Care Home: Swansea Terrace Nursing Home

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What the care home does well People that use services live in a welcoming and comfortable homelike care home, which has been maintained and has a choice of quieter areas in which to sit as well as dining space so have more choice where they spend their day and free time. There is a stable staff group who have positive attitudes to the people that live there so staff generally treat people with dignity and respect. Appropriate staffing levels are provided so people that use services were supported around their needs. The personal care and health needs of people that use services are usually met to a good standard so they are supported to maintain their personal appearance and hygiene. A varied menu is available so people that use services can choose different meals. What the care home could do better: An application to register as the manager must be made to the Care Quality Commission so that we and the people that live and work at Swansea Terrace will be confident the home is run in their best interest. The home must improve how it gathers important information about the needs of people that use services before they move into the home so staff have important information and plan how to meet their different needs. Care or support plans and risk assessments must be improved where it is recognised that people have eating and swallowing difficulties and there are known risks to their health as a result so professional advice and guidance is used to provide staff with training and guidance on how to assist people to eat safely and reduce the risk of them choking. Reviews of care must be thorough and demonstrate that the needs of people are continuously monitored by staff to see if the care or support they require is appropriately planned so their care needs are met. Appropriate training must be sought and provided for staff on assisting people with eating and swallowing difficulties to eat a meal safely so there is an effective system in place of gathering information about the needs of people with eating and swallowing difficulties providing guidance, training and ongoing supervision for staff so people are not placed at risk by poor records keeping and inconsistent procedures and practise. The recruitment of staff must be improved so people that use services are protected from harm and by thorough employment procedures. Quality assurance must improve so mistakes made in recruitment of staff, poor guidance and training around assisting people to eat and insufficient gathering of information about people before they move into the home are not repeated so the home is managed more effectively and the welfare of people living there is promoted. Random inspection report Care homes for older people Name: Address: Swansea Terrace Nursing Home 108-114 Watery Lane Ashton Preston PR2 1AT two star good service 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: Anthony Cliffe Date: 1 0 0 3 2 0 1 0 Information about the care home Name of care home: Address: Swansea Terrace Nursing Home 108-114 Watery Lane Ashton Preston PR2 1AT 01772736689 Telephone number: Fax number: Email address: Provider web address: sobhimathew@yahoo.com Name of registered provider(s): Name of registered manager (if applicable) Swansea Terrace Care Home Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 44 Number of places (if applicable): Under 65 Over 65 44 0 old age, not falling within any other category physical disability Conditions of registration: 0 5 The registered person may provide the following category of service only - Care home with Nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Physical Disability - Code PD (maximum number of places: 5). The maximum number of people who can be accommodated is: 44. Date of last inspection 2 6 1 1 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Swansea Terrace is situated in the docklands area of Preston and it is close to shops, cinema and restaurants. The home provides nursing care to older people. The home comprises of 42 single bedrooms and 1 double bedroom. Bedrooms are situated on the ground and first floor, with access being available by a passenger lift. There are lounge and dining areas on the ground floor. Information about the range of fees for accomodation and nursing care can be obtained by contacting the manager directly. Care Homes for Older People Page 3 of 13 What we found: We looked at the information gathered by staff from Swansea Terrace about the needs of two people who had recently chose to live there who needed help with personal care and could see that since the last visit we did in December 2009 there had not been improvements so important information on which to plan care and support was not gathered. We saw that some information had been gathered about their social interests, medical information on their physical and mental health, how they communicated with people, maintaining their safety, help with personal care and some information about their life and the circumstances of why they needed to live in a care home so staff had limited information about the people they cared for and supported. Before the visit Her Majestys Coroner raised concerns following the death of a person at Swansea Terrace. We were requested to look at how the needs of people who had difficulty with eating and swallowing food and fluids were being met. We looked at the records of three people who were known to have eating and swallowing difficulties. We saw that staff recognised that people had problems eating and swallowing food and had requested professional advice as there were risks of them loosing weight or choking. Professionals such as dietitians or speech and language therapists had visited the people at Swansea Terrace and given advice and written guidance to staff on how to support people with eating where there was a risk of them choking. Speech and language therapists and dietitians provided guidance on improving peoples diets by providing additional food supplements and thickening agents in drinks or pureed or soft diets were people had difficulty eating and swallowing. We saw that staff recognised there were ongoing problems with people being at risk of choking but the advice and guidance from speech and language therapists was not included in care or support plans so staff did not have the guidance they needed to reduce the risk of people choking and would not see the risk of choking as a continuous risk. There were no risk assessments in place to help staff reduce the risk of people choking so people who were at risk of choking were not being protected. We spoke to staff about the training they had on assisting people to eat and to see what they knew and understood about the people they provided care and support for who had difficulty with eating and swallowing. We found that staffs knowledge about people was inconsistent. Staff said that people could help themselves to eat or needed to be assisted