. There are 45 of care staff who have achieved their NVQ Level 2 qualification, and some staff who are studying for their Level 3. Staff are receiving induction and foundation training to NTO specification. All staff have an individual training and development assessment and profile that demonstrates their ability to meet the assessed needs of residents. Swinton Lodge DS0000003090.V308761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38 Quality in this outcome area is good, and this judgement has been made using the evidence available, and a visit to the home. Residents are protected by the homes policies and procedures. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 23 EVIDENCE: At the last inspection in December 2005, the registered person had appointed Anne Murray & Associates (10th August 2005) an experienced nursing and care home management consultancy company who have been assisting in the general management and running of the home. The registered manager who was due for retirement in 2006 took her retirement as from the end of January 2006, and the home appointed an acting manager who has put an application form in to CSCI to be registered as a “Fit Person” that is currently going through the process. In addition an administration manager has been appointed and is in post, whose role is to primarily deal with the administrative aspects of managing a care home. The Care Centre manager informed the CSCI that Anne Murray Associates are no longer acting as consultants to the home and it is being purchased by Evergreen Care Ltd who have been managing the home since November 2005 and are now purchasing it. One of the directors of the company owns several other homes in the area. The acting care manager was on annual leave at this inspection, but the deputy care manager came into the home to see if could help out on the inspection. Staff supervision is up to date and staff continue to undertake statutory training to safeguard the residents interests. All the safe working practice certificates were examined and were satisfactory, and the administration manager is to find out whether the shaft lift is having a “Thorough Examination” in addition to regular servicing. In addition efforts are being made to find out whether the electrical wiring test is due. Swinton Lodge DS0000003090.V308761.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 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Swinton Lodge DS0000003090.V308761.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 Requirement The registered person must ensure that residents assessments and plans of care are recorded in a more rigorous manner as detailed in this report. The registered person must ensure that all residents healthcare needs are being met, with particular reference to the absence of annual health checks and medication reviews for some residents. The registered person should ensure that a minimum ratio of 50 trained members of staff NVQ Level 2 or equivalent is achieved as soon as possible. Timescale for action 15/10/06 2. OP8 12 31/10/06 3. OP28 18 31/12/06 Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 26 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 OP31 Good Practice Recommendations The registered person should ensure that the Care Manager achieves a qualification at Level 4 in management and care or equivalent as soon as possible. Swinton Lodge DS0000003090.V308761.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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