Care Home: Swallows Meadow Court

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What the care home does well The home is managed by a team of people who are well trained to understand the needs of the residents and who ensure that their needs and requirements are listened to and acted upon as far as possible to maintain their health and welfare. The staff were observed to be friendly and approachable and interact well with residents in a supportive way. Both residents and visitors to the home spoke positively about the care and services provided. One resident said "staff can`t do enough for you" and staff are "very very good". Residents feel at ease to raise any concerns or complaints and it was evident from records in place that these are investigated and resolved as far as possible to the resident`s satisfaction. Over 50% of the care staff have achieved a National Vocational Qualification (NVQ) in Care to help them provide more effective care to the residents. This exceeds our standard of 50% of all care staff to achieve this. Residents enjoy good home cooked food and are consulted on their likes, dislikes and choices to make sure meals provided are to their liking. The home employs three Activity Organisers to help provide social stimulation to residents each week. As this is a new home the environment is spacious with furniture and fittings of a high standard to enable residents to enjoy pleasant, clean and safe surroundings. What has improved since the last inspection? Not applicable, first inspection to the home. What the care home could do better: The planned staffing arrangements for the home are not being met consistently and need to be reviewed to ensure there are sufficiently trained staff at all times to meet the needs of the residents. Duty rotas also need to display clear information in regard to staff shifts and designations. The care plans for residents are in need of review to ensure staff can easily identify current needs without having to read all of the information in the careplan and monthly reviews which is time consuming and could lead to an oversight in resident care. The assessment process for people admitted to the home via the Supportive Pathway Pilot Scheme needs to be improved. This is to ensure there is sufficient information available to staff about the resident prior to them staying at the home to ensure their needs can be met. There are some actions required in regards to the management of medications to ensure staff can audit medications effectively and ensure residents have received their medication as prescribed. It is not clear that social activities and stimulation are fully accessible to those less able residents. This needs to be reviewed to ensure all residents benefit from a social activity/stimulation programme suitable and acceptable to them. Systems for identifying small laundry items such as socks need to be reviewed to ensure residents receive all of their laundry items back. CARE HOMES FOR OLDER PEOPLE Swallows Meadow Court 31 - 73 Swallows Meadow Shirley Solihull West Midlands B90 4PH Lead Inspector Sandra Wade Key Unannounced Inspection 8th September 2008 09:30 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 Swallows Meadow Court DS0000071876.V369606.R02.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. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swallows Meadow Court Address 31 - 73 Swallows Meadow Shirley Solihull West Midlands B90 4PH 0121 706 3630 0121 746 6099 manager_smc@solihullcare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Solihull Care Ltd Ms Geraldine Mary Banham Care Home 55 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (55) of places Swallows Meadow Court DS0000071876.V369606.R02.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: Dementia over 65 years of age (DE)(E) 15 Old age not falling within any other category (OP) 55 2. The maximum number of service users to be accommodated is 70. Date of last inspection N/A Brief Description of the Service: Swallows Meadow Court is a new purpose built 70 bed nursing home which opened in March 2008. It is registered to accommodate 55 elderly residents who need nursing care plus up to 15 elderly residents over the age of 65 with a diagnosis of dementia. The accommodation for residents is based on the ground floor and first floor. There are four houses within the building (two on each floor). These are known as Kingfisher House, Heron House, Nightingale House and Robin House. Two of the houses have 15 beds each and two have 20 beds each. Care staff are employed to work within the specific houses so there is continuity of care provided to the residents. All of the bedrooms provide single accommodation and are suitably furnished and have an ensuite shower room and toilet. There are also communal toilets and bathrooms on each floor. The corridors, doorways and toilets are of a generous width to allow for easy wheelchair access. There is also a lift to each floor to ensure residents can access all areas of the home. The manager and deputy manager’s offices are on the first floor. Each floor has a communal lounge and separate dining room and there is also a Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 5 quiet lounge and social activity lounge on the first floor. The home has a call bell system to allow residents to call upon staff for assistance if needed. Staff carry phones with them around the home so they can be easily alerted and can respond to residents as required. There is a large, attractive and secure garden which some residents can view or access from their bedrooms. There is a CCTV camera which is focused on the entrance of the home and there are various TV screens in staff areas so they can see who is entering the home. There is an allocated doorbell for the reception as well as each house within the home. Entrance is only via staff as the door is kept locked for security. There is a car park to the front and side of the home for visitors and there are transport links and local amenities near by. The scale of charges at the time of this inspection were £800.00 per week. Additional charges are made for hairdressing and personal items and sundries such as newspapers. Swallows Meadow Court DS0000071876.V369606.R02.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 2 stars. This means the people who use this service experience good quality outcomes. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This was the first unannounced inspection to this home and was undertaken by two inspectors due to the size of the home. The inspection took place between 8.00am and 9.45pm. A completed Annual Quality Assurance Assessment was received from the service prior to the inspection and information contained within this has been included within this report where appropriate. Quality satisfaction surveys were sent out to ten residents to obtain their views on the service. Discussions were held with staff, residents and visitors during the period of the inspection. Four people who were staying at the home were ‘case tracked’ this included two people in the Heron House and two people in the Nightingale House. The case tracking process involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records and medication records. The inspectors spent a period of the day observing the residents in the dining room to ascertain what the mealtime experience was like. