Inspection on 08/09/09 for Swinton Lodge

This inspection was carried out on 8th September 2009.

CQC 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 10/09/08

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

Similar services:

Abbey The

Snydale Care Home

Whiteley House

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT Lead Inspector Jayne White Key Unannounced Inspection 8th September 2009 09:30 DS0000003090.V377529.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Swinton Lodge DS0000003090.V377529.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 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.V377529.R01.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 10th September 2008 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 toilets. All bedrooms have en-suite toilets. On 8 September 2009 the manager said the fees ranged from £353.00 to £464.00 plus funded nursing care. Additional 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 people and their families via the Statement of Purpose and the Service User Guide. Swinton Lodge DS0000003090.V377529.R01.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 by CQC about the home and a site visit. The site visit was undertaken without giving the service any notice from 9.30 am to 6:15 pm. A pharmacy inspector, Mr Steve Baker also visited with the inspector to examine the current medication administration record charts (MARs) and review the medication storage, ordering and disposal arrangements on all three units, because of concerns that had been raised about how the service were managing people’s medication. The manager, Christine Price was present during the visit. The 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 developing in the next twelve months. Various aspects of the service were then checked during the site visit, including inspection of parts of the environment, records relating to the running of the home, observing care practices and inspecting a sample of policies and procedures. Surveys were sent to people, their representatives and health and social care professionals asking them about their opinion of the quality of the service provided. Four surveys were returned by people living in the home, four were returned by representatives, this was either peoples’ relatives or friends and two were returned by health care professional. Five surveys were also sent to staff to ask them about their work at the home, one was returned. Throughout the visit we observed the care people received and we spoke with some of them about this, together with a representative. The care provided for people was checked against their records to determine if their individual needs identified in their plan of care were being met. We also spoke with staff and the manager about their knowledge, skills and experiences of working at the home. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.2 Page 6 A random inspection also took place at the service on 20 January 2009, because there had been several referrals to adult safeguarding since the key inspection on 10 September 2008, information from Doncaster Social Services highlighted environmental issues including a lack of heating, there were queries about whether people were being placed on the unit most suitable for their assessed needs and category of care and we had not received the improvement plan to verify that requirements made at the key inspection had been met. We checked all the key standards and requirements made at the last key and random inspections. The manager was provided with initial feedback from the inspection during and at the end of the visit. What the service does well: People could be confident the care home could support them with their care needs, because an assessment had taken place about what these were. People were generally satisfied with their daily life in the home. What has improved since the last inspection? What they could do better: The manager should apply to be registered with the Commission, so that they can determine her fitness to be registered. Improve record keeping in peoples’ care plans to demonstrate peoples’ health and personal care needs are being met. So that peoples’ living environment is respected and hygiene controls met, the lounge/dining room should not be used to cut peoples’ hair. Provide sufficient numbers of nursing staff to make sure medication administration records are fully completed to demonstrate people receive their prescribed medication correctly. Improve record keeping for medication and implement safe practice, for example, staff administering medication to make the record they have done so, obtaining a witness signature to any changes of medication and record medicines carried forward from one month to another. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.2 Page 7 Provide a more person centred approach to meet peoples’ social and recreational expectations. The provider and manager need to have a better understanding of how to meet the needs of people with dementia and enduring mental health, including, their environment and managing their care and put this into practice. Have the complaints procedure displayed, so people know how they can make a complaint should they need to do so. Improve the living environment for people with dementia, so they are more easily orientated, which would promote their independence. For people with enduring mental health needs the living environment needs to be better maintained, organised in a less institutionalised way and much brighter. Deploy staff in a better way, so they are better placed to meet peoples’ needs and in more appropriate numbers. Provide specialist training for staff, so that they have sufficient knowledge to understand the needs of the people they care for. They need to improve their quality assurance processes to make the outcomes for people, better. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 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.V377529.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): We looked at outcomes for standards 3 & 6. