Care Home: Swan Bank

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What the care home does well Relatives value the respite service, particularly as people and carers are growing older, and told us that Swan Bank "cares for ...x...very well indeed"; "provide age appropriate care and activities"; "very good manager and staff...all are very helpful". People went out, enjoyed their hobbies and had good relationships with staff. They had individual and sensitive support and dignity. Independence is encouraged, and staff responded to any requests and brief distress speedily. Everyone had their needs met and progress is recorded. We complimented staff, the cook, the food and the manager. There are systems in place to manage medication, health, safety, food hygiene and to prevent the spread of infection. The premises are well maintained, safe, comfortable and homely. Personal safety is ensured inside and outside of the home. The views of people and families are sought in a variety of ways so that the service can develop. There have been no complaints or safeguarding referrals since the last inspection. Swan Bank keep us informed of events. The home is well run, and ran smoothly in the manager`s absence. High care standards have been sustained to the satisfaction of those using the service. What has improved since the last inspection? Everyone now has a person centred care plan and health action plan, with objectives. Reviews take place with families and all services involved in a care package, have an independent chair and a new format so that support is consistent. People`s health, goals and aspirations for personal development and the needs of their family carers are holistically planned. The transition for young people moving from children`s to adult respite services improved, as well as a focus on health. Health conditions are now effectively managed as a partnership between families and services. Work experience takes place at the home. Communication aids and guidelines were prepared with a speech and language therapist, which has improved relationships between people and staff. There is now a pictoral menu so people can make choices, and more Makaton signs and symbols are used by staff. There are also new tools for quality assurance to seek the views of people and families in more depth. More emphasis on social inclusion has increased community based activities, such as swimming. Staff development was reviewed and prioritised. More staff were trained or refreshed in infection control, first aid, adult protection and fire safety. Staff had their knowledge of advocacy support updated, and some were trained about mental capacity and consent to promote people`s rights. The manager had training in new legal duties about Deprivation of Liberty Safeguards. Safety was improved by the purchase of flat screen TV`s fixed to the wall, and the dining room door now has an electronic opener linked to the fire alarm system. New furniture was provided in bedrooms and the dining room, and new CD players. Bedding and soft furnishings were replaced for infection prevention. What the care home could do better: The statement of purpose should reflect that services are provided to people with autism as well as learning disabilities. A scheme to prevent and manage risks of malnutrition, pressure sores and falls is needed for health promotion. The medication procedures, storage and disposal of drugs must protect people`s health at the care home and on return to the community. The home needs to learn from family experience of the medication policy. The safe range of hot water should be maintained to prevent scalds, and staff need more familiarity with the hot water heating system to adjust it. Timely action is needed to protect people, staff and the community during the swine flu epidemic. Respite services are in demand during bank holidays so unexpected staff absence should have been proactively anticipated and planned for. Rotas do not reflect how the home is staffed to meet everyone`s needs as there are vacancies. Charging policies for transport should be reviewed to ensure they are fair and people`s financial interests are protected. Unannounced visits by the provider must take place monthly so that there is accountable oversight of health, safety and welfare. Key inspection report br Care homes for adults (18-65 years) br Name: Address: Swan Bank 2 Swan Bank Penn Wolverhampton West Midlands WV4 5QE br br     br br The quality rating for this care home is: br   br br two star good service br br A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Tina Smith br     br br Date: 2 9 0 8 2 0 0 9 br br This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. br br The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor br br There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. br Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things br br This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. br This is what people staying in this care home experience: br br Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) br Page 2 of 35 br br We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. br br Reader Information br Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk br br Internet address br br Care Homes for Adults (18-65 years) br br Page 3 of 35 br br Information about the care home br Name of care home: Address: Swan Bank 2 Swan Bank Penn Wolverhampton West Midlands WV4 5QE 01902557995 01902557996 br br Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: br br www.wolverhampton.gov.uk Wolverhampton City Council care home 4 br br Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD) 4 Date of last inspection Brief description of the care home Summary br This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service br br Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home br peterchart br br Poor br br Adequate br br Good br br Excellent br br How we did our inspection: The last key