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: The planned staffing arrangements for the home are not being met consistently and need to be reviewed to ensure there are sufficiently trained staff at all times to meet the needs of the residents. Duty rotas also need to display clear information in regard to staff shifts and designations. The care plans for residents are in need of review to ensure staff can easily identify current needs without having to read all of the information in the care Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 8 plan and monthly reviews which is time consuming and could lead to an oversight in resident care. The assessment process for people admitted to the home via the Supportive Pathway Pilot Scheme needs to be improved. This is to ensure there is sufficient information available to staff about the resident prior to them staying at the home to ensure their needs can be met. There are some actions required in regards to the management of medications to ensure staff can audit medications effectively and ensure residents have received their medication as prescribed. It is not clear that social activities and stimulation are fully accessible to those less able residents. This needs to be reviewed to ensure all residents benefit from a social activity/stimulation programme suitable and acceptable to them. Systems for identifying small laundry items such as socks need to be reviewed to ensure residents receive all of their laundry items back. 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. Swallows Meadow Court DS0000071876.V369606.R02.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 Swallows Meadow Court DS0000071876.V369606.R02.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): Standards 1 and 3 were assessed. Quality in this outcome area is good. There is some information about the home made available to residents to help them make an informed decision on whether to stay. Generally, the needs of prospective residents are assessed and information is requested to ensure the needs of residents can be met prior to them staying at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A Statement of Purpose detailing information about the care and services provided by the home has been developed and was being kept in the reception area for visitors to view as required. The manager said that this could be copied if a visitor requested a copy. It was not evident that the home issue copies of a Service User Guide to prospective residents to help them to make an informed decision on whether to stay at the home. Staff advised that the Statement of Purpose is being used as a combined Statement of Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 11 Purpose/Service User Guide but this was not evident as it was not clear these were being issued to residents. Three questionnaires returned to us from residents showed that they all felt they had received enough information about the home before they moved in. Some of these residents transferred from another home within the organisation. One resident spoken to said that they were shown around the home prior to their stay and had decided they liked the home. Four residents files were viewed to confirm the assessment process prior to them staying at the home. The format included a tick box response to all sections but gave sufficient space to allow for any specific assessment detail. It was evident from records in place that three of the four residents had received an assessment of their needs prior to them commencing their stay at the home. Assessment records showed key areas of need had been considered including personal care, diet and weight, sight, hearing, communication, oral health, nutrition, mobility and dexterity. One of the assessments completed showed pressure relieving and transferring equipment required. There was also a medical history on each file so that staff could consider any care needed to support specific needs associated with these conditions. Assessments also indicated any potential areas of risk such as falls or poor food intake. This detailed information helps staff to produce detailed plans of care to ensure nurses and carers meet the needs of the residents effectively. One care file belonged to a resident who had been admitted to the home under the newly implemented pilot for ‘The Supportive Pathway’ scheme. This is meant to give respite to the carers of people with a terminal illness and life expectancy of 6-12 months for periods of one to two weeks. The staff at the home had not carried out a pre-admission assessment and the team leader of the unit said that it was intended that the home would rely on the referrers for this information. However the paperwork supplied was sparse and did not give staff at the home sufficient assessment details for them to have been able to make a decision about whether the person’s needs could be met or not. This had already been identified by the home and a meeting was to be held the following week with the Continuing Care team to address this. Other information brought in by the resident’s family included the hospital discharge information and the domiciliary care agency records that were usually kept at the resident’s home. A Gold Standard Framework assessment had been completed and was included in this paperwork but did not supply sufficient information for the home to appreciate that the person was not ‘end of life’. The manager advised that in regard to those residents admitted under the Supportive Pathway Scheme, there had been problems in obtaining sufficient information about their care prior to their admission. Swallows Meadow Court DS0000071876.V369606.R02.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is good. Plans of care are in place but the current health care needs of residents are not always clear to ensure they are met consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans for four residents were read in detail during the inspection. It was evident that due to the way these are formulated, it was not always easy to identify current needs. It was evident that information collected at their admission stage had been used to develop care plans showing how each need was to be supported by staff with the exception of the resident admitted under the Supported Pathway Pilot Scheme. One person who was admitted to the home had poor mobility and was of a low weight due to not eating properly. They had developed a pressure sore to their skin and were also incontinent. It was evident from discussions with Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 13 staff and observations of the resident that this resident’s health had improved significantly which was clearly due to the care planned and carried out by staff. The care records showed that the resident had put on two stone in weight within three months, the sore had healed and they were now fully continent and were mobilising around the home independently. This demonstrates that the home had provided effective care to restore the wellbeing of the resident. The resident said how pleased they were that they had gained weight and explained how independent they had become since living at the home. It was difficult to establish from care records the current