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be confident the care home could support them, because there had been an assessment of their needs. EVIDENCE: All the surveys returned by people told us they had received enough information about the home before they moved in so that they could decide if the place was right for them. Four stated theyd received a contract, one hadnt. One social and health care professional survey felt the services assessment arrangements ensured that accurate information was gathered and the right service planned for people, one sometimes. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 10 The manager told us in the AQAA, all relevant information is gathered prior to and during admission from the person, their representatives and other professionals. She stated all potential people will undergo a new revised full admission assessment by the manager or deputy and letters of confirmation of acceptance or not are sent to people. People were invited to visit the home prior to admission. Since the last inspection, Rotherham Borough Council placed an embargo of new admissions because there had been several referrals to adult safeguarding since the key inspection on 10 September 2008, they had highlighted environmental issues including a lack of heating and there were queries about whether people were being placed on the unit most suitable for their assessed needs and category of care. This was lifted on 7 August 2009. The home had made two admissions since that date. We looked at one person’s file to check the information we were told in the AQAA. A social care assessment was in place from the placing authority, but an assessment hadn’t been completed by the home, as per their own procedures. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for 7, 8, 9 & 10 were inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Health and personal needs were not consistently met due to shortfalls in record keeping and medication. This may place people at risk of harm. EVIDENCE: We observed people living in the home. On the whole, they looked well cared for, clean and appropriately dressed, but some people were wearing glasses that weren’t clean and some looked as though they hadn’t had their hair brushed. The hairdresser did visit that day, but this doesn’t mean people shouldn’t have their hair brushed on a morning. We saw staff treating people with respect and kindness, but interactions were generally of requests to assist people with their care and not spending quality time with them engaging them in conversation. People said that they were Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 12 treated with respect and dignity. One person said, “treat you good, but I’d rather be at home”. Both health and social care professionals’ surveys returned felt the care service only sometimes respected peoples’ privacy and dignity. Three people that returned their surveys stated they always received the care they needed, one that they usually did. They all stated they received the medical care they needed. They commented, “cares for individual needs” and “take care of me and all of my needs”. Three representatives in their survey stated they always get enough information about the care service to help them make decisions, one that they usually did. Three stated that they always felt the care service met the needs of their representative, one that they usually did. Three stated they were always kept up to date with important issues affecting their representative, one that they never were. Two stated the care service always gave the care they expected to their representative, one that they usually did and one didn’t answer. Their comments about the service provided included, “the service already does everything well”, “I know the service couldn’t do better, the service already does excellent”, “… is taken care of very well at Swinton Lodge” and “treats individuals as individuals, person centred care”. The staff survey stated they were always kept up to date with information about the needs of people they cared for and that the way information is shared about people they cared for with other carers and the manager usually worked well. They commented in what they thought the service did well, “the quality of care personalised for individuals care needs” and “always striving to improve the quality of care and services provided”. One health and social care professional survey that was returned felt that peoples’ social and health care needs were properly monitored, reviewed and met by the service, one that they sometimes were. One felt the service sought advice and acted on it to meet peoples’ social and health care needs to improve their well-being, one that they sometimes did. One commented, “record keeping has improved in care plans and in the recording of medications”. The manager in the AQAA told us all care plans were person centred and people and their representatives were involved in their planning of care. They stated care plans, risk assessments and weights were reviewed at least monthly and intervention sought if necessary. We looked at four care plans to check the information in the AQAA and what surveys had told us. In two of the files we looked at people had diabetes. Their blood sugars were being taken and recorded, but the blood sugars levels Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 13 varied significantly and there was no information in the plan or on the blood sugar list any action that had been taken to try and stabilise the blood sugars. Three people had lost weight. The care plan or the list where the weights were recorded didn’t identify action or monitoring that was taking place as a result of this, which means more weight could be lost and be the result of an underlying problem. For people on the dementia unit the daily record did not always describe what peoples’ behaviour was, but staffs’ comments of how they perceived the behaviour. Examples include, “behaves unruly” and “inappropriate behaviour at times”. Activity plans had started to be introduced for some people. This should help to improve peoples’ quality of life, but staff need to make sure what is identified is offered, as there was no evidence it was. On one of the plans, monthly reviews had not taken place for two months. In the main, 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. Examples of good medication practice we found include the checking of monthly prescriptions by staff before the medication is delivered