by staff at all times. Staff did not have any training about how to assist people to eat. Training and supervision for staff on assisting people to eat and drink was inconsistent and dependent upon the responsibility being delegated to a registered nurse or senior carers to train and supervise staff when they had not received appropriate recognised training so staff would assist people to eat based on their individual knowledge of people and practise they had developed so their practise was not based on professional guidance or training. We saw that information gathered about the needs of people that use services was transferred in to care or support plans so staff had information to provide support and care. We could see some examples that the home uses a person centred approach to care but do not use person centred thinking and planning to provide care and support to people living at the home so their care is not always based around their needs and choices. Person centred planning is a really good way for people that use services to take Care Homes for Older People Page 4 of 13 control of their lives. Person centred thinking helps staff that care and support people that use services to listen to them and then to get what they want. A person centred plan contains information on what is positive about people that use services for example what people like and admire about them and their gifts and talents. Information should be included about what and who is important to people that use services from their viewpoint, as well as what people want for their future. A person centred plan should have information about how people that use services want to be supported, so stay healthy, safe and well. This is called a support plan but may be called a care plan. This should be detailed enough to provide a living description of how people that use services want to be supported, how they make decisions and says who will do what by when. The care or support plans we saw were not individual to people using the service and included limited information about their personal routines and choices about personal care or if they could help themselves. The care plans we saw said where people needed care and support but did not tell us how people wanted their care to be arranged and how staff would provide support or care to help them to care for themselves or if care was arranged or planned around their daily routines. So care based on their personal preferences was not always provided. We saw information in care and support plans that guided staff to offer people assistance with help but did not include information about their food preferences other than telling staff they needed a pureed diet. Care or support plans were usually a set of instructions for staff to follow so did not guide staff on providing individual care. Reviews of care were poor and did not tell people living at the home if the care or support they needed was appropriate or being planned based on the changing needs of people as care or support plans recorded no change, continue as planned, reviewed and no change so people did not know if their care or support plans were working or not working for them. We saw that staff treated people that use services with courtesy, dignity and respect and sought their views about how they wanted to be supported by asking them questions and saw staff help them make decisions. We did not see care plans refer to how people made decisions about their daily routines and choices or how people that use services made decisions for themselves. If people that use services did not make decisions due to them having memory problems or they lacked capacity, experience or judgement to make them. we could not could not confirm why, when, where and how staff supported them to make decisions so were unsure what decisions they made for them or supported them to make. At the time of the visit the home had employed an activities coordinator so there was someone to plan and encourage people to do activities. We saw staff sitting and talking with people that use services. We saw that the communal areas of the home usually had a staff member sat in them so people living at the home had contact with staff. We saw people living at the home sleeping at times so were not engaged in doing anything. We did not see the activities coordinator on duty so did not see activities taking place. We looked at the bathing facilities available as at the last visit we made a requirement which is something the provider must do to put something wright where we have identified a risk to people or lack of sufficient facilities or services. At the last visit there was only one domestic bath available for people to use on the ground floor as well as a shower on the first floor. A bath designed for use by people who need a lot of assistance with bathing due to their physical or medical needs had been replaced as required so people who needed the specialist bath had access to this facility. Care Homes for Older People Page 5 of 13 The homes staff induction programme was seen to be a tick list and not based on Skills for Care induction standards which are nationally recognised standards for people who work in social care so care staff did not sufficient training to understand their roles and responsibilities. We examined the recruitment records of three staff employed at the home. Recruitment procedures had improved since the last visit and included staff having to complete an application form, employment history and two references sought about their suitability for employment. The recruitment of staff also included a Criminal Records Bureau (CRB) disclosure which is a check of staff to see they are suitable people to provide personal care and support to vulnerable adults. We saw that one person had been employed with only one reference on their file and the manager immediately acted to prevent the person commencing employment until the second reference was received. We saw the records of the deputy manager who had been employed before the manager had been recruited and commenced employment. The deputys employment had been completed by the provider. We saw that a reference from a previous employer had been sought but the reference was not from someone who was in a senior position to provide a reference for the deputy manager. The deputy manager said she had fallen out with her previous employer so the home had accepted a reference for some one who she had worked with but who had been in a junior position to her so an employers reference had not been sought which would provide information on the competence and experience of the deputy manager. Staff were provided with training which included moving and handling, dementia care, managing challenging behaviour, safeguarding adults, food hygiene and health and safety as some examples. Only four out of twenty eight staff had training in nutrition and we were unclear if this included staff having training on assisting people to eat. We spoke with