inspection was held on 25/07/07, when there was one requirement made. Prior to our visit the home sent their Annual Quality Assurance Assessment (AQAA) which tells us what has improved and is planned for the future, and current information about running the home. The AQAA arrived on time and had all the information we asked for. The self assessment quality was generally good. Information from this and from other sources was also used when forming judgments on the quality of the service. The home sends us notifications about legally required events, and we receive reports from other sources. We received 15 out of 28 surveys we sent to people in the home, relatives and staff. One inspector visited the home on a bank holiday, 09:10 am - 16:50 pm so that we could talk to people using the service. The home was not informed that we would be visiting, and the manager was on annual leave. One person showed us around the home. We spoke with and observed four people and looked at three care records. Care Homes for Adults (18-65 years) br Page 6 of 35 br br Dinner and tea were observed. Records about the running of the home were seen including: medication, communication and financial records, training charts, complaint and incident logs, contractor certificates and maintenance logs, other certificates and service plans on display, audits and reports of provider spot checks. We visited the home again on 07/09/09 to see staff records and published information about the home that was not available to us on our first visit, and to confirm whether the outstanding requirement was met. At this visit we also saw annual questionnaires with the views of families. Policies and procedures were seen and/or discussed about medication, Deprivation of Liberty Safeguards, human resources, Health and Safety, and plans about contagion. We were assisted by two staff and discussed findings, and fedback to the manager by phone partway through our first visit at the request of staff. We discussed this further with the manager on our second visit. No immediate requirements were made as staff acted on concerns we raised to make sure people were safe. Requirements and recommendations are at the end of this report. br br Care Homes for Adults (18-65 years) br br Page 7 of 35 br br What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. br br Care Homes for Adults (18-65 years) br br Page 9 of 35 br br Details of our findings br Contents br br Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection br br Care Homes for Adults (18-65 years) br br Page 10 of 35 br br Choice of home br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. br br This is what people staying in this care home experience : Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that their needs will be met and personalities matched for short breaks. There is user friendly information about the home. Families visit and introductions are individually tailored. br br Evidence: People and families told us they had enough information to make a decision about using the service, and that their needs are usually met as they want and expect. The AQAA told us that the service is now more responsive and flexible, and they had positive reports on their efforts to improve the transition for younger people from children to adult short break services. We wanted to see the changes made and affect on people, so we looked at three pre-admission assessments, and spoke to someone experiencing transition on our visit. The pre-admission process is explained in the homes published information. The AQAA said that an introductory pack is provided to prospective service users referred to the home by the council Short Breaks Coordinator. An Easy Read brochure about Swan Bank has symbols and photographs, summarising the statement of purpose and br Care Homes for Adults (18-65 years) Page 11 of 35 br br Evidence: service user guide which are available in other languages and formats. Information about the service, facilities and staff are accurate, but services we saw provided to people with autism are not mentioned and the Commissions details are out of date. Transition includes a visit by the manager to a school or other service used by a person when they are 17 years of age. Information is gathered from all relevant sources, such as health, social workers and childrens services, and a meeting is held with families. If the home determines that needs can be met, an introductory plan is agreed with families. This may include short visits, increasing hour by hour in one situation. Other people may meet staff through activities in the home or community, until overnight stays commence after the age of eighteen. The process of pre-admission for other people is similar. There are 22 families currently using the service. Most people have regular respite programmes, usually one to three nights every 3-6 weeks. One person comes one night a week. Occasionally there are emergency short stays, such as when a family carer is ill, and the maximum length of stay is 28 days. Three assessments we saw were detailed and thorough, including what people are able to do themselves, what they need help with and how this is best achieved. Account is taken of peoples ability to make decisions. The purpose of the service for each individual was clear, and ways in which this service contributes to their personal development and interlinks with other services. For instance, the objective for one person is to develop independence and emotional maturity to attend college. Personalities are matched for each visit, and for some people this is learned over time. For example a person who is lively and inquisitive did not mix well with people who like quiet. People have a choice of room if possible, as there is only one room with a tracking hoist. One person said that they always choose a room with pink bedding. Dates are agreed with families for the year in advance, and the home tries to flexibly meet individual and family