and the provision of additional security measure for handling and recording the use of controlled drugs. When checking the MARs, we found 16 administration gaps in 6 of the 32 MARs examined. This means that people living in the home may not always receive their prescribed medicines correctly. The gaps were mostly at times when only one nurse was covering all three units at night. The home must ensure that sufficient numbers of qualified nursing staff are always available to meet the assessed needs of people living in the home. This will make sure that people’s healthcare needs are always met in a safe and timely manner. Some other improvements in record keeping and safe medication practice need to be made. These include ensuring clear records of the use of skincare products are made, ensuring hand written changes and new entries on the MARs are checked for accuracy, checking and recording the temperature of all medication storage areas, and recording the quantities of medication carried forward each month. Finally, the home’s medication policy and procedures should be reviewed and updated in line with current best practice. This will help to ensure staff know exactly what is expected of them when handling and administering medication. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 12, 13, 14 & 15 were inspected. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were generally satisfied with their lifestyles in the home, but social and recreational activities could be improved to meet peoples’ expectations. Generally, people enjoyed the meals they were served, but the mealtime experience could be improved. EVIDENCE: One person in their survey told us the home always arranged activities they could take part in, three that they usually did and one that they sometimes did. When we spoke to people about their experiences of living at the home they said, “spend too much time on my own”, “having hair done after – have it done every other week”, “I like company, but don’t get it”, “staff come and spend a bit of time with me”, “I’d rather try to walk down there (lounge)”, “do nothing (during day)” and “nurses say I can have my hair cut short with a fringe – I’d like that”. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 15 Two surveys from representatives stated the service always helped their representative to keep in touch with them, two that they usually did. Two stated the service always responded to the different needs of people, one that they usually did and one that they never did. Two stated the service always supported people to live the life they choose, two felt they usually did. One of the health and social care surveys that were returned stated the care service usually supported people to live the life they chose where possible, one said they never did. One commented, “more activities on the EMI unit in particular. This unit has a mix of residential and nursing and the residents would benefit from some stimulation to help alleviate some of the behavioural problems displayed by some residents” as something the service could do better. The manager in the AQAA told us there was an open visiting policy. She stated daily activities were carried out by two activity co-ordinators, but more direction was needed for them. There were DVD’s available for people to watch, the mobile library comes every month, the local church visit regularly to hold sing a long and short service, a visiting amateur drama group attend three monthly and people can request what they would like to see or listen to, a retired organist comes when available to play music and baking sessions are held. At the time of the inspection, one activity worker was working. The service had improved by installing an activities board to inform people and their families the activity programme, a previous recommendation; however, it was displayed in the entrance. This meant people on the different units would not know what this was. The board gave no indication on each unit what might be the activity routine for the day. On the day of the visit it was advertised as hairdresser and individual time. The hairdresser was there, but we didn’t see any individual time spent with people. We saw the activity co-ordinator encouraging people to kick a brightly coloured sponge football on the dementia unit. We did not see any other staff engaging with people in any meaningful way, other then carrying out tasks or ‘supervising’ people. We spoke to the activity co-ordinator. She told us activities are carried out with people both individually and in a group. She said most of the individual activities were doing reminiscence. She explained how she had themes dependent on the time of year, so at the moment it’s the sea side. She said she had books and films to initiate interactions with this. She said day trips had taken place to Bridlington and Cannon Hall and they have entertainers to the home. Information in care plans to provide evidence of what activities were carried out with them in practice was sparse, but the manager had identified this as an area of improvement (also see health and personal care). Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 16 We saw that people in the dementia unit had access to a secure garden area with paths and seating and they made use of this. Visitors were welcomed and several were seen throughout the day. Three people in their surveys told us they always liked the meals at the home, one that they usually did and one that they sometimes did. One commented, “they give good meals”. One person when we spoke with them said, “very good meals, but I’d rather go into dining room”. We observed lunch time on the dementia unit. There was no signage to indicate where the dining room was or on the dining room door itself. The service had improved by providing a menu board in the dining room, a previous recommendation, but it was not being used. There was no information about the meal that was being served or what the menu was. We spoke to the cook who told us that people chose what they wanted the day before, but they could change that if they wanted. This is not appropriate for people with dementia as they wouldn’t be able to recall what choice they had made yesterday. This was confirmed when we spoke to people, however, we saw that people today chose what they had ordered yesterday. Tablecloths were placed on all tables, but one, but there were no condiments or cutlery on any table. Lunch was cheese omelette, chips and salad or mince and onion pie, creamed pot, cauliflower, carrots. Sweets included fruit pie and cream, semolina or yoghurt. The cook served meals that needed pureeing in an attractive manner. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 16 & 18 were inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be confident their concerns would be listened to and acted on. Staff are aware of the signs of abuse, but this hasn’t always protected some people being placed at risk of harm. EVIDENCE: The manager in the AQAA told us 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. She stated people were also advised verbally how to make a complaint if they needed to. When we looked to see where the complaints procedure was displayed we could not see it. The AQAA told us there had been two complaints that had been resolved in 28 days and that there had been eight adult safeguarding referrals, resulting in six investigations. As a result of one of the investigations a member of staff was referred to the protection of vulnerable adults register and the NMC and in neglect was substantiated in regard to the omission of medication. An action was put in place and this is now being adhered to. On 20 January 2009 a random inspection was undertaken because there had been four referrals to adult safeguarding since the key inspection on 10 Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 18 September 2008. The referrals related to people not receiving the correct medication, their assessed needs not being met and the provision of 1-1 care for someone. We looked at the complaints record to check information regarding complaints. There had been four complaints, that had all been upheld and action taken to prevent a reoccurrence. One complaint had been directly to the Commission’s predecessor. Four people in their surveys told us there was someone they could speak to informally if they weren’t happy, 1 said there wasn’t. Two stated they knew how to make a formal complaint, three didn’t. When we spoke to people they 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 staff survey stated they knew what to do if someone had concerns about the home. This corresponded with what staff told us when we spoke with them. Three of the representatives’ survey stated they knew how to complain about the service if they needed to, one didn’t. Three stated the service usually responded appropriately if they or the person they represented raised any concerns. One of the health professional surveys stated the service responded appropriately if they or someone they knew raised concerns about the service, one that they sometimes did. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standard 19 & 26 were inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Aspects of the environment would not encourage peoples’ independence and emotional wellbeing and some parts of the home were not suitably maintained and comfortable for the people that lived there. EVIDENCE: Three people in their surveys stated the home was always fresh and clean, two that it usually was. One person commented, “the washing’s done every day”. A random inspection took place on 20 January 2009, because of information received from Doncaster Social Services highlighting environmental issues, including a lack of heating. Checks of the environment showed that there had been some improvements, but the upstairs lounge/diner was cold and the Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 20 thermostat couldn’t be altered. The room was being used to store wheelchairs and there was evidence people had been smoking in the room, a narrow lounge had a three bulb overhead light fitment, but only one bulb was working, an electric heater was supported by a piece of wood and room thermometers had not been purchased with temperatures monitored and recorded. The Regional Manager agreed that room thermometers would be purchased and that temperatures would be monitored and recorded. The manager told us this was now in place and was satisfactory, but when we looked for this, no monitoring had been dome for some time, according to the charts. The manager was asked to recommence this and take action if necessary to make sure people have adequate heating at all times, as today was a warm day and the home was warm enough. The lighting in the reception was working. We saw that lockable facilities had been placed in peoples’ rooms, but the manager said currently no-one looks after their own medicines or finances. The manager in the AQAA told us a new smoking lounge had been put in place for people living upstairs. This was as a result of a safeguarding incident. People were still using the smoking room downstairs, because it had become custom and practice to do so, but the manager intends that for new admissions it will be the room upstairs that will be used. In the meantime, staff had been instructed to be more vigilant with people entering the dementia unit to have a cigarette. She also stated a relative’s room was now available, antibacterial soap dispensers are available at all sinks, alcohol dispensers are available at all entry and exit points for relatives and visitors to use, all staff are issued with personal alcohol dispensers and all staff have attended infection control training. When we looked round the environment there was poor orientation for people with dementia, although the manager had implemented names and pictures on peoples’ doors. This was helpful to people, as we observed one person looking for their room using these signs. All the clocks showed a different time, which is poor in orientating people to the time of day. A wipe board was in place to orientate people to the day, date and weather, but it wasn’t completed. There was no signage to identify to people different living areas. Improving this would help promote peoples’ dignity and independence. On the Balmoral Unit that was registered for people with enduring mental health needs the dining room/lounge carpets were stained and dark. This does not respect people’s dignity, by making it a pleasant well maintained environment for them to live. In the corridor, a number of spotlights weren’t working, which again made it dull and dismal, which doesn’t help the mental condition of people with mental health needs. The arrangement of furniture with chairs against the wall looking at the kitchen units and dining table made it look very institutionalised. