Care Home: Swan House

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What the care home does well One of the surveys added that the home does well as `It makes us very comfortable & well looked after.` Medicines are stored securely for the protection of residents in a room which is temperature controlled to ensure medicines are of a suitable quality. People told us that the staff were `Very helpful.` They also told us that the food was `Very good.` What has improved since the last inspection? The details within the care plans have improved so that people`s health care needs are safely met. Records made when medicines are received into the home, when they are given to people and when they are disposed of have improved. These account for all medicines in use and demonstrate that people receive their medicines as prescribed. The requirement made about this on the last inspection has been met. Menus now have `seasonal vegetables` included so that people have information about their food. Appropriate crockery has been provided to enable people to be more independent with their food and to be able to eat in a dignified way. There have been improvements to the environment with the removal of `clutter` from internal parts of the home and from the inner courtyard. There has been refurbishment of the dining areas. The recruitment process has improved as we found no gaps in people`s employment histories. What the care home could do better: Care records must contain guidance for staff in how to manage high blood sugars in someone who has diabetes. The care records must also detail the frequency of when a person is to be weighed and these records should always provide recorded evidence of when people are given fortified food and drinks. An investigation should be carried out with regards to how and when people`s blood sugars are monitored. Where people look after and uses their own medicines, this must be identified in their care plan and the risks posed to themselves and other people must be assessed and documented. All staff authorised to give medicines must have a documented assessment that they are competent to do so. The home could be more homely with the removal of notices in people`s rooms and bathing areas. People`s confidential information must be kept private. Confirmation of any nurses` current registration qualification must be obtained when recruited and when their registration expiry date occurs. This is to ensure that people are protected from unsuitable staff. Key inspection report Care homes for older people Name: Address: Swan House 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX     The quality rating for this care home is:   two star good service 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: Elaine Boismier     Date: 2 7 0 4 2 0 1 0 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. 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 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. 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 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. This is what people staying in this care home experience: 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 Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Swan House 47 - 49 New Road Chatteris Cambridgeshire PE16 6EX 01354696644 01354696645 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (No 4) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Type of registration: Number of places registered: care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 25 nursing places only No more than 25 places for terminally ill residents over 65 years of age (TI(E)) only Date of last inspection Brief description of the care home Swan House, close to the centre of the town of Chatteris, is a care home registered to provide care, including nursing care, for people over 65 years of age. There are 40 single bedrooms and 39 of these have ensuite facilities. Six bathrooms are also available in the home. The home is arranged on two floors that offer bedroom Care Homes for Older People Page 4 of 30 1 9 0 5 2 0 0 9 0 0 0 Over 65 40 40 25 Brief description of the care home accommodation, dining room areas and a choice of sitting rooms. The upper floor can be reached via stairs or a lift. There is a small garden at the back of the home. Current fees range from £354 to £689 depending on the assessed needs of the person. Additional costs include those for hairdressing, chiropody, newspapers and toiletries. Further information about fees should be available from the home. A vacancy has arisen for a registered manager. A copy of the inspection report is available at the home or from our CQC website at www.cqc.org.uk Care Homes for Older People Page 5 of 30 Summary 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 Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We, the Care Quality Commission (CQC), carried out this unannounced key inspection, by two Inspectors, between 10:10 and 16:10, taking six hours to complete. Before the inspection we received surveys from five of the residents and four from the staff. We also received surveys from two health care professionals. We looked at information that we have received about the home since our last key unannounced inspection. The home sent us, as requested, an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. During this inspection we looked around the premises and looked at some of the documentation. We case tracked two of the current thirty- two residents. Case tracking Care Homes for Older People Page 6 of 30 means speaking with some of the residents and visiting their rooms and speaking with some of the staff who were looking after them. We compared what we saw and heard with the peoples individual records. We also spoke with and watched other people who were not part of our case tracking. We spoke also to some of the other staff, including the Manager and a visitor to the home. For the purpose of this inspection report people who live at the home are referred to as people, person, resident or residents. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Care records must contain guidance for staff in how to manage high blood sugars in someone who has diabetes. The care records must also detail the frequency of when a person is to be weighed and these records should always provide recorded evidence of when people are given fortified food and drinks. An investigation should be carried out with regards to how and when peoples blood sugars are monitored. Where people look after and uses their own medicines, this must be identified in their care plan and the risks posed to themselves and other people must be assessed and documented. All staff authorised to give medicines must have a documented assessment that they are competent to do so. Care Homes for Older People Page 8 of 30 The home could be more homely with the removal of notices in peoples rooms and bathing areas. Peoples confidential information must be kept private. Confirmation of any nurses current registration qualification must be obtained when recruited and when their registration expiry date occurs. This is to ensure that people are protected from unsuitable staff. 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. Care Homes for Older People Page 9 of 30 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. 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 can be confident that there is enough information about the home to help them in their decision where to live. They can also be confident that their needs will be assessed to ensure that the home can meet their assessed needs. Evidence: Four of the five residents surveys said the person had received enough information about the home to help them in their decision where to live with the remaining survey saying that the person did not know if they had received such information. The Statement of Purpose was examined and, according to the Manager, is currently being reviewed to amend, for example, the name and contact details of the current registration and inspection authority, the Care Quality Commission. The AQAA noted that there have been no placement breakdowns indicating that there is a robust pre-admission procedure. We looked at three peoples care records and we Care Homes for Older People Page 11 of 30 Evidence: found that these people had their needs fully assessed before they moved into the home. The assessments were detailed and provided clear information about what the person would need when they moved in. Care Homes for Older People Page 12 of 30 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. 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 can be confident that they are safe due to improved care records. Evidence: As part of our case tracking we looked at two peoples care records and we looked at one other persons care records. Findings indicated that there has been an improvement in the standard of information provided for how the staff are to manage someone with diabetes (mellitus). This included how staff were to identify the signs and symptoms of when the person became unwell, due to high or low blood sugar and what the lower range of the blood sugar should be. We found there was clear guidance in what staff should do should the person have too low blood sugar. We noted that the persons blood sugars were usually within normal range with the exception of some, but not all, of the blood sugar recordings for evening time. We could find no guidance within the persons care plan on what staff should do in such instances and we could find no record of what the staff did when the persons blood sugars were of a high range. On further examination of the persons blood sugar monitoring records we noted that there was a certain pattern to these records: the Care Homes for Older People Page 13 of 30 Evidence: Deputy Manager agreed with our view that this should need further investigation into how and when the persons blood sugars are tested and recorded. According to the AQAA none of the residents have acquired a pressure sore whilst living at the home. It also said that We have staff trained in tissue viability who are able to assess for pressure areas and sores, and take appropriate intervention where required. Some of the staff surveys said that the home provides does well with Tissue viability and Pressure care management. With the Deputy Manager we looked at how the home was monitoring and recording a persons care- the person had acquired pressure sores before they moved into the home. Evidence indicated that the persons treatments were having a slow, but positive affect as there was recorded evidence that the sores were healing. We noted that, due to the absence of details of photographic records, it was difficult to ascertain where some of the sores were acquired. Body maps and other pressure sore monitoring tools were in place. We noted, from our case tracking, that care plans had improved with regards to food and drink; these were more person centred and based on evidence, such as how much a person should drink according to how much they weighed. Reviews of care plans were carried out at least once a month and, according to the Manager, it is their intention to improve the content of these reviews. For example we saw that a persons nutritional status had been reviewed and recorded as No change although we saw that the person had a change of body weight from the previous month. With the Deputy Manager we looked at a persons care records for their nutrition and hydration. We noted that the person was assessed to be at a high risk of malnutrition and, according to the records, the person was to be weighed either weekly or monthly. It was unclear how often the person was to be weighed: the Deputy Manager agreed that this staff guidance was confusing. (We noted that this persons weight remained stable although the level of risk remained the same). All of the residents surveys said that the person received the right care and support that they needed and four of these five surveys said that the home made sure the person received the medical care that they needed. The medical care question was not answered in the remaining survey. One of the surveys added that the home does well as It makes us very comfortable & well looked after. Both of the health care professional surveys said that the home properly monitors and reviews the peoples health care needs and that the peoples dignity