preferences and changes. br br Care Homes for Adults (18-65 years) br br Page 12 of 35 br br Individual needs and choices br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated as individuals, with respect and dignity. Needs are planned and reviewed with them and families, and they can have confidence that support is provided the way they want. People have opportunities to continue their interests and experience new things for personal development. br br Evidence: Each person has a care plan agreed with them and signed. Account is taken of likes and dislikes, gender, religious and cultural needs, communication modes and personal routines so that people have support they want and need. Best interest decisions are made by a multi-disciplinary team and families. The home told us about improvements to care planning and health promotion. There are detailed guidelines for staff about personal care and health, safe mobilising and use of equipment, personal safety and behaviour management as necessary. A quality assurance system checks peoples experience after short stays so that changing needs are met. Care reviews take place with families and other agencies so br Care Homes for Adults (18-65 years) Page 13 of 35 br br Evidence: that there is a seamless approach to meet peoples goals, aspirations and needs. This is good practice so that care is consistent. As a result, people have support to continue their hobbies and social clubs in the community, to practice or learn skills or have help to maintain their health conditions. Key health risks assessments are not part of the homes care planning system. We spoke to three people in the home and discussed others with four staff and the manager. We also saw three care records. This showed us how individual objectives are broken down into achievable steps. For example on our visit one person was encouraged by staff to practice literacy and making a drink. They told us about unpacking, making their bed and about their morning outing. Their care records show that emotional upsets decreased and they are developing social skills by learning to respect peoples personal space and privacy. Some people attend leisure activities with support while their families have a break. We were told that the home match staff skills to peoples needs, for example staff that drive or swim. Each persons routine was different, and their requests were met about food, music and DVDs. Staff and people knocked on doors and waited before entering. People chose whether to take part in activities and outings; one person occupied themselves in their room most of the time. This shows us that people have their diverse needs met with sensitivity, privacy and respect. The home worked on communication guidelines with advice from speech and language therapy. This improved staff relationships with people. The manager is planning for staff to learn more Makaton signs. People told us about particular staff they like. All staff including the cook took time to converse with each person. We complimented all staff on duty whom we observed. Individuals moved around freely. Someone agitated as a result of their condition went into the garden. Staff followed to support them, and to play a diversionary game. Behaviour plans use distraction techniques and staff have training to best practice standards. These plans are regularly reviewed and noted progress for two people who present risks to themselves and others, now with less frequency. People bring small amounts of money to spend on outings. The home provides safekeeping and has an accounting and receipt system, which tallied. Staff record however in different ways. br br Care Homes for Adults (18-65 years) br br Page 14 of 35 br br Lifestyle br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are flexible routines, activities and outings and people can lead the lifestyle they choose. Relationships are maintained with families and friends. Food is nutritious and well liked, with dietary and cultural needs met. br br Evidence: The home told us that they place a greater emphasis on socially inclusive activities so that people have more opportunity to use community facilities. Two people went out in the morning by taxi with staff, to walk around the city centre and have a snack. One person had early morning medication and went back to sleep. Two people remained in bed until 11 am and noon. One person likes to stay up late and get up late. This shows us that care is flexible and individual. One person occupied themselves in their room, but also brought a CD player into the dining room to play music that others also enjoyed. People used the garden, kitchen and lounge. One person watched a DVD and used drawing materials they brought with them. br Care Homes for Adults (18-65 years) Page 15 of 35 br br Evidence: In care records we saw that some people have support to attend worship and to exercise e.g. walks, swimming. There is multi-sensory equipment in the home which is used to calm or stimulate people. There are CDs to suit tastes and in asian languages appropriate to people using the service. People can watch TV in their rooms or the lounge, and one person used a computer console. This shows us that people can move about freely, use facilities the home provide and they bring with them, and have privacy when they want. Mealtimes were calm to promote good eating. Food was prepared in small pieces or cut so that three people managed by themselves. One meal was staggered so that someone could be fed without diversions. A relief worker was guided by staff to encourage the person to use special utensils. They were also sensitively fed and managed their own beaker for drinks. One person said the food was not hot enough and was provided with hotter food, and another person had a choice of pudding after brief distress was expressed about what they were served. The AQAA told us that there is a picture menu so that people can make food choices. On our visit this menu was