Care Home: Swan House Care Home

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What the care home does well This is a random visit and therefore not all core standards were assessed. What the care home could do better: This is a random visit and therefore not all core standards were assessed. Care plans must be in place for peoples health care needs such as sore skin so individual needs are met. Items that might present a risk to people must be stored securely so that people are safe. The home must be kept clean and free from offensive smells that are unpleasant for people living in the home and their visitors. Staff must receive training so that they know how to support people who are unable to make their own decisions and have behaviour that can be difficult to manage. There should be enough staff working in the home so peoples needs are well met. Regular meetings with staff should take place so they have an opportunity to talk about improving the home for the people who live there. The manager should ensure that the home is being well managed and staff are clear about what they should be doing so people live in a well run home. Random inspection report Care homes for older people Name: Address: Swan House Care Home Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ two star good service 03/04/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Donna Ahern Date: 1 4 0 6 2 0 1 0 Information about the care home Name of care home: Address: Swan House Care Home Swan House Care Home Pooles Lane Willenhall West Midlands WV12 5HJ 01922407040 01922407010 swanhouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Maxine Ann Cleobury Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ashbourne (Eton) Limited care home 45 Number of places (if applicable): Under 65 Over 65 0 45 dementia old age, not falling within any other category Conditions of registration: 9 0 The maximum number of service users to be accommodated is 45. The registered person may provide the following category of service only: Care Home with Nursing (Code N); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 9, Old age, not falling within any other category (OP) 45 Date of last inspection 2 4 0 9 2 0 0 9 Care Homes for Older People Page 2 of 10 Brief description of the care home Swan House Care Home is a purpose built two-storey property, which is divided into three units for the purpose of providing care. The home accommodates up to forty-five people with dementia, social care and/or nursing care needs. All bedrooms have an en-suite toilet and wash hand basin.There is a lounge/dining room on each of the units enabling people to socialise, and take their meals together if they wish. A passenger lift provides access between floors, enabling people access to all areas of the home. Communal toilets and assisted bathing facilities are located throughout the premises, so they are easily accessible to peoples bedrooms. The home provides all support services including in-house laundry, catering and housekeeping. The home is situated on a local bus route, adjacent to local shops. As this report does not include any information in relation to fees, the reader is advised to contact the service direct for this information. Care Homes for Older People Page 3 of 10 What we found: The focus of this inspection undertaken by the care quality commission (CQC) is upon outcomes for people who live in the home and their views of the service provided.This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. The last Key inspection of this service was completed on 3rd April 2009. The random inspection was undertaken by one inspector over six and a half hours. There were 42 people living at the home. The home did not know we would be visiting.The reason for the visit was to review information we had received as a complaint. Because the complaint was made about the dementia care and residential unit we visited this part of the home only. During the visit we looked at peoples care records, medication management, staff training records, some health and safety records and we looked around parts of the home. We spoke to five people who live in the home, six staff and five relatives. We spoke to one relative on the telephone after our visit. We became so concerned during our visit that we spoke to one of the organisations senior managers. They arranged for the manager who was not on duty and a quality manager to come in to meet with us. We discussed our concerns and we made three immediate requirements. These were regarding procedures for infection control and the mal odour in the home, safeguarding people from risks due to hazardous items being left unsecured and the care of one of the people who had sore skin and had health needs that the home couldnt evidence that they were meeting. The home had to take immediate action to put these things right. We returned to the home three days later and all three immediate requirements had been met. These are our findings: Concerns had been raised in the complaint to us about poor infection control, odour throughout the home, laundry and personal items going missing, people not getting the care they need, wounds not being dressed and no dignity with the care given by staff. We walked around the home and there was a mal odour upon entering the home. There was also a mal odour in several peoples bedrooms that we visited. In one persons room that we went into there was lumps of feaces on the carpet. The sluice room was unlocked and there were soiled pads in a yellow bag on the floor. We were told by staff that the clinical waste bin was broken and that was probably why the bag was on the floor. We asked how long it had been broken and staff told us it had been broken for a few weeks. There was a bed pan with feaces in. The sluice machine was blocked by a chair and boxes. There was a pair of pants on the floor and aprons and other items thrown around the room including empty boxes. People were at risk from poor infection control practice. We looked in the second sluice room which was in satisfactory condition. However the door was not locked. Staff told us they use a two pence piece to lock and open the door which they leave on a ledge but staff thought this was a risk to people as they may swallow it so the door was left unlocked. Care Homes for Older People Page 4 of 10 We looked