is respected by the home. Care Homes for Older People Page 14 of 30 Evidence: We saw, from our case tracking, that people had access to a range of health care professionals to include dieticians, speech and language therapists, general practitioners, opticians and chiropodists. On the day we were at the home we saw some of the people were being visited by a general practitioner. As part of our case tracking we spoke with one of the peoples guests: they considered that the resident, who they were visiting, had noticeably improved in their health and well-being since moving into the home. The persons care records also demonstrated that the person was improving in their sense of well-being. When speaking with this person they said that they were comfortable and satisfied with their care. We spoke with another person, who was not part of our case tracking, and they said that they were satisfied as to how the home was looking after them. Both of the health care professionals surveys said that the home supported people, where possible, to give and manage their own medication. We looked at the practices and procedures for the safe storage, use and recording of medicines. Medicines were stored securely for the protection of residents in a room which was temperature controlled to ensure medicines are of suitable quality. Records made when medicines are received into the home, when they are given to people and when they are disposed of have improved. These provided an account for all medicines in use and demonstrated that people received their medicines as prescribed. The requirement made about this on the last inspection has been met. We saw that one person looked after and used their own inhaler but their care plan made no reference to this and the risks posed to themselves and other people, had not been assessed. We saw that there was information about what medicines are prescribed for people kept on a clipboard outside their rooms and this could be accessed by unauthorised people. This compromised peoples privacy and must be reviewed. Medicines were only given to people by authorised staff who have been trained to do so. We looked at the training records for three people and, although there was evidence of training courses attended, for two of these people there was no assessment that they were competent to administer medicines. We expect this to be managed by the home. People said that the staff were Very good and Lovely and found that they were also Very helpful. We noted that the staff knocked on peoples doors before they went in Care Homes for Older People Page 15 of 30 Evidence: to the room. Care Homes for Older People Page 16 of 30 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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 can be confident that they are offered opportunities to live a good social life. Evidence: Both of the health care professional surveys said that the home properly monitors and reviews the peoples social care needs and that peoples choices in how they wish to live are valued by the home. Four of the five residents surveys said that the home always or usually provided suitable activities with the remaining survey saying that they did not know if this was the case. The AQAA told us that We have employed an experienced and enthusiastic Personal Activities Leader (PAL) who has spent time developing life histories with our residents. We are offering a varied activities programme to cater for all of our residents needs. We have started a resident of the day programme to offer each individual one day per month where they have individual time with the PAL. As part of our case tracking and from examination of another persons care records we were unable to find information about the peoples life histories, which would have given a sense of the persons uniqueness and individuality. According to the Manager there is work in progress to develop these life histories and they were able to provide Care Homes for Older People Page 17 of 30 Evidence: an example of one already completed. We saw photographs of people taking part in Easter celebrations with the wearing of Easter bonnets, enjoying a trip out and watching and listening to visiting entertainers. Since our last inspection a room has been converted from a lounge to an activities room where we saw pots of carrot seeds sprouting and a large wall collage which some of the residents had contributed in developing. After lunch we saw people enjoying entertainment provided by a visiting choir of female singers. As part of our case tracking we visited the peoples rooms; one of the people said that they were really enjoying the music on their radio. The records of the other person indicated that they did not like to take part in the activities but enjoyed listening to music and watching DVDs in their room. They were asleep when we visited their room and noted that their entertainment systems were not switched on, allowing a sense of peace to their room. Peoples rooms, that we visited, had personal possessions in their rooms such as photographs and ornaments. We saw, from speaking with a visitor and one of the residents who we case tracked, that there was no restriction when people could receive guests. We also saw other people receiving visitors in their room and in the lounge and dining areas. All of the five residents surveys said that the person always or usually liked their meals. The AQAA noted that We have developed a varied menu within the home, we also offer a room service menu where the residents can order a varied menu anytime of the day. According to the AQAA twelve of the staff have attended training in malnutrition and how to help people with their food. As part of our case tracking we looked at how these people were supported in having their drinks and food. We saw that the staff supported the people and this was in line with the persons care plans. We also noted that one of the people was encouraged to be as independent as possible in eating their meal, with the support from the staff and with the aid of appropriate crockery, which prevented spillage of their food and that they were able to get their food on to their cutlery, in a dignified way. Records of food and