Inspection on 08/10/08 for Swiss Cottage Nursing Home

This inspection was carried out on 8th October 2008.

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

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

Other inspections for this house

Swiss Cottage Nursing Home 22/04/09

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 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Swiss Cottage Nursing Home Plantation Road Leighton Buzzard Bedfordshire LU7 3HU Lead Inspector Kathy Jones Unannounced Inspection 8th October 2008 10:00 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.V372723.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.V372723.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 Vacant post 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.V372723.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 22nd January 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 this inspection in October 2008 were varied dependent on the funding source and assessed need of the person. For people funded by the County council fees range between our hundred and fifty seven pounds and six pence to four hundred and seventy five pounds and Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 5 ninety four pence. An emergency admission, which may prevent a hospital admission, is charged at five hundred and ninety five pounds. For people paying for their own care fees range between five hundred and fifty pounds to six hundred and ninety five pounds fifty pence. In all cases where people are entitled to a nursing contribution this is collected and retained by the company. 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.V372723.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 1 star. This means the people who use this service experience adequate quality outcomes. Standards identified as ‘key’ standards and highlighted through the report were inspected. The key standards are those considered by the Commission to have a particular impact on outcomes for residents. Inspection of the standards was achieved through review of existing evidence, pre-inspection planning, an unannounced inspection visit to the service, collating information received in surveys received from relatives, people who use the service and staff and drawing together all of the evidence gathered. The pre-inspection planning was carried out over the period of half a day and involved reviewing the service history, which details all contact and correspondence with the home and previous inspection reports. The last full inspection (this is called a key inspection) took place in January 2008. Information from this inspection was taken into account as part of the planning. This unannounced inspection visit was carried out by two inspectors over a period of a day. The inspection was carried out by ‘case tracking’, which involves selecting samples of residents’ records and tracking their care and experiences. Observations of the homes routines and care provided were made and views on the care provided were sought from people who use the service, visitors and staff. The management of residents’ medication was checked through reviewing prescribed medication for a sample of people. A sample of staff files were reviewed to check the adequacy of the recruitment procedures in protecting people who use the service. Communal areas and a sample of bedrooms were viewed and observations were made of people’s general well being, daily routines and interactions between staff and people who use the service. Some verbal feedback was given to the Acting Manager to the Operations Manager at the end of the inspection. Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Information needs to be kept up to date to ensure that people have correct contact numbers in the case of complaint. Information about fees also needs to be freely available to help people make decisions and plan their finances. More thorough completion of assessments of people’s needs prior to admission would provide better assurances that people’s needs can be fully met. People’s care records on the ground floor (nursing) were poorly organised, making it difficult for staff to establish quickly and easily people’s current care needs. This creates a risk that important information may be missed and needs not met. More thought is needed about how people are supported on a daily basis to engage in meaningful activity/occupation throughout the home. Someone commented, “there is nothing to do here”. We noticed that some people had long waits for assistance with washing and dressing, with some people on the ground floor not being washed until nearly lunch time. It is important that staffing arrangements are reviewed to ensure that there are enough staff to meet people’s needs in a timely manner. Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 8 Staff training records show that there has been some slippage in the provision of training in all areas. The manager advised that training is being booked to address this. 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.V372723.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.V372723.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, standard 6 is not applicable as intermediate care is not provided. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to people about the services provided and an assessment of need takes place prior to admission. A more thorough approach is needed to ensure people always receive accurate information and that they can be fully satisfied their needs will be met. EVIDENCE: Information is available to people considering using the service and their families in the form of a statement of purpose and service user guide. A copy of the documents and a copy of the most recent inspection report are also available in the foyer. Copies of the statement of purpose and service user guide were also in peoples rooms. Review of a copy of the statement of purpose and service user guide received during the inspection found that they were not up to date. Names of people given as contacts for making complaints such as the home manager, operations manager and operations director were Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 11 incorrect. Contact details for the Commission for Social Care Inspection were also not correct. Fees are referred to in the documents, however the actual cost or range of fees is not included. It is important that people have accurate information to help them to make decisions about their care. There is a procedure whereby an assessment of peoples needs is carried out prior to admission, which is important in helping to determine whether their needs can be met. Records for someone who had recently been admitted identified that the pre-admission assessment had only partially been completed. However in this particular case supporting information had been obtained from the placing authority and a discharge summary received from the hospital, which identified the person’s current needs and condition. Prior to the inspection we had received information that suggested that the equipment people needed was not taken into account as part of the preadmission assessment. We randomly selected the pre-admission assessment for someone who had recently been admitted and found the required equipment was clearly recorded as part of the assessment and also that the necessary equipment was available. Swiss Cottage Nursing Home DS0000069674.V372723.