Care Home: Swarthdale Nursing Home

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What the care home does well People we spoke to during the visit spoke well of the staff and manager and the support they received. Overall the home provides a relaxed and homely environment for people living there and we saw that many staff had a good rapport with people, supported them as they wanted and knew their needs and preferences. One person living there told us, " On the whole its very good here and the staff do all they can. The laundry is very good and I am well satisfied with my care". The home is kept clean and tidy by the domestic and care staff and people are encouraged to personalise their rooms to make them homely. The home has a plan of routine maintenance and refurbishment, and this can be seen in the redecorated areas of the home. There are some areas in need of upgrading and repair and these have been identified for planned work by the manager and providers. People living there told us they found the home to be clean and liked the redecoration work done in their bedrooms. Efforts are made to make sure that there is a choice of nutritious meals for people that meet their needs and preferences and the chef asks people for their views on the food provided. People living there told us there were activities to take part in if they wanted to although some may "prefer to stay in my room". The manager and staff work well with other health care agencies and have, when needed, acted quickly to get the specialist support and advice people may need. This includes local doctors and district nurses as well as specialist support from specialist nurses and teams. The service tries to make sure people living there are included in the way the home is run and welcomes their comments. There are effective quality monitoring systems so the manager can measure the service`s performance and identify areas of the service provision they need to improve or change. People living there and care staff were positive about the way the service was being run and the changes that were being made to improve the service for people living there. The management team have a clear vision of improvement and continuous development for the service. The home has a robust recruitment process and this helps make sure that the right staff are being recruited to work with the people living there. What has improved since the last inspection? Since the last key inspection at Swarthdale the improvements made to systems found at that previous visit have been maintained. Medication systems have been improved and are being carefully monitored to maintain safe standards. We found from our checks of the records and current stock that medicines were being given to people properly and accurate records were being made. This was a significant improvement from our last visit and had been achieved by regular audits (checks) by the managers and by staff being made aware of their mistakes to help prevent them happening again. Medication times have been reviewed and there is no evidence that anyone misses night time medication because they are asleep. Improvements have continued to be made in the provision of training to staff includingend of life care, dementia training and safeguarding vulnerable adults. Although there has been a high level of staff turnover the recruitment procedures are robust and consistently applied to make sure there is an effective and motivated staff team. Forward business planning and the identification of areas where improvements and change may be needed has continued to be developed and be effective in improving the quality of life for people living there. More attention is being given to providing more recreational opportunities for people with dementia. Staffing is also being reviewed with a view to continuous improvement and staff recruited for 1 to 1 support through continuing care funding. We found that the manager continues to develop person centered approaches to care with detailed personal profiles now in place with information on people`s social needs, interests and abilities and that generally people are being encouraged to influence how they want to be cared for. The way the home gets feedback from people using the service has been improved and the satisfaction surveys are being refined to gather more useful information for forward planning. What the care home could do better: Overall the manager and staff have worked hard to greatly improve the service for the people living there and are clear about their objectives. Many areas of practice and systems needing improvement have been identified by the manager using the home`s own quality monitoring systems so these are in the process of being addressed. We have made some good practice recommendations, although we found no obvious areas that needed immediate improvement relating to the safety of people or issues of poor management. Where areas of weakness do emerge or are identified by quality monitoring the manager has demonstrated that she can manage them effectively and make changes where required. We made good practice recommendations that all plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Medicines should also always be given to people at the right time and dose to help make sure their health and wellbeing is maintained and records should make clear the correct time to give medicines in relation to food intake. Reviews are being carried out on staffing to ensure busier periods are covered effectively and we recommend that when recruiting new nursing staff the management team consider the need to have nurses with additional training, skills and experince in dementia care nursing to meet people`s mental health needs and to provide a resource and specialised support for staff. Training within the home is well monitored and reviewed and we recommended to further promote the welfare of the people living at Swarthdale that the manager should include basic food hygiene training on the staff training plan. This way all staff who serve or handle the meals that people eat will have this training routinely. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ     The quality rating for this care home is:   three star excellent service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Marian Whittam     Date: 0 6 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Swarthdale Nursing Home Rake Lane Ulverston Cumbria LA12 9NQ 01229580149 01229581333 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Vishomil Limited care home 43 Number of places (if applicable): Under 65 Over 65 0 43 dementia old age, not falling within any other category Additional conditions: 10 0 The registered person may provide the following category/ies of service only: Care home with nursing- Code N to people 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 Dementia - Code DE (maximum places: 10) The maximum number of people who can be accommodated is: 43 Date of last inspection Brief description of the care home Swarthdale Nursing Home is a large Victorian house that has been adapted and extended for its current use and provides accommodation and care for up to 43 people, up to 10 of whom may have dementia. The home is in a quiet residential area on the outskirts of the market town of Ulverston and approximately a mile from the town centre with all the usual amenities. The home is on a bus route and the station is less than a mile away. There are shops, a post office and a public house on the nearby residential housing estate. The home is on two floors and there are two passenger lifts for residents. Care Homes for Older People Page 4 of 32 Brief description of the care home There is a small private garden to the rear of the building with seating. At the front of the building there is a car park, garden areas and seating. There are two main communal areas on the ground floor, a lounge with a conservatory attached and a large dining room. Information is available to current and prospective residents in the Statement of Purpose and the service users guide and from the recently introduced newsletter. These and the latest inspection report are available within the home. The fees charged by the home range from 398 pounds aweek to 469 pounds per week for residential care and between 514 pounds per week to 588 pounds per week for nursing care as at the date of the inspection. An additional charge is made for personal toiletries, newspapers, magazines, also hairdressing and private dental services, private chiropody and any personal travel such as taxis. Care Homes for Older People Page 5 of 32 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection peterchart Environment Staffing Management and administration Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that the people who use this service experience excellent quality outcomes. This site visit to Swarthdale nursing home forms part of a key inspection. It took place on 06.05.09 and we (CQC, The Care Quality Commission) were in the home for seven and a half hours. Information about the service was gathered in different ways: 1. We sent an Annual Quality Assurance Assessment (AQAA) form to the home and this was completed by the registered manager Mrs Caroline Suttle and returned by the date requested. The AQAA is a self assessment and a dataset that is completed annually by all providers of registered services. It is one of the ways we gather information from Care Homes for Older People Page 6 of 32 the providers of services about their service and how they believe they are meeting outcomes for the people living there and using their service. The AQAA also gives us statistical information about the individual service and trends and patterns in social care. 2.We sent out surveys to people living at Swarthdale and to the staff who work there. We also sent out surveys to health and social care professionals who come into contact with the people living and working at Swarthdale. 3. We looked at all the information we have about the service, any changes that have been made and how the manager has dealt with any complaints or safeguarding of vulnerable adults. We looked at what the manager has told us about things that happened in the service, these are called notifications and are a legal requirement. We looked at the previous key inspection and any calls or visits we have made to the home since their last inspection. 4. We spent time talking to people who live there throughout the day, and spent time with them at mealtimes to see what happens during their day and see what they think about the way the home is run for them. We also spent time talking with staff who work there on the night and day shift to get their experiences of working there. 5. We looked at any relevant information we had received from other agencies and organisations and any written comments people have made to us. During the day we spent time talking with people living at Swarthdale, in the lounge and also in private to get their views and opinions about living there. We looked at care planning documents and assessments to make sure that people received the level of care they needed and expected. We made a tour of the premises to look at the environment people lived in and what facilities were available to them. We also looked at staff training and recruitment files and a sample of records and safety assessments required by regulation. The Pharmacist inspector also visited the service as part of this key inspection and assessed the handling of medicines through the inspection of relevant documents, storage, and meeting with the deputy manager and staff. What the care home does well: What has improved since the last inspection? Since the last key inspection at Swarthdale the improvements made to systems found at that previous visit have been maintained. Medication systems have been improved and are being carefully monitored to maintain safe standards. We found from our checks of the records and current stock that medicines were being given to people properly and accurate records were being made. This was a significant improvement from our last visit and had been achieved by regular audits (checks) by the managers and by staff being made aware of their mistakes to help prevent them happening again. Medication times have been reviewed and there is no evidence that anyone misses night time medication because they are asleep. Improvements have continued to be made in the provision of training to staff including Care Homes for Older People Page 8 of 32 end of life care, dementia training and safeguarding