not used and people were not offered choice unless they voiced a concern. The cook knows people well and is aware of their likes and dislikes. It would have been difficult to offer choice so that the cook had enough time to prepare food as two people slept late. There is a menu prepared by the main cook for ordering food, appropriate to the dietary needs of people expected. Food is nutritious and freshly prepared. The cook used the ingredients available to prepare culturally appropriate food. People ate all their food and enjoyed it. Records are kept about this. We tried the food and complimented the cook not only on the excellent food but for the response they evoked by the way they spoke to people about themselves. br br Care Homes for Adults (18-65 years) br br Page 16 of 35 br br Personal and healthcare support br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and health needs are appropriately met. Staff have training to manage medication, but improvements are needed to the medication procedure, storage and practice so that peoples health is fully protected. br br Evidence: People are encouraged to wash, dress and bathe themselves and they are supported with areas they need help with. For instance, one person had clean clothing laid out by staff and they were reminded not to overfill the bath. Another person needs two staff to assist with a shower using a tracking hoist. The three care plans we saw had detail about personal care, health monitoring, medication and encouraging independence so that staff have clear guidance. On our visit people were dressed appropriately for the weather in their own clothing. One person has clothing kept at the home, arranged with the family. Their clothing is not used by anyone else. People had good personal hygiene. They had prompting and assistance with continence and feminine hygiene, discretely and in private as needed. Dietary needs are assessed, as well as mobility and manual handling but there are no br Care Homes for Adults (18-65 years) Page 17 of 35 br br Evidence: risk assessments to prevent malnutrition, pressure sores or falls. No one on our visit raised our concern in these regards, however one person is a wheelchair user and some people using the service are growing older, which we discussed with the manager. We saw two very good plans about the prevention of over eating and discomfort for people unable to regulate their food intake. Food was appropriately controlled for one person during our visit for this reason and the person who was unable to communicate appeared comfortable and satisfied. We were told that everyone using the service needs medication administered. Allergies are recorded, and how medication is preferred to be taken. No one on our visit had covert medication; the homes procedures ensure that this is agreed in advance with a doctor and multi-disciplinary team as part of a seamless care plan in a persons best interests. One person had a variable dose medication booklet that goes home with them so that they have the correct medication by any service. Families provide sufficient prescribed medication for the short stay in a variety of containers and systems, and are advised in the service user guide what the home needs to ensure peoples safety. Medication needed occasionally, such as pain relief for headaches, must be prescribed and the pharmacist labels we saw had clear instructions on maximum doses. We drew staff attention to one medication container for an occasional medication. The container was cracked and had a hole, and the container was dated 2006. The label had no clear year for the prescription and was pasted over an older label. This had been missed when medication was checked into the home by two staff. Staff understood that this posed a risk that the medication was contaminated and took action to ensure the medication was not used. They were uncertain whether to phone the family to provide more medication, and whether to dispose of it or to send it home at the end of the short stay and consulted the on-call manager at our request. The homes log shows that disposals are infrequent - staff said they use a local chemist if staff accidentally drop medication because of contamination. The manager informed us on our second visit that a meeting with the family was arranged, and the contaminated medication had been sent home with the person by staff, so the manager did not have the opportunity to see it. One family told us that they have been contacted by staff who are uncertain about medication instructions and labels, so we know that labels are usually queried. All medication is returned or disposed of by end of a short stay. The homes procedures have insufficient guidance to ensure safeguarding health extends to what is sent home. It is recommended that the procedure is improved so that there is clarity. We made the manager aware that the procedure does not match legal regulations about br br Care Homes for Adults (18-65 years) br br Page 18 of 35 br br Evidence: the storage of controlled drugs. These are not currently prescribed for anyone using the service. There is an appropriate controlled drugs cabinet but it is not attached to the wall. Other medication is securely stored in a fixed cabinet, however the current system does not ensure medication is kept within a safe temperature range in accordance with manufacturer instructions. Temperatures are not taken in the storage room. Fridge temperatures are taken daily but do not note all three temperatures on the thermometer and staff did not know what is being measured or the safe range. Although there was no medication requiring refrigeration on our visit, and the room was not excessively warm, the home needs to be able to spot problems to act upon them so that people have stable medication to maintain their health. Medication was otherwise safely administered and managed during our visit. There are audits of medication by the manager and by the council. Staff have accredited