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 21 The hairdresser was seen cutting peoples’ hair in little lounge area off the dining room. This does not promote good hygiene practices and respect peoples’ living environment, as there was a hairdresser’s room and people have their own bedrooms. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 27, 28, 29 & 30 were inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff were not always deployed and trained correctly to meet the needs of people with dementia and enduring mental health. This can effect how people are cared for and their wellbeing. EVIDENCE: The surveys returned by people that lived there told us: Three of them felt staff were always available when they needed them, two that they usually were Two felt the staff always listened and acted on what they said, two that they usually did and one didn’t know. The surveys returned by health and social care professionals told us that both of them felt that managers’ and staff only sometimes had the right skills and experience to support peoples’ social and health care needs. One commented, “the care staff are incredibly good and caring but they carry a lot of work and responsibility on the minimal amount of staff/resident ratio” and one commented, “more staff, more training, bigger management presence” as something they could do better. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 23 The manager in the AQAA told us: All staff were undergoing dementia training. The remaining carers without an NVQ are to commence this in August. Approximately 61 of staff hold NVQ level 2 or equivalent. The surveys returned by representatives told us: Two felt the staff always had the right skills and experience to look after people properly, two that they usually did. The staff survey that was returned told us: Their employer carried out criminal record bureau and reference checks before they started work. Their induction covered everything they needed to know to do the job when they started very well. They were being given training relevant to their role, helped them understand and meet the needs of people, kept them up to date with new ways of working and gave them enough knowledge about health care and medication. They always felt they had enough support, experience and knowledge to meet the different needs of people who lived there. There are usually enough staff to meet the needs of people who use the service. The manager told us that out of eight people on Balmoral (the enduring mental health unit), six were nursing. The numbers of staff based on that unit was one member of care staff on each shift. Discussion with the care staff working on that unit identified they had received no specialist mental health training. The nurse that supported the unit was based on Spencer Unit, which was on the same corridor, but where two care assistants were based and where there were only two people with nursing needs. The manager stated if the carer needed assistance they would press the emergency buzzer and shout. Subsequent to the inspection, a professional had undertaken a review of someone on the Balmoral Unit. It highlighted people on the unit had been left unsupervised, someone had fallen and it was another person living on the unit that had to summon assistance. We looked at two files to check them for the recruitment process and that training was undertaken. The manager told us one member of staff had been re-employed on a permanent basis after leaving. This was not clearly evidenced in the file and the manager was told this needed to improve. The other told us some recruitment checks had been made including a POVA first check and the receipt of two references, but gaps in employment had not been fully checked. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): The outcomes for standards 31, 33, 35 & 38 were inspected. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service need to improve their quality assurance processes to make the outcomes for people, better. People and staff may not always be safeguarded by safe working practices, because not all staff had received appropriate training. EVIDENCE: The staff survey told us the manager gave them enough support and met with them regularly to discuss how they were working. When we spoke to staff they said, “(there was) bad leadership”, (difference now) “absolutely brilliant”, “she Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 25 (manager) listens, she’s got time, her doors always open” and “it’s picked up no end”. A health and social care professional in their survey commented, “the service has had recent changes in ownership and management and they have worked well with the contracts team from RMBC to improve upon the service”. The manager in her AQAA told us she was to commence the registered manager’s award in September and is also doing a Level 4 Course in Management and team leadership. We established at the visit that the current manager commenced as manager at the service on 14 April 2009 and her application to register has not yet been submitted. She told who she qualified as a registered general nurse in 1992, has worked in elderly care for seventeen years and has been a manager for three years. The manager in the AQAA stated the service doesn’t have an annual development for quality assurance purposes. When we spoke with the manager at the visit she didn’t know about the last quality assurance that had included stakeholders of the service, but was in the process of conducting her own. She didn’t know how the annual development was identified. The Home from Home Assessment Report of 8 and 12 January 2009 by Rotherham Borough Council gave them a bronze rating. To ensure that people’s dignity, health and welfare are protected and National Minimum Standards met, the quality assurance system must improve. 