vulnerable adults. Although there has been a high level of staff turnover the recruitment procedures are robust and consistently applied to make sure there is an effective and motivated staff team. Forward business planning and the identification of areas where improvements and change may be needed has continued to be developed and be effective in improving the quality of life for people living there. More attention is being given to providing more recreational opportunities for people with dementia. Staffing is also being reviewed with a view to continuous improvement and staff recruited for 1 to 1 support through continuing care funding. We found that the manager continues to develop person centered approaches to care with detailed personal profiles now in place with information on peoples social needs, interests and abilities and that generally people are being encouraged to influence how they want to be cared for. The way the home gets feedback from people using the service has been improved and the satisfaction surveys are being refined to gather more useful information for forward planning. 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 4. Care Homes for Older People Page 9 of 32 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 10 of 32 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 11 of 32 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. Peoples needs are assessed before they come to live in the home to make sure that their identified needs can be met and information is made available to help them in making their decision. Evidence: The Statement of Purpose and service users guide are available at reception in the foyer of the home. These are both subject to review to provide up to date information and only the information on fees needed to be updated following a change in April. The relevant information, including how to make a complaint, was clearly presented and both documents can be provided in large print if requested. We spoke to the deputy manager and people living there about provision of the guide to people on admission and not all people living there are given a guide for reference and information when they come to live there. Inspection reports are also available on request if people wish to see these. Care Homes for Older People Page 12 of 32 Evidence: The notice boards in the home also give information about what is going on in the home and organised activities for people to take part in if they wish to. The manager and staff also produce a newsletter periodically to keep people living there and their families up to date with what has been going on in the home and any changes being planned. The registered manager or a member of the nursing staff undertake pre admission assessments with prospective residents in addition to any care management assessments done by social or health services. We looked in detail at the pre admission assessments for five people living there including the latest person to come to live there. One person had been admitted as an emergency and a copy of the care management assessment from the social worker had been obtained so the manager could assess if the service was able meet that persons individual needs. The pre admission assessments we looked at contained the relevant information and details from which to begin developing a care plan with the person and made clear the persons individual needs and the level of care and support they required. Where appropriate other health and social care professionals had been involved in providing admission information such as previous care settings, hospital discharge information and mental health services. It is the homes stated policy to encourage people thinking of coming to live there to visit the home, have a meal if they wish and speak to staff and other people living there. A member of staff can be made available to show people and/or their families around the home and answer any questions people may have. Following admission there is a trial period for people to decide if the home suits them and a review is undertaken to make sure the home is meeting their needs and expectations. The service does not provide intermediate care Care Homes for Older People Page 13 of 32 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. The personal and healthcare needs of the people living at Swarthdale are well managed so that they receive the care and support that they need in a way that respects their privacy and dignity. Evidence: Everyone living at Swarthdale has an individual plan of care in place that is clearly set out and easy to follow. We looked at five peoples personal care plans in detail and these stated their individual health, social and personal care needs including specialist health and nursing needs in a way that reflected their individuality, preferences and expectations. Staff had worked with people to help develop their personal profiles and histories and record what was significant to the individual in their life and for their care. The care plans were based on initial and ongoing assessments of individual need and risk, including the risk of falls, pressure areas, skin condition, continence and nutritional needs. We found the wound care plans to be detailed and clearly planned to monitor and evaluate progress. Specialist nurses were being involved in the management of wounds and we spoke with the Tissue Viability Nurse who was visiting Care Homes for Older People Page 14 of 32 Evidence: to support and advise nursing staff on the management of some peoples wounds. The feedback from the specialist nurse about the wound management in the home was positive. Individual records did indicate that people living there had good access to other health care services, such as the dietitian, speech and language therapists and specialist nurses. The manager and deputy had been carrying our care plan audits to make sure peoples care plans were up to date and are regularly reviewed working documents. The home has general policies and procedures in place for care and support at the end of life and is presently working towards the implementation of recognised palliative care pathways. Some training has been undertaken by staff and training and support has been obtained from the MacMillan, specialist palliative care nurse as well as through outside training bodies. As part of the inspection a pharmacist inspector checked how medicines were being handled. We found medicines stock and records to be generally well organised and securely stored. Our checks of the records and current stock showed that medicines were being given to people properly and accurate records were being made. This was a significant improvement from our last visit and had been achieved by regular audits (checks) by the managers and by staff being made aware of their mistakes to help prevent them happening again. A clear system of stock control was in place that helped make sure medicines did not run out of stock and made sure they could be fully accounted for. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. However, one person had a strong pain relief patch replaced a day late on four occasions which could have resulted in this person suffering pain unnecessarily. We also looked at the times medicines were given and found the records did not always state the correct time to take them in relation to food intake. We found one example where a medicine that should be given before food was being given after breakfast. Medicines should be given to people at the right time and dose to help make sure their health and wellbeing is maintained. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We found some good information about some medicines that helped make sure they were handled correctly and made sure required tests and GP visits were carried out. However, we found little information about how epileptic seizures were to be managed for two people and how someone elses painkillers were to be given. One person that lacked capacity to give consent to have their medicines did not Care Homes for Older People Page 15 of 32 Evidence: have up to date paperwork so we gave some advice to the deputy manager about this. We also gave some advice about how to develop some paperwork for when required medicines because having clear written care plans helps make sure people get their medicines when they need them. Care Homes for Older People Page 16 of 32 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 living at Swarthdale have a choice of nutritious meals and have the opportunity to take part in social activities and recreation that meets their expectations and abilities. Evidence: Improvements have continued to be made in the provision of organised activities within the home and on obtaining peoples views and opinions on what activities they would like the opportunity to take part in. We saw some completed activity questionnaires that the activity co-coordinator was doing with people to get their ideas on what they wanted. This should help with planning activities that have value and meaning for them, including what music, crafts and concerts people would like and had enjoyed taking part in. A more individualised approach to recreation was evident than at the last visit and the focus was upon finding out what people wanted and liked and supporting them to participate where they wanted to. There was clear information in peoples individual plans about their interests and what held meaning for them in thir daily lives. The notice board in the main corridor has information on forthcoming planned Care Homes for Older People Page 17 of 32 Evidence: activities in the home and information on hairdressing and chiropody. The home also has a newsletter to help keep people up to date with what is going on and changes. There was a a book of photographs of the activities and events people had attended kept on the hall table for people to look at along with a file of messages from families and cards of thanks. The activity coordinator is in the home three afternoons a week for group and one to one activities. The activities records and peoples comments indicated that bingo, sing a longs, nail care, massage, music, quizzes and dominoes were popular pastimes. Also once a month there are armchair exercises and musical entertainers, every three months there are singers, and twice a year a music theatre and magic show. People living there we spoke to told us that they liked the activities lady and enjoy the music and singing. People told us they got up at their leisure and we observed that this was the case when we arrived at the home that morning. When we arrived at 7 am only 3 people were getting up. One person told us they were the advance party, one of the 7 oclockers and that breakfast was served until 10am. Some people we spoke to had chosen to stay in their rooms for breakfast and we saw staff bringing fresh porridge and toast to people who wanted to stay in bed longer. We spent time talking with and observing people at lunch time in the dining room and in their own rooms. Menu choices were explained and people got what they asked for. Staff helped people cut food as needed and helped people who needed additional support with their meals in a patient and sensitive way and encouraging people with different food if they were reluctant to eat. The chef came out of the kitchen to chat with people and see if all everything was alright and chatted to some gentlemen about the previous evenings football match. It was a relaxed and sociable occasion. We saw that people taking their meals in their bedrooms were assisted where necessary and were sat up and comfortable. People we spoke to said they enjoyed their food and said the meals were usually very good and that thy had a choice of meals. The days menu was on the board outside the dining room. There are facilities for residents to have a meal with their family if they want to. During the visit we saw a visitor having lunch with their family member at the table in the lounge. This was quiet and private as everyone else was in the dining room. We visited the kitchen and we looked at the menus and records of food served and the cleaning records and spoke with the chef. The kitchen was clean and tidy and there were records of the food served and the cleaning regimes. The home uses local suppliers and has weekly deliveries for which invoices were available. The chef does the baking for the teas and was making flapjack for the afternoon tea. Care Homes for Older People Page 18 of 32 Care Homes for Older People Page 19 of 32 