distance learning about safe handling of medication, which is refreshed every three years. They are regularly observed, and their knowledge and competence is checked. We were notified about three medication errors since the last inspection. Discussion and records showed us that staff act responsibly and report errors quickly; medical advice is sought and no one has had adverse effects. Families are informed. The manager and council have followed up that appropriate action was taken to improve staff performance. br br Care Homes for Adults (18-65 years) br br Page 19 of 35 br br Concerns, complaints and protection br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Concerns are acted upon quickly as there are individual guidelines to recognise distress. The complaints procedure has not always used to identify trends and to learn from the experience of families. There have been no adult protection concerns, and there are additional ways the home checks whether abuse is affecting a persons life. br br Evidence: No complaints or adult protection concerns were recorded since the last inspection. Two relatives told us that they do not know how to make a complaint but the procedure is in the homes brochure and service user guide, also on the council website, in various formats including Easy Read. It is clear about the rights of people and their representatives. The Commissions contact details have not been updated for some time, and details of advocacy services are not included so that people can report a concern outside of the home or readily access support to make a complaint. The Commissions published guidance on complaints, concerns and safeguarding gives examples of each type. Swan Bank informed us of a few events affecting people that did not result in serious injury or health deterioration. We wanted to see how the home uses this guidance and applies their procedures. Staff told us that they know how to respond if a concern is expressed. Care plans have detailed guidance for staff to recognise distress affecting people with limited communication and what to query further. On our visit one persons distress was br Care Homes for Adults (18-65 years) Page 20 of 35 br br Evidence: responded to with reassurance and further choice, so it was brief. In contrast, the complaint procedure was not always used to log matters that families verbally raised with staff, i.e. the informal stage of their complaints process. However our findings give us confidence that actions taken are better than the homes complaint records. For example, we discussed a note about recent missing possessions and money. We were told that this was investigated and the items were safe; errors were rectified within a few days with an apology. This should have been logged so that management can analyse how often things go missing and act upon any trends. One family raised dissatisfaction in the past - there is no current complaint, but the family remain wary that the issues might occur again to themselves or others. They queried staff interpretation of the homes medication rules and staff not reading the medication guidelines prepared with the family. They felt that the objective of a short stay for their family was to have a break from caring responsibilities and to be able to undertake other essential family matters, but felt unnecessarily disturbed by staff late at night and did not understand why the home could not query matters with pharmacists and GPs involved. Swan Bank also needs to use their complaints procedures to learn and develop from the experience of all who use the service so that family views are also taken seriously and their rights are promoted. Adult protection procedures, and safe systems to manage small amounts of peoples money were understood by staff we spoke to. The code of conduct prohibits staff involvement in peoples financial affairs or benefiting from wills. Staff have training in these matters so that abuse can be prevented. Since the last inspection the manager took action so that people are protected by the homes best practice recruitment process, and people now have help in an emergency from appropriately skilled first aid staff. There are policies about transport charges that we recommend are reviewed so that people are fairly treated and the financial interests of people with incapacity are protected. When the homes vehicle is used, people contribute a fixed fee. But if a taxi is used people share the full costs, without a contribution from the home for staff. Staff said that the choice of transport is determined by staffing levels and staff skills. Four staff are named as drivers for the home, after attending training about safety in vehicles. br br Care Homes for Adults (18-65 years) br br Page 21 of 35 br br Environment br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Swan Bank is comfortable, clean and well maintained. Facilities and equipment are safe and afford privacy and security. There is a health and safety culture that prevents accidents and good infection control measures, but more timely action is needed to make use of national advice to prevent the spread of illness and to prevent scalding from hot water. br br Evidence: Swan Bank is in a residential neighbourhood and is not distinguishable as a care home. There is a discreet ramp for wheelchairs at the front, and a passenger lift so it is wheelchair accessible throughout. People needing the tracking hoist have a bedroom and ensuite wetroom on the ground floor. The home have a vehicle to provide transport, and a wheelchair for one persons use in the transport. There is a welcoming and homely atmosphere. It is comfortable and a smoke free environment. The premises are well maintained. It is decorated in one colour throughout. People would find it easier to choose rooms and find their way around if each room had a different colour scheme. There were no pictures on most walls. We found pictures in wardrobes, and staff said some people