health and care needs of this resident. This was due to the fact that the home develop a care plan when the resident first comes to the home and this is then reviewed monthly on a separate sheet showing any changes. It was found that the review sheet did not always fully show the changes so it was not clear what support the resident needed. For example a moving and handling care plan dated in June 2008 showed that one member of staff was needed to assist the resident with all transfers such as getting in and out of bed, from the chair to the toilet etc. This was reviewed indicated that the resident still required this support. Following discussions with staff and observations of the resident, it was evident that the resident was now self-caring except for help needed in the shower. In this case the care plan bore little resemblance to the current needs of the resident due to the significant improvements in their health. It would therefore have been beneficial for the care plan to be updated so that staff did not have to read all of the plan and all of the reviews to get a clear picture of the resident’s health. If the care plan information is not clear, this could result in inappropriate care and support being provided. The member of staff spoken to updated the records during the inspection to show this resident was now independent. It was evident that upon the admission to the home, staff had considered the potential risks to this resident in regard to poor nutrition, falls and damage to the skin. Risk assessments had been completed to alert staff to these risks and how they should be managed. The risk assessment for bedrails showed that these should be used but this had not been signed by the resident or a member of their family to confirm their agreement they could be used. This agreement should have been sought as they are considered a form of restraint. Staff confirmed that the resident was no longer using these and explained that the resident was too ill to make this decision upon their arrival at the home but it had been discussed and agreed with their relative. A risk assessment for the use of bedrails in the second care plan had been completed. A second care plan set out the care required in sufficient and up-to-date detail to ensure that all aspects of the health and personal health needs of the resident were met. Details for personal care requirements were detailed and showed specific assistance required and the level of independence of that person. The person’s psychological/emotional needs had been updated to show Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 14 that this had changed since the pre-admission assessment and the care plan had been reviewed accordingly. However changes identified in the reviews had not been added to the care plans and therefore staff were having to read the reviews as well as the care plan to get a full picture of their current needs. In one case the care plan bore no resemblance to the changed needs identified in the plan. The risk assessment in this care file relating to pressure sores showed that the person had a high risk of these developing. However there was no care plan in place to instruct staff how they would provide the care that could prevent pressure sores, although a pressure relieving mattress was in use. Care staff recorded the turning of a resident to prevent sores in a separate folder but this relied on new or temporary staff knowing where to look for this information. The third care plan viewed showed that the resident required full support with all of their care needs. Some of the records were clear in showing the support needed such as the moving and handling care plan which detailed all of the equipment needed as well as staff support which is good practice. Others were less clear. Records showed that the weight of the resident fluctuated and when the care plan was devised the resident was to be weighed monthly. The latest review on the care plan showed they should be weighed weekly. It was not evident that this was being done as weight records showed this was happening monthly. In June their weight was 42.4kg, this dropped in July to 40.5kg, August to 39.1 (6 stone 2lb) and then in September to 35.4 (5 stone 6lb) This shows the resident has consistently lost weight over a four-month period with an increased loss between August and September indicating a deterioration in their health. It was not evident that staff had consistently completed food or fluid intake records to monitor this and ensure the resident was receiving sufficient calorie intake to support their health. Food and fluid intake charts that were on the residents file were dated May 2008. There were no charts available after this. A nutritional supplement – “fortisips” had been prescribed but medication records showed that the resident did not always have all of them, sometimes this was sips, sometimes a quarter and sometimes half. Daily records showed that the resident would refuse to eat and drink despite persuasion and the doctor had been informed of this. The care plan records showed that the resident suffered with arthritic pain in both their knees and this was worse in one knee. Relatives visiting said that this leg was bent and on observing the resident this was confirmed although care records did not show this. The care plan said that passive exercises should be encouraged to prevent stiffness. It was not evident this was happening. The nurse said that the physiotherapist visited the home regularly to see any residents referred by the doctor. The nurse also confirmed that the doctor visited residents regularly and had not made a referral for this resident suggesting that physiotherapy was not required. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 15 This demonstrates the need for care plans to be kept updated rather than relying on reading the monthly reviews as it is clear staff are following some instructions in the original care plan as well as some of the instructions in the reviews. It also is difficult to be clear that initial care prescribed is still appropriate such as passive exercises. This matter will need to be addressed in regard to this resident. It was established that this resident could not reach their call bell to alert staff that they needed their assistance. There was no clear risk assessment in place to show how this should be managed by staff. The nurse said that staff regularly checked on the resident and the tracker devices held by staff could demonstrate the frequency this was happening. The care plan for the resident admitted under the Supported Pathway Pilot Scheme did not have any information that gave staff the information they required to meet the person’s needs. Some information could be gleaned by reading all the records, particularly the daily records from the care agency brought in with the resident, but this would have been time consuming and not necessarily up to date. This person’s needs were extensive and nursing and care staff had to rely on information that had been given verbally. Staff did know what the residents needs were and although the resident had only been in the home for a few days, they were aware of the person’s care needs and that the resident and spouse, who they had already built a friendly rapport, had recently celebrated their Diamond