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. There are good procedures in place at Swarthdale so the people who live there are able to express their concerns and be listened to and be protected from abuse. Evidence: Swarthdale has a clear and accessible complaints procedure that is displayed in the home and in the statement of purpose and guide for people living there. The manager has logged three complaints in the last year and the records kept indicated that these had been fully investigated by the manager or provider with all correspondence and statements kept securely. The improvements in complaint handling and monitoring found at the last inspection have been maintained. The management approach to complaints is now clearly more focused upon learning from concerns raised and action planning to reduce the risk of them happening again. The people we spoke to were aware of the complaints procedure and said they would talk to the manager or nurses if they were unhappy. Survey responses we received from local doctors indicated that they were satisfied with the way the service had responded to any concerns they had raised and that the manager always responded appropriately to matters they raised. There are clear policies and procedures in use on safeguarding vulnerable adults and information on how to respond to any suspicion or evidence of abuse and neglect. The manager has referred any safeguarding issues to the appropriate agencies to protect peoples safety and welfare and one has been investigated by social services. Staff Care Homes for Older People Page 20 of 32 Evidence: records indicate that training had been given to staff on safeguarding and identifying signs of abuse. This training is given by a senior member of staff who has completed relevant training course to do so. The staff we spoke to and who responded to our surveys confirmed they had received this training. There are also procedures in place on whistle blowing so staff could report any concerns about colleagues and poor practice. There is also a clear grievance procedure in place for staff to use if they feel they need to and policies on bullying and harassment to help protect staff in their work. There are policies in place regarding the use of any restraint and a recording system if this arises. The use of bed rails that may restrict peoples freedom is done following a risk assessment and subject to consent and review. There are keypad locks in use to areas where access by people living there could pose a risk to them, such as the laundry, sluice and medication storage room. The manager has identified the need to examine more closely the issues relating to restraint and is developing, and intends to implement, accepted principles and codes of practice on this to ensure continued good practice so individuals rights will be consistently upheld and protected. The home does provide information for people living there on advocacy arrangements should anyone wish or have need to use this service. The information is in the statement of purpose and service guide kept in the reception area. We looked at the care plan for one person who received medicines and fluids by a tube into their stomach but could not find any record in their care plan upon how their consent for this had been obtained or decided in their best interests if needed. There was no policy document evident in the procedures files on the Mental Capacity Act and how the staff were to put it into practice to ensure peoples rights are always upheld. Staff on duty confirmed they did not have a policy statement at present. We were aware this was an subject that the manager had identified for improvement and had outlined this in the Annual Quality Assurance Assessment as requiring further improvement over the next 12 months. Having identified this need from the homes own quality monitoring processes the manager and senior nursing staff had already begun to address how to fully incorporate the requirements of the Mental Capacity Act to make sure peoples rights were upheld during care. The manager and senior staff continue to develop and maintain systems that are designed to protect peoples rights and safety. When all identified improvements and systems have been fully implemented and evaluated this should provide a highly robust system to safeguard people living there. Care Homes for Older People Page 21 of 32 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. Swarthdale provides a comfortable and clean home that is being generally maintained and improved for the people who live there. Evidence: Since the last inspection the home has been continuing with its planned programme of maintenance and refurbishment to improve the environment for the people living there. Over the last twelve months more peoples bedrooms have been redecorated, refurbished and new carpets have been fitted and people we spoke to were happy with these improvements in their rooms. The main entrance hall, stairs and corridors have been decorated and have new carpets fitted giving a light and homely appearance. Improvements have been made to the office space and reception area to make better and more secure office facilities and the reception is more welcoming for people coming into the home. The home has its own maintenance person to take care of general upkeep and maintain the grounds. There is one large communal lounge with a conservatory area that was well lit and was used as two distinct seating areas to encourage group seating. The dining room can also be used by people if they want to meet with their visitors away from the lounge giving more privacy and quiet. The majority of bedrooms have en suite washing facilities including the three double bedrooms. The bedrooms we saw had been Care Homes for Older People Page 22 of 32 Evidence: personalised by the people living there bringing in their own personal possessions to give a more homely feel. There are accessible toilets on both floors close to the areas people living there use, there are bathing aids and appropriate adaptations and moving and handling equipment to assist people to be independent and safe. As we walked around the home we could see that some items of maintenance needed attending to to make sure the home was safe and homely for people. One bath was