take these down. We discussed with the manager how more could be done to provide a safe but stimulating environment that celebrates cultural diversity. The lounge has a secure picture of the sea which creates br Care Homes for Adults (18-65 years) Page 22 of 35 br br Evidence: a calm atmosphere. Bedrooms have keys in the door locks which people have learned to use, so there is privacy. Rooms also have a lockable drawer. There is a keypad on the kitchen door which prevents access when people staying may be at risk. This door was open during our visit and one person used the kitchen with staff support. The front door is secured; staff are needed to use it. People have free access to an enclosed garden, but the back door is alarmed so that staff can support anyone who may be agitated or upset. We queried an open cupboard with cleaning equipment in the laundry room. Staff said they were interrupted from cleaning duties by the inspection, and accidentally left the cupboard open. Later we found the cupboard locked, but staff need to take care to ensure that people are safe when accessing the back garden through the laundry. We saw a health and safety audit February 2008 but none for 2009. This showed us that the homes risk assessments were in place, the fire evacuation plan had been reviewed. Fire doors were found wedged open but improvements have prevented this happening. An up to date risk matrix was seen showing regular checks are done. We saw a note about a problem with the hot water supply to the kitchen and a shower and zero boiler temperature in August 2009, so we looked in both rooms. The water was fine in the kitchen but appeared too cold in the shower and a stiff mechanism made it hard to turn off. Staff said the boiler was checked the previous week; they were not fully familiar with the hot water heating system to adjust it. We confirmed that contractors had serviced the homes heating system, tracking hoist and slings, and tests were conducted on portable electrical appliances in accordance with council policy (two yearly). There are records of weekly checks on hot water. Showers have thermostatic valves. Baths and room taps are kept low, no more than 36 degrees C, but one tap in a room used by people was last recorded for two weeks to be 48 degrees C, vastly exceeding the Health and Safety Executive safe range and presenting scald risk. No one knew if action had been taken. Staff did not know where the homes thermometer was kept so we were unable to test. Staff turned off the water supply to the sink so that people were safe and said they would request a visit from the repair service after the bank holiday. On our second visit the manager confirmed this service attended quickly, and we tested the temperature with the homes thermometer and confirmed it was safe. The home need to know the safe range and take action in future without delay. The AQAA told us that the home further improved infection control since the last inspection. Nearly all staff are trained in infection control, and training is planned br br Care Homes for Adults (18-65 years) br br Page 23 of 35 br br Evidence: about safe food handling where there is shortfall. Staff said that the council employment service supervises domestic work experience at the home for people with learning disabilities, and staff at the weekends also clean the home. There were sufficient supplies of liquid soap, paper towels, gloves and aprons. Cleaning schedules have not been reviewed and anti-bacterial gel was not readily available in response to government guidance for care homes about the swine flu epidemic, to prevent the spread of illness. The food probe is usually tested monthly so that prepared food is tested and safe to eat. The last test had been missed; the cook said they would check the probe during our visit. br br Care Homes for Adults (18-65 years) br br Page 24 of 35 br br Staffing br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment checks protect people. A competent staff team have good inductions, training and supervision to meet peoples changing needs and health. Proactive cover arrangements and rotas need to reflect how vacancies and staff absence ensure needs are met at all times. br br Evidence: Staff tried but found there were insufficient relief staff available to cover unexpected staff absence on our visit. Staff have been working extra hours to cover vacancies and did not know when this would end. They said that they were unable to provide people with the level of activities expected due to staffing levels and some staff felt there should be a second vehicle so that everyone can go out. Staff said they would have struggled with three staff in the morning and two in the afternoon if all four people in the home on our visit had been high dependency. Everyones needs were met while we were in the home. When temporary staff are necessary, they are guided by staff familiar with people. One person was familiar with the relief worker showing us that there is consistency. Staff have clear roles and the home ran smoothly in the managers absence. Staff were not aware how long unexpected sickness would last, and could not plan for relief staff for the next two days of the bank holiday. They said the list of employed br Care Homes for Adults (18-65 years) Page 25 of 35 br br Evidence: relief staff was small and shared; the on-call manager was aware but was covering unexpected absence at another home. Respite services are usually in demand on bank holidays, so a proactive contingency plan should be in place. The rota did not show how vacant shifts were being covered. We were told that some staff cancelled leave, and a relief worker was arranged for one shift on our visit. We have not been notified of any staff shortage. The AQAA does not reflect upon two staff vacancies and recruitment delay. It tells us that there is a diverse workforce, a same gender policy for providing personal care and that staff are matched on rotas for planned