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The quality of information available to guide staff in the individual care they need to provide varies. In some cases this is very good, however the shortfalls in the care planning and the monitoring of health care needs for others puts them at risk of their needs not being met. EVIDENCE: We looked at a sample of care plans; spoke with staff, the manager and people who use the service to see how peoples care is planned and their needs met. A requirement had been made at the previous inspection that staff must update care plans as people’s needs alter. We had also received information prior to the inspection, which indicated that there might be concerns relating to the management of pressure ulcers. We found that information about people’s changed needs had been added to records, however the way people’s care records were organised and used Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 13 made it quite difficult in some cases to establish quickly and easily what their current care needs were. For people admitted for respite care a ‘short stay care plan’ was used and in some cases, such as for wound care an additional care plan was on file, but with no cross referencing this was not easily picked up. In the files reviewed there was evidence that there was ongoing review and treatment of wounds, however the poor record keeping creates a risk that people do not receive appropriate, timely and consistent care. Some of the information within the care plans was very general and one care plan for wound care contained general statements, which could have applied to the care of any wound and didn’t contain information such as the type of dressing or specific treatment required. This information was later found in other supporting documentation. Similar examples were identified in other care plans on the ground floor where nursing care is provided. Advice was also given regarding the need to record the care actually delivered. For example there were no records for the care of the site for someone’s PEG (Percutaneous Endoscopic Gastrostomy) feed tube. In contrast the care plans and records looked at on the first floor (dementia unit) contained sufficient information to enable staff to provide the individualised care for people using the service. Risk assessments were in place, which identified specific areas of risk to individuals such as weight loss, falls and pressure area care. There were records of weights and dietary requirements being monitored and the input of specialist support through the dietician services and other healthcare professionals. Records for people receiving nursing care also confirmed that ongoing advice is sought from relevant health professionals such as General Practitioner, dietician and chiropodist. The acting manager told us that a tissue viability nurse is employed and that she has reviewed all of the wounds and had given advice regarding appropriate treatment. We looked at medication records and medication for two people on the ground floor to see how this is being managed. Prescribed medication was in stock and records confirmed that it was being administered as prescribed. Quantities of medication carried forward to the next medication cycle were being recorded helping to establish a clear audit trail. Two inhalers were found without names, the nurse confirmed that people had their prescribed inhalers and these would be returned to the pharmacist. A requirement had been made at the previous inspection that medication, that belongs to a resident, but is destroyed by the home because it is not needed, must be documented. We found that this was now happening; however we were concerned that on the first floor we found a large amount of medication Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 14 waiting to be recorded and returned to the pharmacist for destruction. Advice was given about the risks of not dealing with this in a timely manner. Following advice a staff member had started to record this medication during the inspection ready to return to the pharmacist. Staff were observed to treat people with dignity and heard to speak to them in a respectful manner. Personal care was provided in the privacy of people’s rooms and staff were observed to knock before entering rooms. Swiss Cottage Nursing Home DS0000069674.V372723.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. 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. Visitors are encouraged and welcomed into the home and people are satisfied with the food provided. The quality of people’s daily lives in relation to meaningful activities and social stimulation appears to be better on the first floor (dementia unit) than it is on the ground floor (nursing unit), where interactions are more task orientated. EVIDENCE: A requirement had been made at the last inspection that activities within the dementia care unit should be developed around individuals known social histories, and promote meaningful opportunities for service user participation, based on principles of ordinary living. Within one of the care plans viewed a detailed profile had been provide by the family, this gave information on the likes and dislikes of the person using the service, such as they adored animals, liked reading books, knitting and crochet. Details were available on previous occupations and achievements, Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 16 which provides a good forum to promote discussion between staff and the people using the service. During the morning people within the dementia care group were observed to be engaged in one to one and group activities one person was playing dominoes with a carer, another looking through their photograph album and a small group of people were engaged in an arts and crafts session making Halloween decorations with the activity person, others were observed to get some enjoyment out of listening to easy listening music playing. Observations of staff interactions were in the main positive one member of staff was heard to compliment a person on their choice of perfume this simple action had the effect of bringing a smile to the persons face and promoted a sense of well being. Discussion with people who use the service and relatives indicated that the quality of people’s daily lives is partially dependent on where they are in the home and their level of independence. One person spoken with on the ground floor had been brought into a lounge by a carer in a wheelchair after being assisted to wash and dress. The television was on and four people were asleep in chairs. The person who had been brought in to the lounge said, “there is nothing to do here, the television is on but I can’t hear it”. Staff were observed