out of order, there were tiles and a bath panel missing in another bathroom and the floor in one shower room was uneven and damaged. In one bathroom the bath hoist chair wobbled when we moved it raising concerns about its safety when used. We discussed these things with the deputy manager and these matters had been noted in the premises audits and were being addressed and a new floor was to be fitted in the shower room. These areas were not being used by the people living there until the work was done. Infection control policies and procedures are in place and reflect current good practice and care and domestic staff have been given training on this. We saw staff following appropriate procedures and using protective clothing for personal care. The home was clean and tidy and people we spoke to who lived there said this was usually the case. The major improvements to the laundry are still ongoing to bring the facility into line with best practice infection control guidance. When complete it will create two distinct areas in the laundry, one clean and one dirty area to reduce the risk of passing on infections We found all the areas of the home to be clean and tidy and there are domestic staff employed to maintain good levels of hygiene and cleanliness. The night staff also do some light cleaning in communal areas to assist. Care Homes for Older People Page 23 of 32 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. The people living at Swarthdale Nursing Home are supported by trained nursing and care staff who have gone through a thorough recruitment process so peoples needs can be met as they want and their safety from possible harm or poor practice is actively promoted. Evidence: Swarthdale has a robust recruitment procedure and the recruitment of good quality carers is considered highly important by the manager and senior staff. All staff have thorough security checks done and references taken up before they begin work and they have a formal induction period and supervision and appraisal of their performance. This and training needs are recorded for any action and all staff have handbooks, job descriptions and health and safety handbooks . The manager has continued to develop, improve and deliver high quality training and recruitment and,where they emerge, has recognised and managed effectively areas that need to be improved through training and development. One staff member survey commented, My induction included supernumerary days and covered all the important aspects, i.e moving and handling, fire training, infection control and protection of vulnerable adults etc. The home has three staff who have trained as moving and handling trainers to provide this training in house and give practice support to staff. Care Homes for Older People Page 24 of 32 Evidence: The duty rotas were clear and showed who was on duty day and night and indicated that there are sufficient nursing and care staff on each shift to provide personal care and support for the people living there. Rotas show a considered skill mix of nursing and unqualified staff and staff may not alter rotas without management authorisation as changes may affect the skill mix. However at present there are no nurses with additional post registration training, skills and experience in dementia to help ensure peoples mental health needs can be met and to provide a resource and support for other staff . We recommended to the deputy that when recruiting new nursing staff they consider this to further improve nursing skill mix to meet peoples different needs. There were two registered nurses on duty during the busier morning period and a senior carer on each day shift as part of the six care staff on duty in the morning. We saw that staff were being deployed effectively over the 2 floors during the day and at meal times. Nursing staff are given dedicated time for office duties and for checking in and auditing medication so they do not have to fit this in around their nursing duties and this helps promote safety and effectiveness in practice. Staff surveys and comments indicated that there was effective communication and we saw the staff handover from night to morning staff that all staff attend. There is a 15 minute handover period for this so all staff should be aware of any changes overnight in peoples needs or conditions. There are minutes kept of regular staff meetings for the nursing and for the care and support staff meetings. The topics for discussion at the last nurses meeting centered on care practices and the audit systems in use to monitor medication, staff can raise issues at the meetings and give feedback under any other business. Staff who are unable to attend the meetings are provided with copies of the minutes so they are kept informed. Staff we spoke to on day and night duty told us it was a pleasant working environment and training is always available also that they felt they worked well as a team. The comments we received in staff surveys and from those on duty we spoke with indicated that staff morale and enthusiasm was good despite a period of high staff turnover. Staff members commented There have been enormous improvements in the service and I think we have gone from strength to strength. People living at Swarthdale we spoke to were positive about the staff and care as were the local GPs we contacted via surveys. One person living there told us, The nurses are marvelous but all the staff I have are very good and another told us Anything I need or I ask for they (staff) will get for me. There are sufficient domestic, kitchen and laundry staff to make sure that standards relating to cleanliness and hygiene and meals and nutrition are met. Domestic staff told us they had received infection control training and had the equipment they needed to do their work and we saw that this was the case. Night staff also help with laundry and light domestic tasks that cannot be done during the day. We discussed this work Care Homes for Older People Page 25 of 32 Evidence: with the deputy and advised that night staff should not compromise the care or support they give to people living there in order to do domestic tasks. The deputy manager confirmed to us that domestic tasks were done only if work load permitted and that care was the priority not cleaning. There