activities, such as for driving and swimming. On our visit there were male and female staff in the morning and afternoon, but the vehicle was not used for a planned outing. There are waking and sleeping night staff, and clear roles about who can administer medication. The manager now ensures there are robust recruitment documents and checks by going to the Civic Centre to see them, maintaining a summary record in the home. We were unable to see staff records in accordance with the council agreement with the Commission as only the manager holds the keys and the Civic Centre was closed for over 48 hours. We confirmed that an outstanding requirement about Schedule 2 documentation had been met on our second visit. The council have introduced a form to record checks on employment gaps. Long-standing staff have now had checks refreshed with police and government lists. Three staff are booked to start a Skills For Care induction, and two staff records showed us that the manager signs off competencies. Staff qualifications exceed minimum standards and staff have opportunities to gain NVQ 3 and 4 qualifications. We saw the managers 2009/10 plan for mandatory staff training and refreshers including hands-on manual handling and medication re-training; staff and the manager confirmed bookings. Additional training is provided in autism, communication, epilepsy management and handling behaviour. Some staff have training about sensory disabilities, mental capacity and consent. The AQAA told us that the health service have not been able to respond in a timely way to staff training needs about peoples conditions since the last inspection. This should be reviewed by the provider. The manager is planning staff training about Deprivation of Liberty Safeguards and encourages more staff to have training so that the home has more drivers. Seven staff have been trained in first aid resuscitation so that people have skilled help in an emergency. People are supported by competent staff whose performance, training and br br Care Homes for Adults (18-65 years) br br Page 26 of 35 br br Evidence: understanding is regularly checked. Audits and provider visits check the human resource systems to protect people. For instance a medication error resulted in the administration of medication under supervision until competence was re-confirmed. br br Care Homes for Adults (18-65 years) br br Page 27 of 35 br br Conduct and management of the home br These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. br br This is what people staying in this care home experience : Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and managed to benefit people. Health and safety is managed but improvements are needed to ensure there is accountable oversight, contingency planning is timely and proactive, and specific policies and procedures need review so that they are lawful, fair and objectives for the service are met. br br Evidence: Swan Bank has a qualified and experienced manager who is registered with the Commission. The AQAA was completed on time and presents in the main a good self assessment. The manager leads a person centred approach which benefits people. We saw in a variety of ways how the manager develops the service to meet diversity, dignity and cultural needs. For example, the recruitment strategy aims to increase male and Asian staff to match people using the service. High standards of care quality have been sustained to the satisfaction of people and families. The manager updates their knowledge of the law and management skills, and progresses what needs to improve such as accessible review minutes. Up to date certificates are on display about the homes registration and insurance. br Care Homes for Adults (18-65 years) Page 28 of 35 br br Evidence: The manager is supported by a management structure and training section. Service and team plans show us that the home are aiming and on track to ensure 100 compliance with staff supervision and appraisal. There are regular staff meetings. However, proactive and timely contingency planning about bank holiday staffing arrangements and service continuity is needed, although peoples needs were adequately met on our visit. The manager said there is a meeting for managers about swine flu, and agreed this has not been timely during an established epidemic. The manager is aware that staff are tired; some had to cancel leave, but planned rest days are taken within the European Working Directive. Staff said that recruitment delay was caused by slow corporate recruitment process. In addition to vacancies, long term sickness is being managed after staff injury caused by service user aggression. There is a recruitment plan and we were told that a new worker is going through checks and will be starting in one week. Another vacancy is held for staff deployment from closing services and the post is expected to be filled by March 2010. The AQAA tells us that staffing is provided up to one to one support for people, but does not explain how staffing is reviewed in light of peoples changing needs. The views of people and families are sought in a variety of ways. The AQAA told us that the home want to learn more from consumer experience and are aware that surveys could be used more frequently with people at the end of short stays. There were a few surveys in each care record we saw, showing what people liked during their stay, and suggestions. Meetings for families are held with another service bimonthly, have topics and speakers to improve attendance. Recent annual questionnaires we saw and complimented. The detailed questions help the home to self assess quality, and check safeguarding, privacy and dignity. It would be useful to families to publish the results and actions planned. We recommend that medication policy and its affect on families is reviewed with them, to consider whether this is meeting the objectives of the service. People are mainly protected by the homes audits, health and safety