Inspection on 19/09/07 for Swiss Cottage Nursing Home

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Swiss Cottage Nursing Home 22/04/09

Swiss Cottage Nursing Home 08/10/08

Swiss Cottage Nursing Home 22/01/08

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Swiss Cottage Nursing Home Plantation Road Leighton Buzzard Bedfordshire LU7 3HU Lead Inspector Vanessa Rumball Key Unannounced Inspection 18 September 2007 08:45 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 Swiss Cottage Nursing Home DS0000069674.V349594.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. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swiss Cottage Nursing Home Address Plantation Road Leighton Buzzard Bedfordshire LU7 3HU 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) 01525 377922 01525 373791 swisscottage@schealthcare.co.uk Southern Cross Healthcare (Focus) Limited Kathryn Dellit Care Home 85 Category(ies) of Dementia (85), Old age, not falling within any registration, with number other category (85), Physical disability (10) of places Swiss Cottage Nursing Home DS0000069674.V349594.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, maximum number of places: 85 Dementia - Code DE, maximum number of places: 85 2. Physical Disability - Code PD, maximum number of places: 10 The maximum number of service users who can be accommodated is: 85 19th July 2007 Date of last inspection Brief Description of the Service: Swiss Cottage Care Home with Nursing is situated in a pleasant suburb of Leighton Buzzard within easy reach of the town centre amenities by car or public transport. Extensive gardens and woodlands surround the home. The accommodation is divided into two main areas with separate dementia care areas on the first floor, and a nursing unit on the ground floor. The home provides single accommodation for up to 83 people. In addition, there is a double room within the dementia care unit. Access to the first floor is via a shaft lift or stairs. Various communal areas are located throughout the home. Copies of the homes statement of purpose and service user guide are available in the reception area. A copy of the most recent inspection report is displayed in the entrance of the home and is available to prospective people who may wish to move into the home. The manager of the home provided the following in April 2007. The fees for this home vary from £443.75 per week, to £669.50 plus per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing, newspapers, toiletries and chiropody. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report includes the findings of this site visit, one other unannounced visit, which took place on 19 July 2007, and information we have received since the last Key Inspection in April of this year. A separate report is available on request, which relates solely to the random inspection visit of 19 July 2007. This unannounced inspection was carried out on 18 September 2007 over 10 hours. The temporary manager, who had been in post for three weeks at the time of this visit, was present for most of the inspection. During the inspection visit we looked at different areas of the home and spent time with many of the people living in the home, mainly in the communal areas. The care of four people was examined by looking at their records and where possible, talking with them and some of the staff who look after them. Observations of care practice and communication between the people living at the home and staff was made at the inspection. We also spent two hours, during the inspection, observing people living in one area of the home that specialises in care of people who have dementia. The views of people living at the home, their relatives and professionals who visit the home, were also received through returned comment cards and their feedback has been used alongside information from the visit. The focus of this inspection was to look at the key standards and to follow up on previous requirements. The ownership of the home changed earlier this year. The home was being managed by the current owners at the time of the last inspection in April 2007, although the registration with us was not completed until May 2007. The Registered Manager had been off sick for three weeks at the time of this visit to the home. An Acting Manager had been appointed to cover her absence and was in the process of addressing areas which were in need of improvement. During that short time he had made a number of positive changes to the service which are reflected throughout this report. In addition the manager and provider had identified the majority of the areas identified for improvement in this report and had devised an action plan to address these. We were grateful for the help of all those who participated in this inspection. This inspection report should be read in conjunction with the National Minimum Standards for Care Homes for Older People. What the service does well: Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 6 A Statement of Purpose and Service User Guide was available to all those interested in the service. Staff made sure that people were assessed before they were offered a place at the home and people living at the home said they were provided with information before they made the decision to move into the home. Medication was stored securely and administered appropriately. In the main people living at the home and their relative’s feel that staff will listen and respond to them, if they are unhappy with the care they receive. One person told us “I am very happy with the care at Swiss Cottage,” another family said, “We are extremely satisfied with Swiss Cottage.” There was a robust complaints policy in place, and documentation indicates that complaints are responded to appropriately and within the identified timeframe. People using the service and their relatives that were spoken to during the inspection knew who they should approach if they had any concerns, and appeared confident that any concerns would be addressed efficiently. What has improved since the last inspection? What