to be busy assisting other people to wash and dress throughout the morning. We spoke with the acting manager and operations manager about the fact that although there is an activity organiser and there is evidence that some activities are provided more thought needs to be given to how people are supported on a daily basis to engage in meaningful activity/occupation throughout the home. They confirmed that they had identified the need to work with care staff to look at people’s individual needs as part of their care planning rather than being totally reliant on the activity organiser. Relatives spoken with confirmed that there are flexible visiting arrangements. Observations of interactions between staff and some relatives confirmed that visitors are made welcome. There is a four-week menu in place, which demonstrates variety and a choice of meal. People were observed receiving their lunch of roast pork, mashed potatoes, mixed vegetables and for afters a pudding of spotted dick and custard, a vegetarian option was also available. Staff were observed providing support for people who required additional help to eat and drink and this was provided with dignity and sensitivity. Records were available within the care plans viewed of people who require their diet to be supplemented and staff were observed to offer fortified drinks and supplements. Swiss Cottage Nursing Home DS0000069674.V372723.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. 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. There are procedures for dealing with concerns and complaints, however contact details have not been kept up to date and not all staff have received appropriate training to help them safeguard people who use the service. EVIDENCE: There are procedures in place for making complaints, which are detailed in the statement of purpose and service user guide. Contact details are available for managers at different levels within Southern Cross; unfortunately as detailed earlier in this report this information is not correct, as it has not been updated as managers have left the organisation. The Commission for Social Care Inspection received an anonymous complaint just prior to the inspection. The complaint was discussed with the manager and area manager at the end of the inspection. Areas of concern related to lack of equipment on admission, pressure area care and staffing levels. These areas have been looked at as part of this inspection. A record of complaints received directly by Swiss Cottage is kept and a sample were looked at and discussed with the Acting Manager during the inspection. This confirmed that concerns raised are investigated and where appropriate action is taken. The Acting Manager confirmed that she was clear about her Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 18 responsibilities for reporting any safeguarding concerns to social services through Safeguarding of Vulnerable Adults procedures and where appropriate to the Police. The Acting Manager had recently had advice from social services about the type of issues that needed to be reported and it was clarified that this would include anyone who was admitted with a pressure ulcer or who developed one while at Swiss Cottage. People spoken with during the inspection felt that they would be able to raise concerns with someone if it was necessary; one person said they would talk to a staff member. Review of the staff training matrix identified that not all staff have received training in safeguarding vulnerable adults. Swiss Cottage Nursing Home DS0000069674.V372723.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. 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. The environment is clean and appropriate for the needs of older people, though some areas could be better organised to make them more comfortable and homely. EVIDENCE: The home is situated in pleasant secluded grounds, which people who use the service have access to. Shared areas such as lounges and dining rooms and a sample of people’s bedrooms were seen during the inspection. Lounges on the ground floor were spacious but in some cases due to the layout of the room and the small number of people in the room people were somewhat isolated and the room appeared quite bare. Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 20 It was confirmed that some re-decoration and replacement of carpets is planned. People on the first floor, which is the dementia unit, are able to, where mobility allows wander freely. Efforts have been made to reduce the confusion for people and assist them with independently finding their room or the bathroom. Examples include signage on bathrooms and toilets, which was clear with a large picture to identify the room. People are encouraged to personalise their bedrooms with pictures and family photographs and other objects of familiarity. People spoken with said they were happy with their rooms. Areas seen were clean and free from unpleasant odour. Some measures were observed to be in place to reduce the risk of infection. For example disposable gloves and aprons were available and staff were observed to be using them. It is important that staff have a thorough understanding of infection control, as older people can be particularly vulnerable. Training records identify that only 69 of staff have received training in infection control. A general requirement has been made about the need for more staff training. Swiss Cottage Nursing Home DS0000069674.V372723.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. 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. Staff recruitment procedures are good, helping to safeguard people who use the service. However review of staffing levels and deployment of staff and more training is needed to ensure that people’s needs can be fully met. EVIDENCE: We spoke with staff during the inspection about the sufficiency of staff in relation to meeting people’s needs. A staff member said that the majority of people on the ground floor require two staff for assistance. It was almost lunch time before everyone was washed and dressed on the ground floor, which staff said was the case on most days. Staff confirmed that the reason for this was that they were not able to assist everyone as soon as they were ready rather than people’s individual choice to get up late. This indicates the need review staffing arrangements and make alterations to numbers of staff and staff deployment to ensure that people’s needs can be met. Review of the matrix of staff training identified that only a small number of the care staff have achieved a National Vocational Qualification at level 2 or 3 or Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 22 equivalent qualification. This qualification provides staff with an understanding of the needs of older people and care practices. On first taking up employment staff undertake a three-day induction during which time they receive training on moving and handling, health and safety, and food hygiene. The process is that further training is undertaken following the initial induction that addresses more the specific needs of the people using the service such as the administration of medication, palliative care and dementia care. The training matrix identifies a number of shortfalls in staff training and discussion with the new manager following the inspection confirms that some action is being taken to arrange further training. It is important that staff have training appropriate to their role and the needs of the people who use the service. For example, the Acting Manager has identified the need for pressure area care, wound care training and care planning training as priorities. Advice was given to focus on the needs of people who use the service and ensure that all staff providing care to them have the appropriate training. Two staff recruitment files were viewed both had information on employment history, and evidenced that people using the service were protected through having criminal records bureau checks (CRB) and having obtained two written references from previous employers. Swiss Cottage Nursing Home DS0000069674.V372723.