is a clear annual training plan in place, systems to monitor that staff have received appropriate training and updates and a business plan for training provision and its cost. Staff training is well planned and well supported by the management of the home and staff are encouraged to gain additional training and skills such as end of life care, person centered care and NVQ level 3 and 4 in health and social care. Over fifty percent of care staff have an NVQ in health and social care at NVQ level 2 or above and training in this is well established and supported. Any training needed that is identified by monitoring systems as overdue is attended to as a matter of urgency to make sure all nursing and care staff have the skills and knowledge to fulfill their roles. It was evident from training and recruitment records, from speaking to staff on duty and from staff surveys that effective formal training is a key part of the homes internal development and given a high priority. Care Homes for Older People Page 26 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Swarthdale benefit from living in a well managed home that is being run in their best interests and with effective quality monitoring to help ensure policies and procedures are adhered to for their protection. Evidence: The home is being effectively managed by the registered manager, Mrs Caroline Suttle. Mrs Suttle has the appropriate qualifications and nursing experience to fulfill her role and undertakes periodic training with staff to maintain her knowledge and skills. The manager has a clear understanding of the key aims and objectives of the service and a strong focus on improving the quality of life for the people living there. The manager shows effective leadership and openness and has recruited and trained a motivated team with great emphasis being placed on continuing to improve standards of practice. Staff we spoke to and staff surveys indicated that they found the manager approachable and people living there we spoke with agreed, one said I see her most days, shes very good. Care Homes for Older People Page 27 of 32 Evidence: The management team have continued to develop the quality monitoring systems in the home and there are policies and procedures in place which the manager reviews in line with changes in legislation and best practice. The quality monitoring and staff supervision help ensure that staff follow the homes policies and procedures and staff have access to the procedures mannuals. Spot checks and senior staff audits give evidence that aspects of the service and performance are being regularly monitored to ensure staff adherence to policies and procedures. Staff meetings and management supervision and appraisal processes make sure that staff get feedback on their work and can give their views. The service has an annual development plan and this is currently under review to make sure that the objectives identified are realistically achievable over a 12 month period. The residents and relatives satisfaction survey that is currently being used is also under review to make it easier for people to use and provide more information to help forward planning. Residents and relatives also have the opportunity to meet and raise any matters that concern them and give and get feedback about the running of the home. Record keeping has been maintained at a good and secure standard to maintain confidentiality. Where areas requiring improvement or change in practice have been identified by the monitoring systems or brought to the managers attention the registered manager has taken steps to address them and review outcomes. The records in the home including financial transactions were in good order and well organised. We did a spot check on a sample of the monies kept securely for people who do not want to, or cannot, manage their own finances. Individual records and running totals are kept and the system is audited monthly to promote the best interests of people living there. We looked at the records concerning health and safety in the home and these were in order. There are systems in place to monitor health and safety and promote good practice. This was demonstrated by the records of regular fire checks, emergency equipment checks, fire drills and training and fire evacuation plans for the people living there. Staff training supports safe practices, with regular moving and handling training and updates, infection control training and there are six staff who are appointed persons for First Aid. However training records and the information provided by the manager indicated that whilst catering staff had food hygiene training to fulfill their role care staff did not. We observed meal times and staff handling food at mealtimes and taking meals to people in their rooms including breakfast. We spoke with care staff who assist with the serving and handling of food to people at mealtimes who had not had food hygiene training and we recommended, to promote good practice, that all staff handling meals and food as part of their duties have this basic training to Care Homes for Older People Page 28 of 32 Evidence: promote best practice. Care Homes for Older People Page 29 of 32 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 30 of 32 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 1 9 Care plans relating to medicines should contain clear detail of how they are managed to ensure people receive safe and consistent treatment. Medicines should always be given to people at the right time and dose to help make sure their health and wellbeing is maintained and so records should make clear the correct time to give medicines in relation to food intake. We recommend that when recruiting new nursing staff the management team consider the need to have nurses with additional post registration training, skills and experience in dementia care to help ensure peoples mental health needs can be met and to provide a resource and support for other staff. To promote the welfare of the people living at Swarthdale the manager should include basic food hygiene training on the staff training plan for all staff who serve or handle the meals that people eat. 2 9 3 27 4 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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