they could do better: There are several things this home could do better. These include making sure that: • • • • • All people using the service, whether self funded or funded by a Local Authority have a copy of the agreement specifying the conditions of living at the home. A requirement has been made in relation to this. Service user plans include all the important information about how to care and support the person. The healthcare needs of people are addressed promptly. Care and support is provided in a way that protects the privacy and dignity of the people using the service. The home communicates better with the families of people living in the home where this is agreed. DS0000069674.V349594.R01.S.doc Version 5.2 Page 7 Swiss Cottage Nursing Home • • • • • The home offers activities that are meaningful and suitable for the people living in the home, and that these are developed around people’s known interests and social histories. The home is free from offensive odours. The home is always sufficiently staffed. Staff are trained and supported to develop their understanding of communication and social care. Staff meet with their managers regularly and are properly supervised. 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. Swiss Cottage Nursing Home DS0000069674.V349594.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 Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The philosophy and care for people with dementia is not sufficient, this places these people at risk from not receiving the care and support that they require. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed. Both were satisfactory and provided good information about the home. These were available in printed and audio forms. Of the people who responded to our survey, 83 said they had enough information about the home before they moved in. People told us that they and/ or their relatives had had the opportunity to visit the home before they moved in and one person said s/he was “made very welcome” by the staff. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 10 Agreements for living at the home were seen for two people who were both self-funding. However, signed terms and conditions were not in place for people whose care was funded by local authorities and 50 of the people who responded to our survey said they had not received a contract. One care organiser who placed a person at the home said that that previous homes had struggled coping with the person’s behaviour but at Swiss Cottage the person appeared calm and even manage a little bit of conversation during the 8 week review. The person’s family said she was very happy in Swiss Cottage and were satisfied with the care the person received. Previous reports had identified that there were significant shortfalls in meeting the needs of people who have dementia and the home was required to make changes to improve this. During our visit to the home in July 2007, the registered manager told us that a specialist, employed by the company, had assessed the service provided to people with dementia and produced, with the home, a six-week action place that included staff training and environmental changes to address the requirement made. At this visit we found that some improvements have been made and the requirements have been changed to reflect this. The improvements seen since the last key inspection included reinstating staffing levels in the home and significant changes to the décor on the upper floor. The changes to décor included the bedroom doors being painted different colours and areas of the home being ‘themed’. This included a bar area, a nursery area and various tactile boards. All of these improvements made it easier for people to find their way around and provided additional interest. We were however, concerned that staff did not understand the importance of communication and the impact their actions had on the people living in the home. For instance, only one of the three orientation boards in the home showed the right date. The board in the area of the home where people who have dementia live showed the 15 September during our visit on 18 September. In addition, while staff were always polite to people living in the home, we not only saw a staff member starting to shave a person in the lounge, but when the shaver stopped working the care worker walked away without an explanation to that person. This is referred to else where in the report and requirements made. The home does not provide intermediate care. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff do not consistently treat people within the home in a way that promotes their privacy and dignity and they do not always ensure that their healthcare needs are met in a timely manner. EVIDENCE: The acting manager had put in an intensive training programme and many service user plans had been reviewed since our last visit to the home. As a result of these reviews some people had been referred for reassessment of their needs. These reviewed plans were more detailed and provided good information about how to care and support the people who live at the home. Detail included things important to the person, if the person liked to wear perfume for example. However, some plans still lacked important information. For Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 12 instance, one plan stated that the person needed to use a hoist to move, but it did not state what sort of hoist or the sling size. This could result in the wrong equipment being used and a person being put at risk because of this. Another person had had exercises prescribed by the physiotherapist, but, although reference was made to this in the person’s care notes, a care plan was not in place and the care notes did not show that these had been done every day. The person who needed assistance with these exercises was not able to verify with us whether they had happened everyday or not. Another person had been prescribed a treatment for constipation, but this had not been actioned until four days after the doctor had been consulted. This