Wedding Anniversary. In regards to professional support to the home it was established that the home pays a retainer for a GP to visit the home twice a week. All residents are seen on a regular basis and access to a GP is available 24 hours a day if necessary. MacMillan nurses also visit to support staff in the care of terminally ill people and the home is visited by a dietician, physio, occupational therapist, stroke outreach team, chiropodist and a dentist as required. Care plans for two residents who had only been at the home for a few days showed that they had received visits by the GP and Macmillan nurses, and other care files looked at showed evidence of visits by the chiropodist and the optician. Visits from health care professionals are recorded separately and are easy to track and cross reference to changes in care needs. A review of medication was undertaken within two of the houses in the home. Each house has its own medication trolley and storage cupboards within a medication storage room. A medication policy is in place and copies kept with the Medication Administration Record Sheets (MARS) for ease of referral. The home was using a multi dose system (MDS) for their medication which means medication is stored in blister packs so medication can be easily identified for each day. Only registered nurses are responsible for medication and administer this. Observation of their administration practice showed that they had a safe system, ensuring that the individual took the medication and that Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 16 each record was not signed until the medication had been taken. The nurses in both houses advised that they are about to change pharmacists. They also advised that current practice is for prescriptions to be kept but with the new pharmacist, scanned copies would be available on-line at any time. In both of the houses viewed it was evident medication was being managed well with only minor exceptions. Medication had been stored appropriately including controlled drugs and an appropriate register was in place to record any controlled drugs being managed by the house. All internal and external medications were stored separately in the main part of the cupboards. It was evident from speaking with one nurse that she had spoken to the doctor about a resident who was refusing their tablet medication to see if this could be provided in liquid format. The medications had been reviewed accordingly and the nurse advised this had helped to ensure the resident took their medication. In both houses there were some cases where medication had been carried over from the month before but this had not been documented on the Medication Administration Record (MAR), which made it difficult to audit and check medication had been managed appropriately. In one of the houses capsules had been carried over on the MAR but the signatures and capsules remaining indicated that either a mistake had been made with the number carried over or one signature had been made when a capsule had not been given. This applied to Flucloxacillin which is a medication that needs to be given in a timely manner to promote effective healing. It was also noted that sometimes staff were squeezing information into the signature boxes on the MARs which made it difficult to read. This included for example details of how much fortisips a person had taken such as ¼ or ½ or the word “sips”. Whilst it is good practice to record the actual amount taken, the boxes on the MAR should be used for signatures or codes. It was advised that this practice be reviewed to see if this information could be recorded somewhere else. Some of the codes on the MAR had not been used appropriately in that one code indicated that the medication had been refused and disposed of but on checking the blister packs the medication was still there. In regard to medication stored in one house it was found that the metal medication cabinet had been fitted very high up and a stepladder had been provided for the shorter members of staff to reach. The minimum and maximum temperatures of one medication fridge were checked and these had been recorded on a daily basis and remained within acceptable limits to ensure that the contents were stored safely. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 17 The majority of the liquid medicine, eye drops and creams/ointments had been dated when opened to ensure that they were destroyed within the timescales required to maintain their stability. However there were some that had not been dated. A list of signature samples was kept with the MARS although that of the agency nurse who had been on duty the previous evening was not included. This person’s initialled signature could have been mistaken for one of the codes used on the MARS for indicating medication was not given. This therefore could be misleading to staff when auditing the medication to ensure all residents have received this as prescribed. Anticipatory medication was in stock (stronger pain killers prescribed for certain individual residents so if that person needs the medication it can be given without delay.) Staff competence audits for medication management had not been carried out, which is considered to be good practice to ensure medication is managed safely consistently. One audit of the amount of medication remaining and the standard of recording had been carried out by the manager and the deputy manager. Residents were noted to generally be cared for in a respectful manner to ensure that their dignity and self-esteem is maintained. A resident and a visitor spoken with confirmed this. It was noted however that one member of staff praised two different residents for eating their meal by saying “good girl”. Whilst done in a kindly manner this can be patronising and demeaning to the resident One resident said that if they wanted to sit quietly in their bedroom then staff would not disturb them and staff always would knock the door and ask if they were alright. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 18 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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is good. Residents have access to some activities to meet their social care needs and can exercise some choices in regard to their care including meals to help maintain their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs three people on a part time basis to provide activities to the residents. Activities are organised between 9.30am and 2.30pm five days per week. On undertaking a tour of the building it was noted that activity schedules were on display in each house showing the activities planned. These included:Monday a.m. floor board games Tuesday a.m. games Wednesday a.m. Board games Thursday a.m. Skittles Friday a.m. Dominoes p.m Floor board games p.m. games p.m. Progressive mobility – (outside contractors) p.m. skittles p.m. Balloon & hoop game DS0000071876.V369606.R02.S.doc Version 5.2 Page 19 Swallows Meadow Court (Activities room) The manager advised that other activities did take place but were not included in the programme, e.g. coffee social morning in activities room when hairdresser is in (Wednesdays), a recent trip to Cadburys World for three residents, pub lunches, shopping in Solihull, trips to the local garden centre’s café. The