checks, policies and use of procedures but some need review or development, such as transport charges, medication storage, and hot water checks. There is fire training to staff roles and fire drills are held. There are no outstanding issues with the Fire Officer and staff were not aware of any environmental health inspections. We saw good food hygiene and infection control measures in place. A timely maintenance and repair service is used, contracted by the landlord. The home keeps all its records up to date and secured so that people and staff have confidentiality. Staff have access to essential records to ensure the smooth running of the home in the managers absence. There is br br Care Homes for Adults (18-65 years) br br Page 29 of 35 br br Evidence: a safe system to handle peoples money, but staff should use a consistent recording method. Money left at the end of a short stay should be sent with the individual. Monthly unannounced visits by the provider are required by law to check health, safety and welfare. We saw evidence that thorough visits took place until April 2009, but not beyond this date. We saw excellent themed audits about recruitment and safeguarding, but it was not clear how action plans were progressed through Regulation 26 visits. Reports after these visits to the home need to be timely and held on the premises so that the manager can progress any required actions, with accountable oversight. The Commission are kept informed of events at the home in accordance with our current guidance. The manager acted upon the last inspection report, and our reports are made available to people. br br Care Homes for Adults (18-65 years) br br Page 30 of 35 br br Are there any outstanding requirements from the last inspection? Yes £ No R br br Outstanding statutory requirements br These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. br No. Standard Regulation Requirement Timescale for action br br Care Homes for Adults (18-65 years) br br Page 31 of 35 br br Requirements and recommendations from this inspection: br Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. br No. Standard Regulation Requirement Timescale for action br br Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. br No. Standard Regulation Requirement Timescale for action br br 1 br br 20 br br 13 br br 13(2): Medication containers 12/10/2009 and labels must be examined when medication is received into the home and irregularities managed so that there is sufficient safe medication for the duration of the short stay. People need medication that is in date and uncontaminated for their health. br br 2 br br 33 br br 18 br br 18((1)(a): Rotas must demonstrate there are sufficient named staff with the appropriate skills on duty at all times. Peoples assessed needs must be met by appropriate staffing levels and skill mix. br br 12/10/2009 br br 3 br br 42 br br 26 br br 26(2)(3)(4)(5): The registered person must ensure that unannounced visits take place monthly, br br 12/10/2009 br br Care Homes for Adults (18-65 years) br br Page 32 of 35 br br Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. br No. Standard Regulation Requirement Timescale for action br br timely reports are held on the premises and actioned. Health, safety and welfare must be promoted and protected. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. br No Refer to Standard Good Practice Recommendations br br 1 br br 1 br br The statement of purpose should reflect services are provided to people with autism as well as learning disabilities, and that staff have appropriate training. The home should ensure there is a scheme to identify, prevent and manage any risks of malnutrition, pressure sores and falls for peoples health promotion. The medication policy must comply with the Misuse of Drugs Act 1971, and the controlled drugs cabinet must be appropriately fixed to the wall when it is in use. The procedures and staff need to be clear about when to dispose of medication and when to return it to families at the end of a short stay so that people are safeguarded in the home and community. Medication must be stored in accordance with its product licence so that it remains stable and effective for peoples health. Daily temperatures should be recorded in the room where drugs are stored. All three fridge temperatures on the thermometer should be clearly recorded. Staff should be clear on the safe range, and action to be taken if exceeded. The complaints procedure should be used to promote the rights of people and families; trends can be identified and acted upon e.g. missing property and dissatisfaction with policies and staff practice. The Commissions contact details need updating in the complaints procedure and other published information and br Page 33 of 35 br br 2 br br 19 br br 3 br br 20 br br 4 br br 20 br br 5 br br 20 br br 6 br br 22 br br 7 br br 22 br br Care Homes for Adults (18-65 years) br br Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. br No Refer to Standard Good Practice Recommendations br br notices so that people can report a concern outside of the home. 8 23 Charging policies about transport should be reviewed to ensure there is equity and that peoples financial interests are protected. Staff need to be aware of the location of the water thermometer, the Health and Safety Executive safe range for hot water temperature, and how to adjust the hot water heating system. Cleaning schedules and products for infection control need timely review when government guidance changes to prevent the spread of illness. There should be sufficient arrangements to cover unexpected staff absence, especially on bank holidays and during an influenza epidemic. br br 9 br br 24 br br 10 br br 30 br br 11 br br 33 br br Care Homes for Adults (18-65 years) br br Page 34 of 35 br br Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. br br Care Homes for Adults (18-65 years) br br Page 35 of 35 br br - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!