staff responsible for assisting people with personal care including assistance to eat and two of the four staff we spoke with said they had not received training or guidance on assisting people to eat. At the time of the visit a new manager was in post who was experienced in managing a care home with nursing having previously been registered with us. The manager had only been in post for a few weeks and had not yet applied for registration as manager with the Care Quality Commission. The manager was honest about the lack of training, guidance care and support planning and risk assessment and management for staff around caring for people with eating and swallowing difficulties so was aware of areas for improvement The manager had been given an action plan by the provider with a large number of actions that needed to be completed so had a lot of work to complete. The manager was very busy with the deputy in introducing new policies and procedures, a new care plan system and organising the administrative systems in the home. There was no administrator at the home as the provider did not see the manager needed one so the manager was doing additional administrative duties such as sending out applications forms for staff and dealing with the administrative employment process, visiting people who wanted to live at the home, recruitment of staff and dealing with the changes introduced by the provider as well as long standing staff problems in the home so was unable to prioritise what needed to be addressed first. In January 2010 we received an action plan from the provider saying that the requirements we identified during our last visit had been actioned so they were completed. During this visit we saw that a number of requirements were still outstanding Care Homes for Older People Page 6 of 13 so the provider is not working with us as we expect them to do. What the care home does well: What they could do better: An application to register as the manager must be made to the Care Quality Commission so that we and the people that live and work at Swansea Terrace will be confident the home is run in their best interest. The home must improve how it gathers important information about the needs of people that use services before they move into the home so staff have important information and plan how to meet their different needs. Care or support plans and risk assessments must be improved where it is recognised that people have eating and swallowing difficulties and there are known risks to their health as a result so professional advice and guidance is used to provide staff with training and guidance on how to assist people to eat safely and reduce the risk of them choking. Reviews of care must be thorough and demonstrate that the needs of people are continuously monitored by staff to see if the care or support they require is appropriately planned so their care needs are met. Appropriate training must be sought and provided for staff on assisting people with eating and swallowing difficulties to eat a meal safely so there is an effective system in place of gathering information about the needs of people with eating and swallowing difficulties providing guidance, training and ongoing supervision for staff so people are not placed at risk by poor records keeping and inconsistent procedures and practise. The recruitment of staff must be improved so people that use services are protected from harm and by thorough employment procedures. Quality assurance must improve so mistakes made in recruitment of staff, poor guidance and training around assisting people to eat and insufficient gathering of information about people before they move into the home are not repeated so the home is managed more effectively and the welfare of people living there is promoted. Care Homes for Older People Page 7 of 13 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 8 of 13 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 3 14 The home must improve how 01/02/2010 it gathers important information about the needs of people that use services before they move into the home. So staff have important information and plan how to meet their different needs. 2 29 19 The recruitment of staff must 01/01/2010 be improved. So people that use services are protected from harm. 3 31 8 An application to register as the manager must be made to the Care Quality Commission So that we and the people that live and work at Swansea Terrace will be confident the home is run in their best interest. 01/02/2010 Care Homes for Older People Page 9 of 13 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, 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 3 14 The home must improve how 01/05/2010 it gathers important information about the needs of people that use services before they move into the home. So staff have important information and plan how to meet their different needs. 2 8 18 Appropriate training must be 01/05/2010 sought and provided for staff on assisting people with eating and swallowing difficulties to eat a meal safely. So there is an effective system in place of gathering information about the needs of people with eating and swallowing difficulties providing guidance, training and ongoing supervision for staff so people are not placed at risk by poor records keeping and inconsistent procedures and practise. 3 8 14 Reviews of care must be 01/05/2010 Page 10 of 13 Care Homes for Older People 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 thorough and demonstrate that the needs of people are continuously monitored by staff to see if the care or support they require is appropriately planned So their care needs are met. 4 8 14 Care or support plans and risk assessments must be improved where it is recognised that people have eating and swallowing difficulties and there are known risks to their health as a result. So professional advice and guidance is used to provide staff with training and guidance on how to assist people to eat safely and reduce the risk of them choking. 5 29 18 The recruitment of staff must 01/05/2010 be improved. So people that use services are protected from harm and by thorough employment procedures. 6 31 8 An application to register as the manager must be made to the Care Quality Commission. So that we and the people that live and work at Swansea Terrace will be confident the home is run in their best interest. Care Homes for Older People Page 11 of 13 01/05/2010 01/06/2010 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 7 33 24 Quality assurance must improve. So mistakes made in recruitment of staff, poor guidance and training around assisting people to eat and insufficient gathering of information about people before they move into the home are not repeated so the home is managed more effectively and the welfare of people living there is promoted. 01/05/2010 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 12 of 13 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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