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 two people was checked against the records. The cash tallied with the records. There was no electrical wiring certificate to confirm this was satisfactory, but the manager stated servicing servicing had taken place, but a certificate hadn’t been received. The manager stated fire drills were held quarterly, but only one was recorded on 15 July 2009. There was no fire risk assessment, but servicing of equipment had taken place on 28 August 2009. Emergency lighting had been serviced in April 2009. When we spoke to staff it identified they undertook mandatory health and safety training, but the manager needs to make sure all staff, including nurses are included in this and refresher training takes place. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 26 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 2 10 2 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 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 27 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 15 (1) Requirement Timescale for action 08/11/09 2. OP8 15 (1) 3. OP9 13 (2) 4. OP19 23 (1) (a) The plan of care must contain information about what action staff have taken when blood sugars are unstable, so that they can demonstrate what action they are taking to monitor and maintain peoples’ health. The plan of care must contain 08/11/09 information about what action staff have taken when people lose or gain weight, so that they can demonstrate how peoples’ health is being monitored. Arrangements must be put in 09/10/09 place to ensure that all medication records are accurately maintained in a timely manner. This will help to promote people’s health and wellbeing by knowing that their medicines are being given correctly. The environment on the units for 09/01/10 people with dementia and enduring mental health needs must be made suitable for their needs. This includes: • Appropriate orientation for people DS0000003090.V377529.R01.S.doc Version 5.3 Swinton Lodge Page 28 5. OP27 18 (1) (a) Making the environment bright • Replacing the carpet on the Balmoral Unit in the dining room/lounge • Arranging furniture in a non-institutional way The deployment of staff must be reviewed: • To increase the levels of staffing on Balmoral, the enduring mental health unit • That nursing staff are based in the areas where the most people have nursing needs. This will ensure suitably qualified and competent staff are in sufficient numbers to maintain the health and welfare of people. • 09/01/10 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. Refer to Standard OP7 OP7 Good Practice Recommendations When describing peoples’ behaviour in peoples’ files staff must describe the actual behaviour, not how they perceive the behaviour. Staff should record in the daily record when they have carried out the interventions identified in the care plan to meet peoples’ needs. This would demonstrate the care has been carried out. It should also describe how each person has spent their day. The medication policy and procedures should be updated in line with current professional guidance so that staff understand exactly what is expected of them. When nurses delegate the task of applying creams to care workers, then the whole of the task should be delegated. Arrangements should be made for the care worker responsible to sign the record of administration in line with DS0000003090.V377529.R01.S.doc Version 5.3 Page 29 3. 4. OP9 OP9 Swinton Lodge 5. OP9 6. OP9 7. OP9 8. OP9 9. 10. 11. 12. 13. 14. 15. 16. OP10 OP12 OP12 OP15 OP16 OP27 OP29 OP29 17. 18. OP31 OP33 current professional best practice guidance. Handwritten entries and changes to MAR charts should be accurately recorded and detailed. This makes sure that the correct information is recorded so that each person receives their medication as prescribed. The prescriber or community pharmacist should be asked to provide information when medication has a dose of ‘as directed’ or ‘when required’. This information can be included in a medication care plan to make sure that the medication is given correctly. A system should be in place to record all medication carried over from the previous month. This helps to confirm that medication is being given as prescribed and when checking stock levels. The temperature of all medication storage areas should be monitored regularly so that staff know that medicines are stored correctly at the temperature recommended by the manufacturer. Peoples’ glasses should be cleaned daily and their hair brushed. Staff should spend more quality time with people engaging them in meaningful conversations to improve their quality of life. Social and recreational activities should be arranged on a more person centred basis to meet peoples’ expectations. Staff should complete the menu boards provided in various formats to help people to plan what they wished to eat at mealtimes. The complaints procedure should be displayed on each unit, so that people know how to make a complaint should they need to do so. Staff should receive specialist training for people with mental health and dementia care needs, so that they have the knowledge of how to meet the needs of those people. Staff files must be better organised to evidence in what capacity staff are working, so that it can be determined appropriate recruitment checks have been made. Staff files must demonstrate that a written explanation has been obtained of gaps in employment, so that people living at the home are protected by the recruitment process. The manager should register with the Care Quality commission, so that they can determine her fitness to be registered. The quality assurance monitoring system should improve to better protect people’s health, safety and dignity and include: DS0000003090.V377529.R01.S.doc Version 5.3 Page 30 Swinton Lodge 19. OP38 Environmental audits and checks to highlight missing, faulty and damaged furniture, furnishings and equipment. Audits of care plans and records to ensure the information is up to date and relevant people. The service should put in place a fire risk assessment that identifies the frequency of fire training and drills for staff and make sure this is adhered to, so that people and staff are sufficiently protected in the event of a fire. Swinton Lodge DS0000003090.V377529.R01.S.doc Version 5.3 Page 31 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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