in bathrooms and the hairdressing room. We saw items such as hair spray, soap dispenser refills, shampoo and conditioner they are all items that could present a safety risk to people with dementia as they could be swallowed accidentally. We looked at three peoples care plans. Care plans are records that tell staff what people can do independently. They also say when staff need to support people to meet their individual needs. Care plans had not always been put in place for specific health care needs such as sore skin and injuries. Turn charts to monitor people who require turning were not in place. Fluid charts for a person at risk of dehydration were not always completed as required. Some days fluid intake entries were recorded up until the afternoon and some days there were no entries made. We were so concerned about the risk that peoples health care needs were not being met we made an immediate requirement. This meant the home had to take immediate action to put these things right so peoples health and well being needs are met. Care plan evaluations are completed each month. However these did not fully reflect what had happened in the month. One of the people had four falls in April and three in May. When their care plan was evaluated there was no reference to these falls which may mean action taken to prevent further risks to people are not taken. It wasnt always clear from talking to staff and reading records when the district nurses would visit people. We shared this with the manager. She told us she would be meeting with the district nurses to try and improve communication and care planning so peoples needs are well met. We had received notification from the home about incidents where people had been injured by other people living there. The manager told us that safeguarding alerts had been made. Care plan evaluations did not include incidents where people had been injured by another person living in the home. There were no risk assessments in place for people with difficult to manage behaviour. This may mean that action taken to prevent risk to people living there are not taken. We looked briefly at the medication arrangements. The temperature in the room used to store medication was above the recommended temperature which could effect the medication being stored. Handwritten medication record sheets had not been witnessed and signed by a second staff member which could lead to errors being made. We saw some incidents where the code had not been entered when people had refused medication. We asked staff about the frequency of staff meetings we were told these dont happen and we havent had a meeting for a long time. The manager told us the last meeting was six months ago in January and the minutes of these had not been typed up so were not available for us to read. Staff told us that there has been an increase in the number of people with dementia living at the residential part of the home. They also said that there has been an increase in peoples care needs and more people now requiring help to move around. The rota indicated that there is usually three care staff and a senior on duty. Staff told us that they do not feel there is enough staff on duty at times to meet peoples needs. Relatives that we spoke to said they have to go looking for staff and at times there does not seem Care Homes for Older People Page 5 of 10 enough staff on duty to care for their relative. We saw that staff were busy during our visit and from meeting and observing people we could see that a number of people required two staff to assist with personal care and to help move around the home. Not all staff have completed dementia training or training in supporting people with behaviour that may be challenging. This may mean they do not have the skills and knowledge to meet peoples individual needs. When we spoke to relatives they were generally not satisfied with the care their relative was receiving. They did say that some staff were very good but if they were not on duty then things slip. Relatives were not happy with personal care and general hygiene standards in the home. They did not always feel able to talk to the manager about these things. This visit raises concerns about the management oversight of the dementia/ residential unit and the well being of the people living there. What the care home does well: 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 set out on page 2. Care Homes for Older People Page 6 of 10 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 7 of 10 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 1 8 12 Peoples health care needs must be identified and planned for. So their needs are met 14/06/2010 2 26 16 Arrangements must be in place to manage infection control. So the home is clean, pleasant and hygienic for people to live in. 14/06/2010 3 38 13 Arrangements must be in place to reduce risks to people. So the health , safety and welfare of people is promoted and protected. 14/06/2010 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 1 7 12 Care plans must include 21/08/2010 details of how peoples individual needs will be met. So that peoples needs are met in full. 2 13 38 Risk assessments should be 21/07/2010 in place and implemented for safe working practices. Care Homes for Older People Page 8 of 10 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 So any risks to people are identified and acted upon so people are safe. 3 30 18 Staff must receive the training they need to meet peoples needs. So they know how to support people with dementia and behaviour that may be challenging. 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 21/08/2010 1 2 7 9 The review of peoples care plans should include their changing needs . So peoples individual needs are met. When medication administration record sheets are hand written these should be witnessed and signed by a second staff member to ensure accuracy. The manager should review the staffing levels on the residential/ dementia unit to ensure peoples needs are met by the right numbers and skill mix of people. The manager should ensure that a clear sense of direction and leadership is communicated to staff and people living in the home so people benefit from a well run home. 3 27 4 32 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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