drink were well-maintained and gave the reader a clear understanding of how much the person ate and drank. Fortified food and supplements were recorded in these two peoples records. We looked at a third persons care records and although there was nutritional advice provided by a dietician we found no recorded evidence Care Homes for Older People Page 18 of 30 Evidence: that this advice was being followed. The Deputy Manager agreed that the records did not provide recorded evidence of the nutritional care provided to the person. According to the staff, including the catering staff, all the food is fortified for people who do not have diabetes mellitus. People with diabetes mellitus were provided with a normal diet. Menus that we saw contained a range of choices from roasts to fish and chips and sardines on toast. A choice of a cooked breakfast was also available on request. People we spoke with said that the food was Very good. Dining rooms had replacement furniture and dining tables had table linen and vases with artificial flowers to provide a homely atmosphere. Care Homes for Older People Page 19 of 30 Complaints and protection 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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 can be confident that they will be listened to and they can also be confident that they are safe from the risk of harm. Evidence: Four of the five residents surveys said that the person knew who to speak to if they were unhappy; three of these surveys indicated that the person knew how to make a formal complaint; one of the surveys said that the person did not know about this procedure with the remaining survey not being completed within this section. Examination of the 2010 results of the homes survey indicated that 53 of the respondents were aware of the formal complaint procedure although 40 of the respondents did not know about this. The complaints procedure was seen on display above the visitors signing in book: the Manager said that they would take action to improve how this information could be disseminated to improve peoples knowledge about how they could make a complaint if they so wished. The record of complaints was seen and findings indicated that the home responded to the complaints in a listening and timely manner. Both of the health care professionals surveys said that the home had responded appropriately to any concerns they or any other person had about the home. All of the surveys from the staff said that the person knew what to do if any one had a concern Care Homes for Older People Page 20 of 30 Evidence: about the home. The AQAA told us that the home had received six complaints within the last twelve months; all of these were resolved within the required 28-day time period and three of these were substantiated. During July 2009 we received a complaint against the home. We referred the complaint to a local community services team. Their investigation concluded that the main issue may have been a break down in communication between the home and the complainant. In November 2009 we attended a safeguarding meeting. The allegations made against the home were not substantiated. We considered that the home had co-operated with the safeguarding investigations. Due to allegations made against the home, in December 2009 we attended a meeting held under the safeguarding procedures and we reconvened in January 2010. The home again co-operated with the safeguarding investigations. Since our last inspection we have received information, from the home, that indicated there was a clear understanding of the correct local safeguarding reporting procedures. We asked some of the staff about their knowledge of safeguarding and safeguarding training and we were satisfied with the answers they gave us. Care Homes for Older People Page 21 of 30 Environment 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, 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. 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 live in a comfortable and clean home. Evidence: Improvements have been made to the home to include refurbishment of the dining areas and the introduction of an activities room. We noted that there was also less clutter in the bathrooms and the inner courtyard garden was clear of unnecessary items, that we had had found during our previous inspection. According to the Manager they have decided to apply for approval, from the registered owner, for one of the decommissioned bathrooms to be changed into a shower (wet) room. We discussed, with the Manager, the appropriateness of notices in peoples rooms and bathing facilities: these notices were for the attention of staff and provided a less than homely atmosphere to these areas. We also noted one of these notices provided information about the persons dietary needs that breached confidentiality. The Manager agreed with our findings. Records of hot water temperatures accessed in bathrooms were seen and these were satisfactory. Care Homes for Older People Page 22 of 30 Evidence: All of the residents surveys said that the home was always or usually clean and fresh and we found that this was the case. Care Homes for Older People Page 23 of 30 Staffing 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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 can be confident that they are safely cared for by a motivated team of well recruited and well trained staff. Evidence: During the safeguarding meeting, held in December 2009, we were informed by one of the attendees that staff morale was low and that there had been a high turnover of staff. In January 2010, at the following meeting, representatives of Swan House confirmed that there had been a significant turnover of staff. The AQAA noted that twelve care staff, which included registered nurses, had left their employment within the last twelve months. To overcome some of the issues the AQAA said that We have removed agency staff from the home, and employed to fill all vacancies. We have also employed a large number of bank staff, care staff and qualified, which has enabled us use staff who are familiar with the home and residents and prevents the need for agency staff. We have addressed the staff sickness and