activity organisers complete social activity sheets showing the activities each resident has been offered or has participated in. The records for those residents who were case tracked were viewed. One of these sheets showed that the resident had declined a visit to a coffee shop and garden centre but the Activity Organiser had arranged for them to go out to a club twice a week. The resident’s file showed they were not interested in music or television and liked to be independent in choosing what to do in the home. The resident told the inspector that they enjoyed going out to the club and were quite happy to walk around the building. They said they were not interested in social activities being provided at the home. They stated that they had been out to the club the night before and during the inspection the resident was observed to walk around the building. The records for another resident who was mostly being cared for in bed showed that they had only participated in a beanbag game once in August. There were no other entries recorded such as one-to-one time with staff, hand massages or playing music in their room. The records for the other two residents showed no social activities or interaction. It was however evident that other residents in the home had been involved in activities such as quizzes, manicure, neck and back massage, proverbs and famous faces, one to ones, target game, skittles, craftwork, garden, bowls, basketball and connect 4. One visitor spoken to said that their relative was receiving excellent care and, “everything about the home is excellent.” When asked if they were made welcome they responded that they were always made welcome and had been invited to make a cup of tea in the kitchenette at any time. The Annual Quality Assurance Assessment provided by the home shows that they also celebrate special occasions such as birthdays and anniversaries. On the day of inspection there were no social activities were seen to take place in one of the houses. In regard to choices and privacy and dignity. A resident spoken to said that staff did honour choices made in regard to their care. They explained for example that they had requested sheets on their bed instead of a duvet and this was changed. They had requested that the time their eye drops were Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 20 given was changed so that they were not given late at night which was also done. They also explained that they wished to sit with another resident at mealtimes so that the other resident did not feel left out. They explained that staff had arranged this and they felt the other resident was now eating better. Residents spoken to felt that there were sufficient choices given at mealtimes and enjoyed the meals provided. One said that they requested a cooked breakfast every morning and this was provided and they enjoyed it. There are dining rooms within each of the houses which have been decorated to a high standard and with different colours in each. They have wood panelled flooring with round tables containing tablecloths, napkins, cutlery and condiments. The dining areas are spacious to allow easy access for wheelchairs and hoists to support residents as required. Each house also has a kitchenette with a fridge so they can serve snacks and drinks during the day. Breakfast was observed in one of the houses and this was noted to be a social event with residents chatting amongst one another. Breakfast came to the house in a hot trolley and was plated in the kitchenette before taking this to the residents in the dining room. In addition to hot breakfasts there was cereal and toast and residents were asked what they wanted. Staff also went to each resident during breakfast to ask them what they wanted for lunch from the menu. This was recorded and then handed to the cook when the trolley was collected. A menu book is kept in each dining room so that residents can see what meals are on offer day. This did not list all drinks available and the cook agreed to review this so that resident were clear what was available. At lunchtime the meals again arrived on the hot trolley. The lunchtime was observed by two inspectors within two of the houses. In one house, the meal was beef casserole with potatoes, carrots, cabbage and gravy followed by apple pie and custard or the alternative was egg salad. Staff served one table at a time. Some of the meals had been liquidised so they were soft but each item had been done separately to help make the meal look more appetising. Residents seemed to enjoy their meals and again this was a social event in the house where the meal was served. One resident had their meals in their room and were assisted with their meal by members of their family. Another had their meal in their specialist chair in the lounge. They were provided with a tray that they could use from the chair with a mat to keep their plate in place while they ate. Some residents were observed to be using spouted beakers so that they could drink independently. In the other house the dining room was spacious although there were only ten people eating and a table had been removed to provide even more space. The Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 21 other residents living on the unit had either chosen to eat in their room or were too poorly to come to the dining room. The mealtime was quiet and could not be considered a social event. None of the residents were being hurried and were eating at their own pace. The meals were brought up to the unit in a heated trolley and taken to the kitchenette where they were plated up and taken to the dining room or to individual bedrooms. There was one member of staff in the dining room throughout the majority of the meal. Whilst assisting a resident to have lunch the member of staff was also supervising the other nine people taking lunch. She frequently had to communicate with a person presenting with disruptive behaviour. She also had to stop helping the resident she was assisting to have lunch in order to attend to another resident who was coughing; going to the kitchen to bring this person a drink. For approx five minutes there were no staff at all in the dining room to supervise the residents there. During that time a resident was trying to open the window and was helped by the visitor feeding their partner. Several (four) residents were sitting in the wheeled bucket armchairs that they had been sitting in the lounge. The team leader spoken with about this said that none of the people using bucket chairs were able to walk and therefore their movements were not restricted by this type of chair, but gave them a better posture for eating. The options for tea time consisted of soup with bread and butter, omelette or corned beef hash. The cook said she also prepared sandwiches each day so that residents could have these instead if they wished or could have some at supper time. She explained that these are delivered to each house so they can be kept in the fridge. The home has a large fully fitted kitchen which when viewed was clean, tidy and well organised. The cook was aware that some of the residents had diabetes and had alternative options in regard to sweet things that they could have. Fresh fruit and vegetables were available and were being stored appropriately and there were also good stocks of tinned and dried produce. The cook said she ordered supplies weekly and made an order during the inspection. Fridges and freezers were clean and records confirmed they were operating at safe levels for the storage of food. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 22 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): Standards 16 and 18 were assessed. Quality in this outcome area is good. There are systems in place to ensure complaints and any allegations of abuse are managed to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is detailed in the Statement of Purpose which is located in the reception area of the home. This includes the name and address of the provider and us should any complaint not be managed effectively by the home. The managers name and contact details were not fully clear within this document so that if a visitor wished to take this away and write in, they would know who to address it to. The Annual Quality Assurance Assessment stated that there are complaints/compliments books on each of the houses and these were viewed during the inspection. One house had received seven compliments from people not connected with the home. One person had written “thanks to all the carers/nurses, X is a lot happier since being in the new home, X has been given more independence which X really enjoys”. There were two complaints, one complaint was that the plates were not hot at mealtimes and there seemed less staff and another was in regards to staff attitude. Records showed that responses had been made to these complaints. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 23 Questionnaires received by us from three residents showed that all knew how to make a complaint but one commented “although staff are not available sometimes” in regards to wanting to raise a concern. One resident spoken to said that if they were not happy they would speak to a nurse. They went on to explain issues they had raised with staff and confirmed that these issues had been dealt with to their satisfaction. The manager was aware of the need to record any incidents relating to safeguarding of residents and allegations of abuse. She advised that all staff had completed training on this. A member of staff spoken to said that they had completed the training and they knew to report any incidents to the manager and to complete an incident report. They were less clear about what happened with the information once it had been reported to the manager. This is important so that staff fully understand the processes followed to safeguard residents. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 24 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): Standards 19 and 26 were assessed. Quality in this outcome area is good. The environment is clean and well maintained to ensure residents are cared for in comfortable and safe surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This is a new home so the environment was in very good order. Accommodation is divided over two floors and there are two “houses” on each floor with their own colour scheme. The décor of the home was found to be light, bright and clean but there were few of the things to make surroundings look homely and interesting such as pictures, mirrors, plants and ornaments. There were scatter cushions in the lounges and a picture in each of the lounges and the dining rooms viewed. The pictures that were displayed and the furniture and fittings were tasteful and of good quality. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 25 Bedrooms of the four residents case tracked were visited. All bedrooms had an ensuite bathroom which consisted of an assisted shower, washbasin and toilet. In addition to these there are communal bathrooms and showers available if residents prefer. The bedrooms were spacious and well furnished, had adjustable beds, an armchair, a second chair and a lockable drawer in the bedside cabinet. The bedroom doors were lockable from the inside and out. Bedrooms had been personalised with photos and plants. One of the resident’s had brought in many possessions from home which had been displayed in a bookcase in their room. Each bedroom has a built-in tracking hoist to enable staff to transfer residents safely. The ‘pods’ for the tracking hoists are stored in a separate storage room where the batteries can be recharged. Currently the slings for these are communal, although the appropriate size is assessed and used. It was advised that the use of slings communally be discussed with the infection control nurse to ensure this is considered appropriate. Residents have access to a call bell in their rooms and there are extension leads to allow these to be within easy reach. Areas of the home viewed were found to be clean and free from offensive odours. Staff had access to protective clothing – disposable aprons and gloves – for when managing personal care. There were disposable aprons available in a different colours for handling food in order to maintain good infection control practices. The laundry was viewed and was suitably organised to ensure a dirty to clean flow of laundry items. Staff were observed during the inspection returning washed and ironed items to the bedrooms. It was noted that there were two baskets of unnamed items in the laundry which were mostly socks. It was suggested that a review of current systems be undertaken to ensure all items are suitably identifiable and can be returned to the residents. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 26 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. Staff are suitably trained on an ongoing basis to ensure they can deliver safe and appropriate care to the residents but it is not clear staffing for the home is always consistent to ensure the needs of residents are always met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of this inspection only three of the four houses were occupied by residents. Staff had therefore only been employed for these three houses. There were 18 residents on Kingfisher House, 13 on Heron House and 18 on Nightingale House. It was evident from the review of staffing that the numbers of staff the home aim to achieve are not being consistently provided to ensure the home is suitably staffed at all times to care for residents effectively. The manager advised that they aim to provide the following staffing within each house:Kingfisher Early Shift – One Nurse and four Care Assistants Late Shift – One Nurse and three Care Assistants Night – One Nurse and two Care Assistants Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 27 Heron Early Shift – One Nurse and three Care Assistants Late Shift – One Nurse and two Care Assistants Night – One Senior (NVQ 3) Carer and one Care Assistant (Nurse from kingfisher to administer medication) Early Shift – Two Nurses and four Care Assistants Late Shift – Two Nurses and three Care Assistants Night Shift – One Nurse and two Care Assistants Nightingale A review of duty rotas showed that Kingfisher were working in accordance with the staffing arrangements above as confirmed by the manager. The duty rotas for Heron House showed that for most of the time the home was covered during the day appropriately. There were two days over a period of two weeks when there were only two carers on during the early shift due to one member