Inspection on 22/04/09 for Swiss Cottage Nursing Home

This inspection was carried out on 22nd April 2009.

CQC found this care home to be providing an Poor 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

Swiss Cottage Nursing Home 08/10/08

Swiss Cottage Nursing Home 22/01/08

Swiss Cottage Nursing Home 19/09/07

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 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Swiss Cottage Nursing Home Plantation Road Leighton Buzzard Bedfordshire LU7 3HU Lead Inspector Louise Trainor Unannounced Inspection 22nd April 2009 07:00 DS0000069674.V375059.R01.S.do c Version 5.2 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. Swiss Cottage Nursing Home DS0000069674.V375059.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 Swiss Cottage Nursing Home DS0000069674.V375059.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 Manager post vacant 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.V375059.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 8th October 2008 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. Fees given as being current at the time of the inspection in October 2008 were varied dependent on the funding source and assessed need of the person. In all cases where people are entitled to a nursing contribution this is collected and retained by the company. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 5 Additional charges are made for hairdressing, newspapers, toiletries and chiropody. A copy of the Commission for Social Care Inspection report is available in the foyer. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that take account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Louise Trainor and Sally Snelson undertook this inspection of Swiss Cottage. It was a key inspection, was unannounced, and took place from 07:00hrs on 22nd April 2009. Sixteen inspection hours were spent on this inspection. The manager was sick on the day of the inspection, however the operational manager Jenni Acres was present from 10:30am. Feedback was given throughout the inspection, and at the end. During the inspection the care of people who use the service (residents) was case tracked in detail. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, visitors, and staff were spoken to, and their opinions sought. Any comments received from staff or residents about their views of the home, plus all the information gathered on the day was used to form a judgement about the service. The inspector would like to thank all those involved in the inspection for their input. What the service does well: The laundry was situated away from any areas used by the residents and was kept very clean and tidy. It was apparent that the laundry and cleaning staff took a pride in their jobs. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 7 Individual’s rooms were furnished and decorated with personal assets and photographs, often reflecting life histories and meaningful subjects. There are gardens surrounding this home, which are well tendered and provide a pleasant area to relax, weather permitting. Safeguarding processes and protocols are well understood by the Area Manager who is spending most of her time in the home at present. All issues of concern are being addressed appropriately and there is now an encouraging transparency between the home and related organisations. Examination of the complaints file confirmed that since the last inspection complaints were being recorded and there was a clear audit trail as to how they had been investigated. Many of the responses to complaints were from the area manager. What has improved since the last inspection? What they could do better: There is presently no registered manager in place at this home, and there has been a serious lack of monitoring of the running of this home. Recruitment processes and training opportunities are good, however care practices do not always reflect that staff have the understanding or skills to ensure the safety of the people who live in this home. The home provides a physical environment that meets the specific needs of the residents, however the cleanliness of some areas of this home are in need of attention. We were advised that some staff regularly fail to appropriately ‘bag up’ infected laundry. This would contribute to the smell in the home, as well as increasing the risk of cross infection within the home. We discussed this matter with the area manager, who addressed this issue immediately. When we arrived at the home at 07:00 hour, a carer opened the door to us, although she responded to our greeting, she did not ask who we were or accompany us through the home. We were concerned that her actions compromised the safety of the residents, as we were left alone to wander around the home. The homes information documents are presently under review. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 8 Pre admission assessments were in place however dates and signatures were missing off these documents. Healthcare is not person centred, and care plans are not being followed by all staff. Medication records are not up to date, and this lack of recording puts residents at risk. Whilst walking around on the ground floor of this home, we saw one gentleman being pushed from his bedroom to the dining room in a wheelchair. Despite the fact that the wheelchair had footplates, the carer was shouting from behind him. “Lift your feet up”. His feet had not been positioned on the plates. This was unacceptable. Staff choose the activities in the home, and residents become compliant with routines, which is not a person centred approach. Limited consideration is given to individual’s choices, particularly those residents with cognitive impairment. 