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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Consistent management arrangements and oversight are needed to help improve and maintain the quality of care and protect the health and welfare of people who use the service. EVIDENCE: Standard 31 relates specifically to the registered manager and their experience and qualifications. At the time of the inspection there was no registered manager in post, therefore this standard was not inspected as such. However it is considered from the perspective of the adequacy of the management arrangements, as this is considered a key aspect of ensuring that residents receive appropriate care. Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 24 At the time of the last inspection in January 2008 it was reported that an acting manager was in post and that he had started the processes with the Commission for Social Care Inspection (CSCI) to be considered as registered manager. However at the time of this inspection there was a different acting manager who had been in post since August 2008, having previously been a deputy manager since May 2008. We were advised that an application for registration as manager would be submitted to CSCI. It is the expectation of CSCI that an application for registration of a manager is submitted without delay and efforts are made to maintain consistent management arrangements to improve and sustain standards of care. As part of the quality assurance system, the organisation has internal systems where various audits are carried out to measure compliance with regulations and identify shortfalls. At the time of this inspection a company auditor was carrying out a full audit of the home. Discussion indicated that similar issues to those identified by inspectors were being identified. The auditor advised that the audit covered all aspects of the running of the home and that following the audit an action plan would be developed to address any identified shortfalls. The Care Homes Regulations 2001 require that organisations arrange for someone to carry out monthly unannounced visits to review and report on the quality of care provided. Reports of the visits carried out in July 2008 and August 2008 were seen. The findings of both visits were positive. The July report identifies the need for attention to some of the care plans seen. Some people leave small amounts of money for safekeeping to assist with paying for services such as hairdressing and chiropody. This is kept in a central bank account, which accrues interest and is added to each individual account. A sample check confirmed that records are kept of all transactions and receipts kept to verify these. This helps to safeguard people. Staff advised that an audit of the systems for managing peoples money had been carried by the company in January 2008 and that no concerns were identified. Observations during the inspection were that staff were carrying out safe practice in relation to the movement and handling of people who needed assistance. Training statistics printed off on 8th October identify that more work is required to ensure that all staff receive training in safe working practices such as fire safety, movement and handling, health and safety and infection control. This is important to ensure that staff have the necessary knowledge and skills to reduce the risk for people who use the service. A general requirement has been made about staff training. Swiss Cottage Nursing Home DS0000069674.V372723.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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X X X 2 Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 26 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 OP1 Regulation 5 Requirement The Service User Guide must contain all information detailed in Regulation 5, including clear information about all charges. This would help prospective and current people who use the service and their families make informed decisions. Care plans must be sufficiently detailed and reflective of people’s individual needs to guide staff in the care to be provided. Delays in arranging disposal of medication no longer required must be minimised to help maintain an accurate audit trail as part of the safe management of medication. Information about how to make a complaint must be kept up to date to ensure that people are able to raise any concerns. Staff must receive safeguarding vulnerable adults training to help safeguard people who use the service. Staff must be deployed in sufficient numbers at all times of DS0000069674.V372723.R01.S.doc Timescale for action 15/01/09 2. OP7 15 30/01/09 3. OP9 13 (2) 15/01/09 4. OP16 22 15/01/09 5. OP18 13 (6) 30/01/09 6. OP27 18 (1) (a) 15/01/09 Swiss Cottage Nursing Home Version 5.2 Page 27 7. OP28 OP30 18 (1) (c) (i) the day to ensure peoples needs are met in a timely manner. All staff must receive training appropriate to their role, this includes training in safe working practices and training to meet the specific needs of people who use the service. 15/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP3 OP7 OP8 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. 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 to demonstrate the care delivered. This should include the care provided to someone with a PEG (Percutaneous Endoscopic Gastrostomy) feeding tube. Arrangements should be made to increase the level of meaningful activities/occupation and social stimulation for people throughout the home. Consideration should be given to the layout and positioning of furniture in lounges in relation to people’s social needs. The manager should ensure that an application for registration is submitted to the Commission for Social Care Inspection without delay. 4. 5. 6. OP12 OP20 OP31 Swiss Cottage Nursing Home DS0000069674.V372723.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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.V372723.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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