of staff being absent and the other being off sick. It was not evident that the night shift was being covered by a senior (NVQ 3) carer consistently. As there is no nurse on this house, it is important a suitably qualified person is left in charge of this house. On some nights there were two agency staff covering the house as opposed to permanent staff. It was not clear from the duty rotas what the full names of these staff were, where they were from or that they were suitably qualified to be in charge of the house. One member of staff was identified on the rota to work a late shift followed by a night shift, this is considered to be poor practice as there is not a sufficient rest period between the shifts to ensure the member of staff can remain effective in caring for the residents. The duty rotas for Nightingale showed that the late shift was not being covered consistently by two nurses. There were several days each week where there was only one nurse on duty during the late shift. A member of staff is identified on the rota to be off sick but there is no additional cover identified. The duty rotas also show that on some early shifts there has only been three carers as opposed to four on duty. Staff spoken with in two of the houses said that there was always a sufficient number of staff available to meet the needs of the people. In one of the lounges the lunchtime appeared to indicate a shortage of staff, it was however established on further investigation that there were several members of staff working elsewhere on the unit, mainly serving food to residents eating in their own rooms. In another lounge the lunchtime experience was a social experience for the residents with sufficient staff on hand to provide any prompting or support needed. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 28 Questionnaires received by us from three residents show that two out of three feel they “usually” receive the care and support they need. One person said they “always” did. All felt that the staff were “usually” available when they needed them. One person wrote “except for occasional shortages”. All felt that staff listened and acted upon what they said. During the inspection one resident said that it wasn’t that they felt there were not enough staff but they “don’t think the organisation is so good”. They commented that some of the residents are sitting in the dining room for long periods after breakfast. They also said that “staff can’t do enough for you”. In addition to care and nursing staff there are specific staff employed to undertake laundry, social activities, cooking and cleaning within the home. Duty rotas showed that laundry staff are available seven days a week as are catering and cleaning staff. It was not always clear from duty rotas what hours all staff worked and in what capacity. It was also not always clear which agency staff had been employed from, what their names were and in what capacity they were working in the home. This is important to ensure there is an audit trail and the home can demonstrate suitable staff are available to care for the residents. The manager has subsequently advised that there is an agency book kept on each house showing the qualification and grade of each agency worker. This information was not volunteered during the inspection to confirm sufficient records are being kept. A review of staff files was undertaken to establish that safe and appropriate recruitment practices are carried out. Three staff files were looked at and all contained the appropriate information needed. This included Protection of Vulnerable Adults (POVA) checks to ensure staff employed are deemed as safe to work with the residents. Criminal Records Bureau (CRB) disclosures were kept at the organisation’s head office with a memo in the staff file of all the relevant details apart from any specific offences that may have been disclosed. On the day of inspection the provider obtained copies of the CRB checks for the inspectors to view. It was evident that applicants for employment are asked to complete a criminal disclosure form at the time of application. Records were available to confirm that the nurses Personal Identification Numbers (PIN) had been updated and those that were due had been highlighted for action to follow up. The manager advised that all references and employment records are validated. All three files viewed contained evidence of induction training, both as initial induction to the home – such as health and safety, timesheets, orientation - and further induction related to ‘Skills for Care’. The ‘Skills for Care’ standards require care staff to complete training over a number of weeks so they can build up their competences and provide effective and safe care to the residents. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 29 One member of staff spoken with said, “we (all staff) work together as a team. I love working here”. The same member of staff said that there was plenty of opportunity for training and that during supervision they had made known a specific training need. Arrangements were then made for the member of staff to attend a relevant training session very soon afterwards. Another member of staff said that they felt because staff are employed specifically to work in each house they “got to know the patients better” and said it “works better”. This member of staff also confirmed that they were able to access all the training they needed. The training schedules for the home were viewed for all staff in each of the houses, these showed that training is being attended on an ongoing basis in regards to moving and handling, fire, health and safety, infection control and food hygiene. It was not clear that all staff had completed food hygiene training within the required timescales. The manager advised that further training had been organised in all of these areas as well as end of life care and dates were evident of training arranged. The Annual Quality Assurance Assessment provided by the home shows that there are 38 care workers employed at the home and out of these 20 have achieved a National Vocational Qualification (NVQ) in Care. This means the home are exceeding our standard of 50 . This training helps carers to provide more effective care to the residents. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 30 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): Standards 31,33,35 and 38 were assessed. Quality in this outcome area is good. Overall the home is managed effectively and there are systems in place for monitoring the quality of care and services the residents receive to ensure the home is run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is managed by a person who is both qualified and experienced to run the home. The manager transferred with residents from a previous existing Care Home within the organisation. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 31 Staff spoken to said that they felt supported by the senior staff and management. One member of staff said “ I feel very supported by the manager, deputy manager and team leader.” On arriving at the home and asking to see the person in charge, a nurse confirmed that there is a nurse on each house who is in charge. It was established that there was no one person who had been allocated to be in charge of the home in the manager’s absence. The implications of not having any one person in charge of the home were discussed with the manager with a view to this being reviewed to ensure the effective management of the home in her absence. The manager did advise that there are specific staff asked to be on-call in her absence. Monthly unannounced inspections by the Responsible Individual (known as Regulation 26 visits) had not been undertaken from the period of the home opening until August 08. Inspectors were advised that this was due to the person who normally did these had not been available. Quality audits of the service are normally carried out by the organisation in April and September. Surveys to residents and relatives had been distributed but there had been limited numbers returned. It was not clear from responses received which ones were from residents and which ones were from relatives. They were also not dated so it was not clear when the surveys were completed. One comment clearly written by a relative stated “our resident relative always comments that the food is very nice indeed and X enjoys it, please keep it up”. The same person wrote in regard to social activities “what we have seen have been very good, we would like our resident relative to go on trips but not aware of any yet”. One person wrote that the meals seemed to take longer to distribute and the menu is not displayed for relatives to see. The manager advised that questionnaires are put in reception and they ask relatives to fill them out when they visit, the total received was six suggesting this method of undertaking quality monitoring is not fully effective. The manager also said that she intended to meet with relatives the week following the inspection to talk through issues raised. The manager was made aware that a report should be compiled showing the responses to all questionnaires received and proposed actions to address matters raised. This should then be made available to both residents and interested parties. Residents spoken to during the inspection had no complaints about the care and services they receive. Any issues they did have they felt were dealt with effectively by staff. One person told the inspector how their health had Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 32 improved since being at the home and how staff had helped and supported them to be more independent and commence a social life. The financial records of residents were reviewed to confirm their personal monies were being managed safely and appropriately by the home. Records and monies checked tallied with one another and it was evident that receipts had been maintained for any transactions carried out such as hairdressing. The manager advised that statements are also sent out to families where appropriate so they know what expenditure there has been and can top up the amounts as necessary. A random check of health and safety records was undertaken although it was acknowledged there would not necessarily be service checks in place for everything as the home is new. Those records checked were found to be in order to ensure the safety of the home. Hot water temperature records were seen for Kingfisher and Nightingale houses and all were within safe guidelines to prevent any scald risks to residents. Resident’s electrical portable appliances had been checked in September and no repairs were found to be necessary. Weekly fire alarm tests were being undertaken and recorded in a logbook. Emergency lighting had been tested on 18.8.08. There was evidence to show a contract was in place for hoists as repairs had been done in August 08. It was noted that some of the records appeared to be for the old home and some of the records referred to 33 – 81 Swallows Meadow Court and not the address on the Registration Certificate for the home which states 31 – 73 Swallows Meadow Court. This matter will need to be addressed by the home to ensure the home is appropriately registered. A public liability insurance certificate was in place and was dated for expiry in August 2009. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 33 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 34 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 OP3 Regulation 14 Requirement Suitable assessments need to be completed for all residents admitted to the home to ensure their needs are fully identified and can be met. Action must be taken to ensure the care of people with poor nutrition is managed effectively to prevent a deterioration in their health. Timescale for action 31/10/08 2. OP7 12 31/10/08 3. OP9 13 The date when eye drops, 31/10/08 creams and ointments have been opened needs to be recorded on the box, container. This is to ensure they can be destroyed within the stated timescales and administered to residents inappropriately. Action must be taken to ensure suitably qualified staff are covering all houses consistently and to ensure staffing arrangements are both sufficient and suitable to allow the needs of residents to be managed effectively. DS0000071876.V369606.R02.S.doc 4. OP27 18 14/11/08 Swallows Meadow Court Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP7 Good Practice Recommendations It is advised that actions are taken to clearly show that residents have been issued with a Service User Guide. Care planning for residents needs to be reviewed to ensure staff can easily identify the current needs of the resident and the actions required to meet these needs. Medications carried forward to the next medication period should be clearly documented on the MAR. This is so that the amount of medication received, administered and remaining can be audited to ensure residents have received their medication as prescribed. The MARS need to be clear and legible at all times so that it is clear what medication the resident has received. A protocol should be developed for recording any additional information such as the amount of fortisips a resident has taken. The codes used on the MAR charts need to be used accurately to ensure the medication is managed safely. It is advised that the labelling systems within the laundry are reviewed to ensure the personal items belonging to residents do not get “lost” within the laundry system or returned to a different resident by mistake. A review of the current programme of social activities should be undertaken to ensure the home can demonstrate all residents (including those less able) have an opportunity for social stimulation as required. The use of communal slings for the hoist should be reviewed with the Infection Control Nurse to ensure this is appropriate and acceptable in regard to good infection control practices. DS0000071876.V369606.R02.S.doc Version 5.2 Page 36 3. OP8 4. OP9 5. 6. OP9 OP10 7. OP12 8. OP26 Swallows Meadow Court 9. OP27 It is advised that the staffing arrangements at mealtimes are reviewed in Nightingale House in particular at lunchtime. This is to ensure there are sufficient staff to sufficiently support the residents to enable a positive lunchtime experience. Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 37 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Swallows Meadow Court DS0000071876.V369606.R02.S.doc Version 5.2 Page 38 - 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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