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. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 9 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.V375059.R01.S.doc Version 5.2 Page 10 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): 1, 2, 3, 4, 5, 6 People using the service experience adequate quality outcomes in this area. The homes information documents are presently under review. Pre admission documentation is in place, however these documents are not always fully completed. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The service has a Statement of Purpose and a Service Users Guide that details information about Swiss Cottage. We were told that the documents have been Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 11 updated since the last inspection and are currently being reviewed to include details about the Commissions change of name. The service had a good pre-admission tool, which if completed correctly would provide staff with clear guidance about the needs of the prospective resident and aide their decision when ascertaining if Swiss Cottage could meet needs. However one of the pre-admissions documents we saw had not been fully completed and another had not been dated and signed. All of the residents were provided with a contract on admission and the administrator ensured these were completed appropriately and correctly stored. The home was registered to care for people over the age of 65 years with associated conditions including old age. We were not aware how the home was able to provide care for those people with a mental heath illness other than dementia. However one of the people who we case tracked had been diagnosed with a bi-polar disorder and would need specialist care. At the time of the inspection the home did not offer intermediate care. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 12 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): 7, 8, 9, 10, 11 People using the service experience poor quality outcomes in this area. Healthcare is not person centred, and care plans are not being followed by all staff. Medication records are not up to date, and this lack of recording puts residents at risk. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans were in place for some areas of care and were being signed as being reviewed, however it was apparent that information was not being recorded accurately and that therefore the care plan did not accurately reflect the care needs. For example one resident who had a diabetes, a below knee amputation, and a urinary catheter did not have a specific care plan for Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 13 diabetes but had information about his condition was included as part of his eating and drinking care plan. His catheter was referred to in the evaluation of his elimination care plan, and he had no moving and handling plan despite needing support. This resident had been discharged from hospital on 15.12.08 with a short-term catheter, which suggested it could be removed as soon as the staff liked. The catheter was finally removed 12.4.09. In that time the resident had had numerous treatments for urinary tract infections, which may well have been caused by having a catheter insitu too long. Staff said they had realised when they started reviewing care plans in detail that they could remove the catheter and had done so. A catheter plan would have detailed the type, size and date of insertion and renewal of a catheter and ensured it was cared for correctly. Another file that we looked at, this time on the Cedar Unit also had numerous care plans in place. These were written in detail and were being reviewed regularly. However despite there being a care plan for pressure area care, instructing 2 hourly turns, the turn charts were not being completed to reflect that this was happening, particularly by night staff. Whilst visiting this resident we had the opportunity to look at her pressure wound site with the Tissue Viability Nurse (TVN). It was healing well. There was also a care plan relating to diet and nutrition. It directed staff to weigh this resident on a weekly basis, however other documentation in the file contradicted this and stated ‘monthly.’ Weekly weight records were being kept for this resident in a book, and her weight was stable at present, but this was not in care plan or personal her file. This plan also instructed staff that ‘Thick and Easy’ should be added to all liquids for this resident, as she was prone to choking and aspiration. We observed a qualified nurse giving water with tablets, and when asked if this was just ordinary water? He replied. “Yes”. We then enquired if this resident drinks plenty of water? He gestured to a jug of water in the bedroom, and again answered. “Yes”. There was no evidence of Thick and Easy in the jug or in the bedroom. Whilst walking around on the ground floor of this home, we saw one gentleman being pushed from his bedroom to the dining room in a wheelchair. Despite the fact that the wheelchair had footplates, the carer was shouting from behind him. “Lift your feet up”. His feet had not been positioned on the plates. During this visit we looked at the medication and the Medication Administration Records (MAR) for all the residents on the Acorn Unit. The new stock had only just been signed in, and it was only the second day of the cycle, however it was not possible to reconcile the medications. Tablets had been clearly carried forward from the previous month, and despite daily auditing of the stocks the number of tablets recorded on the Medication Administration Records (MAR) did not correspond to the number of tablets held in stock. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 14 We looked at one resident’s MAR sheet, and found that although only 48 hours into the present MAR sheet, there were already a number of gaps. When we spoke to a senior member of staff about the omission of signatures we were told that the medication had been given, but not signed. The staff member did not appreciate the seriousness of this. We also found the reverse situation on other files, where tablets had been signed for but were still in the blister packs. This was totally unacceptable. A MAR sheet for another resident indicated that a controlled drug (CD) had not been given at 20.00hrs the night previously, however when we checked the CD Register we found it had been signed by two nursing staff. No controlled drugs were actually stored on Acorn unit, although there was a controlled drug cupboard available. When we opened this cupboard we found a large collection of items including two out of date ready to use enemas, in excess of 8 pairs of glasses, pots of money, unopened personal mail and receipts for items bought on behalf of a resident. This is not appropriate storage for these items. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14, 15. People using the service experience poor quality outcomes in this area. Staff choose the activities in the home, and residents become compliant with routines, which is not a person centred approach. Limited consideration is given to individual’s choices, particularly those residents with cognitive impairment. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There were activity programmes displayed around the home, however there was little evidence of any meaningful activities ongoing throughout our visit. On the dementia unit we spoke to visitors who told us that with the exception of ‘Michael’s Music’, which was a visiting entertainer, there was little else in the way of activities to stimulate the residents. We did however see one or two residents having their nails painted on the dementia unit. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 16 Two of the residents that we case tracked during this visit, spend much of their time in their bedrooms. Interactions from staff for these people was limited to when staff were carrying out personal care. We spoke to one lady who was sitting on the ground floor, with her hat and gloves on by the door when we arrived at 07:00 hours, we spoke to her briefly as we passed her on occasions throughout the day, however she was still in the same place when we left the home at 15:30 hours. Although we appreciate that staff are busy with other more clearly defined tasks throughout the day, it is important that social interacting becomes an integral part of care for the people in this home. We observed the lunch service on the ground floor. There was roast turkey, roast potatoes, carrots and green beans followed by sponge and custard or ice cream on the menu. The meals were delivered to each unit via a hot-lock and served by the staff to each individual. The staff were recording the temperatures of the food before serving, but we noted that on one occasion the food was recorded below 63 degrees. We did not see what was done to rectify this matter, and staff were unable to tell us how it was dealt with. When people are admitted to this home, details of personal choices are recorded, however these do not include the very basics, such as how often they would like a bath or shower. One lady that we spoke to on the Cedar unit, looked a little unkempt. When we looked at her records, we found that the last time she had had a shower / bath was on the 02/04/09, nearly three weeks earlier. This is not acceptable. We also noted that she was not wearing a bra or a vest under her t shirt, this was very undignified and her husband confirmed she would never have gone without these undergarments. We were also aware that on the Acorn there is only one member of staff allocated to work at night. On the day of the inspection, we met the male carer who had been on duty all night. When asked, he was unaware of whether all the residents, many of whom were female, were happy to have their personal care carried out by a young male. We were told by a social worker visiting the home, that she knew of at least one resident on this particular unit that did not like men. This had not been addressed, and this member of staff was unaware of this issue. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 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): 16, 18 People using the service experience adequate quality outcomes in this area. The service has a complaints policy, which is accessible to residents and visitors to the home. There was a limited understanding amongst staff of what may constitute a safeguarding risk to residents. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Examination of the complaints file confirmed that since the last inspection complaints were being recorded and there was a clear audit trail as to how they had been investigated. Many of the responses to complaints were from the area manager. When we arrived at the home at 07:00 hour, a carer opened the door to us, although she responded to our greeting, she did not ask who we were or accompany us through the home. She later told us that she thought we had been in the home the day before, and she was expecting us to return. She had confused us with someone else. We were concerned that her actions compromised the safety of the residents, as we were left alone to wander Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 18 around the home to find a senior member of staff to whom we could announce our visit. This was unacceptable. Safeguarding processes and protocols are well understood by the Area Manager who is spending most of her time in the home at present. All issues of concern are being addressed appropriately and there is now an encouraging transparency between the home and related organisations. The Area Manager is presently liaising with the local safeguarding team, who have agreed to deliver training to all staff in the home. We hope this will improve staff understanding of what constitutes abuse, as presently omissions of care, lack of choices and isolation are not recognised or reported as such. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 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): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience adequate quality outcomes in this area. The home provides a physical environment that meets the specific needs of the residents, however the cleanliness of some areas of this home are in need of attention. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: We spoke to one resident in his bedroom and he told us it was his choice to store many of his papers on the floor. However as he only had one bedside cupboard and that held a piece of medical equipment we did not think he had been given any choice in the matter. In addition to papers and books being stored on the floor there were three empty mugs, a metal teapot and a very Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 20 discoloured urinal on his over bed table. He told us the teapot was to provide him with water hot enough to shave. Also in his room we saw a mobility frame and a wheelchair, which left very little space for any additional furniture. On the ground floor the home was clean and free from any offensive odours, however this was not the case on the dementia units, where there was an overwhelming smell indicative of poor continence management. This indicated that it was unlikely that the cause was due to general poor housekeeping practices. Although comfortable chairs on the dementia unit had been replaced about 28 months previously as a result of our last Inspection, the cleaning staff told us that they were having great difficulty in keeping the material clean and odour free and would prefer vinyl chairs that could be correctly cleaned. This indicated the need to review / replace the furniture and flooring. We were also advised that some staff regularly fail to appropriately ‘bag up’ infected laundry. This would contribute to the smell in the home, as well as increasing the risk of cross infection within the home. We discussed this matter with the area manager, who addressed this issue immediately. Individual’s rooms were furnished and decorated with personal assets and photographs, often reflecting life histories and meaningful subjects. There are gardens surrounding this home, which are well tendered and provide a pleasant area to relax, weather permitting. The laundry was situated away from any areas used by the residents and was kept very clean and tidy. It was apparent that the laundry and cleaning staff took a pride in their jobs. We were disappointed to see that a request for a new iron, was ignored and a new plate fitted instead. The one in use was spraying excess water and steam, creating a high risk of scalding to the staff using this equipment. The head housekeeper was confused by information from the Department of Health advising the use of disinfectant on articles used by those with Clostridium Dificile infection, while Southern Cross policy advised the use of detergent. We asked the Area Manager to look into this immediately. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. Recruitment processes and training opportunities are good, however care practices do not always reflect that staff have the understanding or skills to ensure the safety of the people who live in this home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we looked at the files of four members of staff, all had been appointed within the last year. Each file contained fully completed application forms, appropriate references, Criminal Record Bureau (CRB) checks, Nursing Midwifery Council (NMC) PIN number checks for qualified nurses, various forms of identification, basic skills and literacy test papers and contracts of terms and conditions of employment. Although the home still has some staff vacancies, the use of agency workers in kept to a minimum, and staffing levels are good throughout the home, and the Files that we looked at indicated that the staff are generally attending training as is required. However the actions of some staff that we witnessed during this Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 22 inspection, indicated that there is a limited understanding of basic but essential care practices, such as individual resident’s choices, safeguarding, respecting individuals’ privacy and dignity, the need to follow care plans and keep records up to date. Examples of all of the above have been detailed throughout this report. There are presently three staff under suspension in this home, two of these staffs files contained all the relevant documentation, indicating that each case is being addressed appropriately, however we were unable to locate the third, which was for a qualified nurse. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 37, 38 People using the service experience poor quality outcomes in this area. There is presently no registered manager in place at this home, and there has been a serious lack of monitoring of the running of this home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: There is presently no Registered Manager in post in this home. The manager, who is not yet registered, has been on sick leave since February, with the Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 24 exception of three days when she was on duty. The home has therefore been lacking any form of leadership. Throughout this inspection we found evidence that indicated that the management of the home was ineffective. Records were not being updated, internal monitoring audits were not being carried out effectively, and care practices were not being monitored and challenged. There have been a number of safeguarding referrals over recent weeks, which have caused serious concerns relating to this home and consequently initiated this inspection. The Area Manager has reacted to these problems by resourcing the skills of a Tissue Viability Nurse, one day a week, and securing the appointment of a Clinical Lead to assist on improving care standards. There is a newly appointed manager on the dementia care unit, and the Area Manager is spending much of her own time in this home, although she has responsibility for nine other homes. However as this was not addressed in a more proactive way, the risk to residents in this home has been increased and there has been a marked deteriorated in the standards of care. There is a full time administrator in this home, who has worked here for many years. Consequently her procedures, such as the resident’s personal money and staff recruitment files were all in order. Records indicated that fire call points and the emergency lighting were being tested on a regular basis, and that fire drills were carried out periodically. Maintenance issues and redecorations were being addressed in a timely fashion. Incidents and accidents are being addressed and reported appropriately. Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 25 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 2 3 2 2 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 X 1 2 Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement People who live in this home must have care plans, which are sufficiently detailed and reviewed to reflect their changing needs. Timescale for action 30/01/09 This requirement was partially met a new timescale for action has been set 2. OP7 18(a) People who live in this home 05/05/09 must be cared for by staff who have the skills and understanding to follow individual care plans, this includes the completion of supporting monitoring documentation. People who live in this home 30/04/09 must be protected by the accurate completion of Medication Administration Record (MAR) sheets. People who live in this home must be treated with dignity and respect at all times. People in this home should be DS0000069674.V375059.R01.S.doc Timescale for action 30/04/09 3. OP9 13 (2) 4. 5. OP10 OP12 12(4)(a) 16(2)(n) 30/04/09 31/05/09 Page 27 Swiss Cottage Nursing Home Version 5.2 6. OP14 12(2) 7. OP18 13 (6) consulted on and encouraged to participate in activities that suit their abilities. People who live in this home must have the opportunity to make decisions about all aspects of their daily life, so far as is practicable. People who live in this home must be care for by staff that fully understands the Safeguarding protocols and procedures. All staff must undertake further Safeguarding training as discussed with the Area Manager. People who live in all the units in this home, must have a clean and comfortable environment to live in. Particular consideration must be given to the Dementia units. People who live in this home must be cared for by staff that understand the importance of, and adhere to policies relating to infection control, with particular attention to the procedures for management of infected laundry. The registered person must ensure that someone manages this home with the appropriate skills, knowledge and experience. All records specified in schedule 3, for all people who live in this home, must be maintained and kept up to date. The Registered Person must ensure that all aspects of residents health and welfare are audited and monitored closely to identify when care is being compromised. 31/05/09 31/05/09 8. OP26 23(2)(d) 31/05/09 9. OP26 13(3) 30/04/09 10. OP31 9(2)(b)(i) 31/05/09 11. OP37 17 31/05/09 12. OP38 13 31/05/09 Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 28 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 OP3 Good Practice Recommendations Pre-admission assessment documentation should be fully completed to reduce the risk of important information about people’s needs being missed and needs not met. This should include dates and signatures. Care plans and associated records should be organised in such a way as to enable staff to access current information about people’s needs quickly and easily. Clear records should be in place and completed to demonstrate the care delivered. 2. OP7 3. OP8 Swiss Cottage Nursing Home DS0000069674.V375059.R01.S.doc Version 5.2 Page 29 Care Quality Commission Eastern Region Care Quality Commission Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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