absence, and worked closely with staff to improve morale. We spoke with some of the staff and they told us that they enjoyed working at Swan House and found that, due to a more settled team of staff, the staff morale had improved. We found the staff interacting with the residents in a relaxed way and gave their time to tell the residents what they were going to do. Care Homes for Older People Page 24 of 30 Evidence: All of the surveys that we received said that there was always or usually enough staff on duty to meet the individual needs of the residents. We timed the response to some of the call bells and we found that the duration of these were no more than one minute. As part of our case tracking we observed how the staff responded to a persons call for assistance; this was done in a timely manner. People were seen to be given 1:1 attention from the staff when they needed assistance with their food and drink. The AQAA told us that the home employed twenty-five care staff and twelve of these have a National Vocational Qualification, level 2 or equivalent, in care; i.e. 48 . This Standard is almost met. The recruitment process ensures that, on the whole, people are cared for by suitable staff. We examined three staff files and we found all the required information was available with the exception of information of a nurses current registration status: the home took action and provided this information following the inspection. There were no unexplained gaps in peoples employment history, indicating that there has been an improvement in the recruitment process since our last inspection. All of the staff surveys said that they were satisfied with their induction and ongoing training. Three of the four staff surveys and one of the two health care professional surveys said that the person always or usually had the right skills, experience and knowledge to meet the individual needs of the residents. The remaining staff survey and the remaining health care professionals survey said that this was sometimes the case. The staff we spoke with said that they had attended a range of training. An examination of three staff training files provided recorded evidence that these people had attended training in topics such as medication, management of diabetes mellitus and how to assess and record the risks of malnutrition. Care Homes for Older People Page 25 of 30 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 can be confident that they live in a safe and well managed home. Evidence: The AQAA told us that The current Home Manager has been in post since 03 June 2009, and holds an NVQ 4 in Care and Registered Managers Award. The Deputy Manager is a Registered Adult Nurse. One of the staff surveys added that the home does well as there is a Good Manager. Another of these surveys said that the home does well as there is ...a good communication with the management... The overall quality rating of the home has been sustained indicating that the current management of the home is satisfactory. The AQAA was completed to a satisfactory standard as it identified where the home does well, what needs to be improved upon and how such improvements are to be Care Homes for Older People Page 26 of 30 Evidence: made. This included areas such as, for example, improving the dining experience for the residents and ...to continue improving our care planning to show the person centred care we are giving. We will do this through staff training and communication with residents and relatives. Where there was a lack of information within the AQAA, such as the last review dates of the homes policies and procedures, we asked for this information when we inspected the home. Copies of reports made by a representative of the registered company were seen for February and March 2010: these contained detailed records of audits of the homes environment and records. The reports also contained evidence that people and staff were asked about their views of the home. Minutes of the last residents meeting, held in March 2010, were seen and suggestions about what they would like to see, were recorded, such as a trip out to a local museum. The registered provider carried out a survey asking peoples views about Swan House. The results indicated that the home was rated as achieving 79 for overall total satisfaction by the respondents. We looked at how the home manages peoples personal allowances and we found that records were made and receipts were obtained, providing a clear audit trail. Discussion with the staff and information provided by the records indicated that the home was subjected to an internal audit during 21st and 22nd April 2010 which concluded there were robust systems in place to safeguard peoples monies. The AQAA noted that five of the catering staff and fourteen of the care staff have attended training in safe food handling; twenty-three of the staff have attended training in the prevention and management of infection control. According to the AQAA service checks were in date for portable appliance equipment, fire detection and fire fighting equipment and for hoists and lifts. We saw service checks for these items and the information concurred with the information provided by the AQAA. Records for fire drills and weekly tests for fire alarms and emergency lights were seen and these were satisfactory. From our discussions with some of the staff and from our examination of three staff training files evidence indicated that staff have attended training in fire safety. We were informed that arrangements are being made to ensure that moving and handling training is attended by all of the staff. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements 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. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 Requirements and recommendations from this inspection: 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. No. Standard Regulation Requirement Timescale for action 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. No. Standard Regulation Requirement Timescale for action 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. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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