could have resulted in considerable discomfort for that person. One person’s plan showed that their family wanted to be informed of any significant events affecting the person. However, there was no evidence on file to show the family had been contacted when the person was diagnosed with an infection and another person’s family stated they had not been informed on two occasions when their relative fell. During a random inspection in July 2007, we were very concerned that a person was seen with bruising and scratches to his face. The care records showed that, four days before the inspection, the person had been assaulted by another person living at Swiss Cottage. Although a system was in place for the person to be checked at regular intervals after an incident, this was not completed the care record only stated that the person had been “monitored close.” It did not state how the person was, if swelling or bruising developed or if further medical care was considered or needed. Two healthcare professionals responded to our survey. They told us that the home “always” and “usually” seeks advice, acts upon it and meets the healthcare needs of people living at the home. One person told us “There seems to be an element of disorganisation possibly due to rapid staff turnover and also turnover of the owner/ management team. Communication can be poor.” They also said “Staff are generally caring, hard working and committed with friendly attitude.” Medication was stored securely and documentation showed that prescribed medication was administered in line with the prescriber’s instructions. During the inspection we spent two hours observing two people living in one of the dementia houses. We were concerned about the way staff interacted with those people. For instance, we saw a staff member ask a person who was sitting in the lounge if he would like a shave on three occasions. Each time the person refused. On the third occasion the staff member brought the electric shaver and started to shave the person while he was sitting in the lounge. The shaver stopped working and the staff member left the person with no explanation. Another person was obviously uncomfortable in an armchair, but Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 13 no staff approached to ask if he needed help to move into a more comfortable position. Staff wrote about people in the care records in a way that upheld their dignity. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Menus are varied and offer a balanced diet. However, choices for some of the people who live in this home are very limited. EVIDENCE: The survey responses told us that 67 of people felt there was ‘always’ or ‘usually’ activities arranged by the home that they could take part in. One person’s representative commented in a survey response to us that s/he felt activities were needed at weekends. Just prior to our visit, the acting manager had arranged for an activity organiser to be on duty every day of the week, and this was due to start the weekend after our visit. The acting manager is also encouraging all staff to be involved with the provision of activities, not just the activity co-ordinator. Four survey responses said that people were unable to participate with activities because of their mobility or poor memory. This suggests that activities are not always targeted to meet the needs of individuals. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 15 Records showed that some activities had taken place and one person’s file showed eight entries for an eight week period, but these records included entries such as ‘friends visiting’ and ‘garden.’ Other activities included ‘beauty’ and ‘crosswords’. Service user plans and other records did show people’s interests, but these tended to be with broad statements such as ‘music’ or ‘TV soaps’ rather than showing what type on music or specific TV shows, enabling staff to focus activities to the areas of particular interest. During the inspection we saw a care worker doing an organised activity with one person. While she was doing this she left the person a number of times to do other things meaning that there was no continuity with the activity. People told us that the quality of meals served was generally good. During this inspection, one person told me at 9.40am, that s/he had not yet had breakfast. An untouched bowl of cereal and drink was out of her reach in her room. S/he told us s/he liked to have her breakfast at about 8am. When we saw this person again at 11am s/he told us s/he had been helped to have her breakfast, and it had been hot. A few people were seen sitting at the dining tables for their meals, but most of the people using this service had their meals either in bed or sitting in their armchair. Whilst we recognise that for some people this is appropriate for the most part, in the areas of the home that cares for people who have dementia, this is not appropriate or in line with the company’s policy. Care workers were seen sitting with people who needed help with their meals and chatting with them, talking about the meal etc. However, one person was seen standing up at the table to eat his dessert. Care workers did not encourage him to sit down, despite being present in the room. Choices of meals were not routinely offered to people in the home unless staff knew the person does not like the main choice. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all senior staff were aware of the Local Authority protocol’s regarding safeguarding procedures. This could mean that people are not properly protected from the risk of abuse. EVIDENCE: The complaints procedure gave simple guidance in how people could raise a concern. Feedback from people living at the home indicated that they would feel confident in raising a concern or complaint and to whom they could complain to. Clear timescales had been included in the procedure so complainants would know when the manager of the home would respond to them. Complaints investigated since the last inspection had been responded to within timescales. Evidence of investigation and responses to the complainants were also seen, as was evidence of action taken as a result of the investigations. One complaint was in the process of being responded to at the time of the inspection. We were very concerned during the last random inspection that the manager and staff seemed unaware of the necessity to refer the assault of one person living at the home against another to the Local Authority for investigation under safeguarding protocols and we made a requirement that this be done. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 17 We were further concerned that when the Registered Manager made the referral, the information did not corresponded with the information seen our during inspection. The Registered Manager then submitted a revised referral and informed the Local Authority that there had been three other unreported assaults of other people, prior to the one we had identified. As a result the Registered Manager arranged for an additional member of staff to supervise the person who had carried out these assaults, so that the other people in the home were properly protected. Since the last inspection appropriate referrals had been made appropriately to the Local Authority. Care workers that we spoke with during this visit knew what to do if any unexplained injuries were identified. However, it was very concerning that not all nurses were aware of this procedure. However, training is planned for later in the month. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although considerable work had been done to improve the environment of the upper floor of the home, in some areas of the home there is an unpleasant odour this does not provide a pleasant environment for people to live in. EVIDENCE: As seen at the previous inspection, the homes gardens were very well maintained with extensive lawns, seating areas and flowerbeds. Many of the areas in the home were decorated to a good standard, with good quality furnishings and fittings. Since the last key inspection, considerable work had taken place to improve the décor on the upper floor to improve the environment for the people living Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 19 there. This work included themed areas having been developed and bedroom doors having been painted different colours and letterboxes and numbers added. Several tactile boards had been put up. All will help people to find their way around the home and one member of staff confirmed she had seen the benefits of this. Of the people who responded to our survey, 76 told us that the home was ‘always’ or ‘usually’ fresh and clean. A requirement had been made at a previous inspection about the offensive smell in some areas of the home. Although the home has reviewed the cleaning programme, this problem has not been resolved completely. Again, during our most recent visit, the first floor had an unpleasant odour and we received comments from surveys such as “the home looks tired and sometimes smells” and “We have turned up on occasions when the whole top floor stank. This has been better recently.” The Acting Manager told us that an order had been placed for some carpets to be replaced and this work was due to be completed a few days after our visit. It is hoped that this, together with the cleaning programme will resolve the problem. Policies were in place regarding infection control and staff were seen to be using protective clothing. Hand washing facilities were sited in the areas where infected material/clinical waste was being handled. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment systems generally protected people through the safe vetting processes of staff. However, the homes failure to cover shifts when people were off sick or on annual leave reduced the standard of care for some of the people living at the home. EVIDENCE: Since the last key inspection the company had increased staffing numbers to those previously experienced in the home. Of those people who use the service and their representatives, who responded to our survey, 99 of said that there were staff available when they were needed. However, people also said “occasionally one staff member is called away to another section of the home” and someone else expressed concern about “the staff/patient ratios” The shift pattern had changed since our last visit. Staff told us that whilst they were not personally happy about these changes, they did feel it was better for the people receiving the service. Staff told us that this had taken some getting used to, and had resulted in breakfast running late at times, but that this was improving. On the day of our visit one worker was off sick and the shift was not covered. It was noted that staff in the house that was short Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 21 staffed were very busy and at least one person had not yet had breakfast at 9.40am. Feedback indicated that the failure of the home to cover these shifts impacted on the level of care given within the home. We looked at the recruitment files of two people who had been appointed since the last inspection. One file was satisfactory and showed that all checks had been made properly before the person was allowed to work in the home. However, the other person’s references did not show a company stamp, nor were they on headed paper. In addition they were addressed ‘to whom it may concern’ and were not sent directly from the referee to the home. It was not therefore possible for the home to verify these references. The operations manager told us that the company has since changed its policy and now requires references are obtained directly from the referee. In view of this a requirement has not been made relating to this. All staff received induction and on-going training. Staff training that has taken place during the last 12 months included COSHH, Fire, First Aid, Health and Safety, Moving and Handling, Safeguarding, Dementia and Care Planning. Staff confirmed that they were encouraged and supported to attend training as part of their development. We were concerned that not all staff were clear about safeguarding procedures, but understand that training is planned for later in the month. Only 20 of staff were working towards or had achieved an NVQ level 2 or 3 in Care. We saw staff speaking with the people who use the service throughout the day. Many staff addressed them in a calm way, sitting down with the person, occasionally touching the person’s hand while they were talking and gave the person opportunity to reply. However, other staff members just spoke to the person and did not try to engage them in a two-way conversation. As mentioned elsewhere in this report, we saw one care worker shaving a person in the lounge and leave the person without saying anything when the shaver stopped working. A requirement has been made about this. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been a number of areas where the outcomes to the people using the service has been poor, the provider had an action plan of how these areas were to be addressed and the Acting manager was clear about how the culture in the home needed to change in order that these outcomes can be improved. EVIDENCE: At the time of this visit the Registered Manager was off sick and an Acting Manger had been in post for approximately 3 just weeks. During that time he had made several changes within the home including changes to the rota Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 23 patterns, assisting staff in the review and writing of service user plans and reassessment of several people who use the service. A care organiser told us that s/he was impressed by the Acting Manager’s commitment and the changes he has introduced. Staff were generally very complimentary about the support they have received from the Acting Manager in the last three weeks and of the company since it took over Swiss Cottage earlier this year. The provider monitors the home through monthly visits made by the operations manager. As mentioned in our previous key inspection report, questionnaires had been sent out in December 2006 and their results had been analysed. Documents seen showed that the manager had looked at the results and implemented changes in response to the 20 returns that had been received. The management of monies held on behalf of some people continues to show that a robust system is in place that provides a clear audit trail. There was evidence that staff were annually appraised and attended regular team meetings. However, more formal staff supervision was not offered in the home. In addition where a workers appraisal showed issues of concern about his/her performance, there was no evidence of how this was being addressed between appraisals or followed through. The home’s Health and Safety policy was noted to contain all required information. Staff confirmed that they had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments had been undertaken and were seen on the service users care files that were tracked on this inspection. All major equipment is serviced regularly and the home maintains documentation to support this and when safety checks such as recording water temperatures have been undertaken. Swiss Cottage Nursing Home DS0000069674.V349594.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 3 2 3 1 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 1 X 3 Swiss Cottage Nursing Home DS0000069674.V349594.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 OP2 Regulation 5 Requirement Timescale for action 30/11/07 2. OP7 15 3. OP8 13 All people living at the home must have an agreement with the home if they are self funding or, where funded by a local authority, a copy of the agreement specifying arrangements made so that people are clear about what is included in their fees paid. A service user plan must be 30/11/07 written to reflect how to manage all aspects of each persons care so staff know what people’s needs are and how to they should be met. Appropriate support must be 30/11/07 provided, to people living at Swiss Cottage, in order that they receive treatment and follow any advice given by other health care professionals. Personal hygiene tasks must be undertaken in private to ensure the privacy and dignity of people living at Swiss Cottage is protected. Activities within the dementia DS0000069674.V349594.R01.S.doc 4. OP10 12 (4) 30/11/07 5. OP12 12,13,18 30/11/07 Page 26 Swiss Cottage Nursing Home Version 5.2 care unit should be developed around individuals known social histories, and promote meaningful opportunities for service user participation, based on principles of ordinary living. Previous requirement timescales of 31/05/07 and 31/08/07 not met. 6. OP26 23 The home must review the standard of carpeting on the first floor and repair or replace areas that are heavily soiled. Previous timescale of 30/06/07 not met. 7. OP26 16(2)(k) All areas must be free of offensive odours to provide a pleasant environment for the people living there. Previous timescale of 30/06/07 and 31/08/07 not met. 8. OP27 18 The home must have sufficient staff at all times to meet the needs, including the specialist needs, of the people living there. Staff must be trained and supported to develop their understanding of communications and social interactions, particularly in relation to people with specialist needs, including dementia, in order to take into account the person’s dignity and respect. All staff must be appropriately supervised to ensure that competent for the role in which they are employed. 30/11/07 30/11/07 30/11/07 9. OP30 18 30/11/07 10. OP36 18 30/11/07 Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 27 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 OP36 Good Practice Recommendations All staff should be formally supervised at least 6 times a year. Supervision should cover all aspects of practice, philosophy of care in the home and career development needs. Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Swiss Cottage Nursing Home DS0000069674.V349594.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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