Care Home: Swinton Lodge

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What the care home does well Individual plans of care were provided that met people`s health and personal care needs. Complaints were taken seriously, investigated and the complainant informed of the outcome of the investigation.The service had taken some action to orientate people better to their environment, so that where people lack capacity, it helped them to understand the layout of their space and maintain their independence. In addition, the unit for people with enduring mental health needs has been redecorated, making it a much brighter environment for them. The service were making a better attempt at providing staff in sufficient numbers to meet people`s needs. What the care home could do better: The service need to improve their procedures for dealing with medication, so that people are better protected by the home`s policies and procedures for dealing with medication. The service need to improve staff rotas to make sure they accurately reflect which staff are on duty at any time and in what capacity they are working. Adequately train all staff so that they are approprately trained and competent to do their jobs and people are safe in their care, in particular, keeping people safe from harm and abuse and how best to meet people`s mental health needs. Random inspection report Care homes for older people Name: Address: Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT one star adequate 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: Jayne White Date: 0 6 0 5 2 0 1 0 Information about the care home Name of care home: Address: Swinton Lodge Wortley Avenue Swinton Mexborough South Yorkshire S64 8PT 01709586704 01709578172 swintonlodge@gmail.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Absolute Care Homes (Swinton) Limited Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 63 Number of places (if applicable): Under 65 Over 65 0 0 28 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 35 35 0 The maximum number of service users who can be accommodated is: 63 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; Dementia - Code DE and Mental Disorder Code MD Care Homes for Older People Page 2 of 13 Date of last inspection Brief description of the care home Swinton Lodge is at the end of a cul-de-sac in a residential area of Swinton. It is near to shops and other local amenities. It is on a bus route and is also close to the local train station, which provides services to Sheffield, Doncaster and Leeds. The home is a two story building served by a passenger lift and stairs. There are three separate units with their own lounges, dining rooms, bathrooms and toilets. All bedrooms have en-suite toilets. On 6 May 2010 the administrator said the fees ranged from £366 - £472 plus funded nursing care. Additional charges were made for hairdressing, chiropody, toiletries, newspapers and outings. The registered person makes information about the service available to people and their families via the Statement of Purpose and the Service User Guide. Care Homes for Older People Page 3 of 13 What we found: This was an unannounced random inspection, to comply with our regulatory processes of the inspection of services. The visit started at 09:15 and finished at 16:00. A random inspection means we visit the service and look at specific areas. On this inspection we checked that requirements issued at the previous inspection had been met and that the health, safety and wellbeing of people who used the service was being maintained. We can only change the star rating following a key inspection, therefore, the rating for this service will stay the same following this random inspection. However, we can still inspect the service at any time if we have concerns about the quality of the service or the safety of the people using the service. Before we visited the service we looked at any information we had received since the services last inspection. This included: The services AQAA (Annual Quality Assurance Assessment). The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The outcomes from the previous inspection report. We also looked at what the service had told us about things that have happened at the service that have affected peoples health, safety and welfare. These are called notifications and are a legal requirement. We also sent out ten surveys to people living at the service and staff. Four surveys were returned by people living at the service and two by members of staff. During the visit, time was spent looking round the home, talking to people using the service, members of staff and the area manager. We observed some care practices and looked at some records and documents. The outcome was as follows: Information in the AQAA completed by the manager told us the complaints procedure was accessible in the reception area and the service user guide, which is in every bedroom also contained the procedure. We saw the procedure displayed in the reception area of the home. The AQAA told us two complaints had been received in the last twelve months that had been resolved within 28 days. We looked at the complaints record to check the complaints had been investigated and action taken if necessary. We saw that the complaints had been investigated and the complainant informed of the outcome of the investigation. All of the surveys returned by people living at the service told us there was someone they could speak to if they werent happy. Three stated they knew how to make a formal Care Homes for Older People Page 4 of 13 complaint, one didnt. In their surveys both staff told us they knew what to do if someone raised concerns about the home. When we spoke to members of staff during the visit we found that most of them knew what action to take if anyone raised concerns about the service, but this wasnt sufficiently robust if it was an allegation of harm or abuse. This was highlighted when we spoke to three members of staff in detail about their understanding of protecting people from harm and abuse. They understood very well what to look out for to identify if someone could be at harm of abuse, but only two of them knew the right action to take to help people keep safe. This could mean people are placed at further risk of harm. The AQAA and inspection of our records told us there had been two safeguarding allegations made. This means concerns about keeping people safe from harm. As a result of the referrals the service investigated the incidents themselves and took appropriate action. The service had the South Yorkshire Safeguarding of Vulnerable Adults in place to refer to if they needed. The AQAA told us the service had the use of independent advocacy services and Independent Mental Capacity Assessors for people who may lack capacity and a care plan about a persons capacity was introduced into peoples files where they may lack capacity. However, although staff had heard of the Mental Capacity Act and Deprivation of Liberty Safeguards they had not received any training and didnt understand what it might mean. We looked at the systems in place for dealing with medicines, to make sure that people were sufficiently protected by them. This was because CQC had made a previous requirement, arrangements must be put in place to ensure that all medication records are accurately maintained in a timely manner. This will help to promote peoples health and wellbeing by knowing that their medicines are being given correctly. This particular requirement has been removed and further requirements and recommendations made because: In the dining room on the unit for people with dementia there was a supply of fresubin on a set of draws, with no name apparent as to whose they were. Staff did not know whose they were and that at the moment no-one was prescribed them. People were not at risk, but they should not be stored there and should be returned to the pharmacy to be disposed of. The nurse was asked to do this. Nurses were not recording on the medication administration record when supplies to assist them in maintaining peoples health were used. This could mean they run out of those supplies. On the medication administration record, there was no record when creams had been applied for people, or if they administered the cream themselves. This is insufficient in monitoring the effectiveness of prescribed medication. On medication administration records for people prescribed insulin, the amount to be administered was handwritten. There was not another signature to verify the entry and for one person the entry could not be verified as correct in the persons case file. The nurse was asked to check the amount was correct immediately. Care Homes for Older People Page 5 of 13 The medication administration record did not record the medication carried forward from one month to the next, which meant an audit of medication could not be conducted easily, to confirm people were being given their medication. When we checked the medication administration records at 11:40 it looked like people hadnt been given their medication. Discussion with the nurse told us they had administered the medication, but had not yet had time to record this. We checked the actual medication. The medication had been taken from the pack. This practice is unsafe as it means the nurse relies on their memory, when recording information. The medication policy and procedure available to staff was dated 22.05.07, with no evidence it had been reviewed. The procedure did not contain all aspects that might be needed for staff in their responsibility of dealing with medication. This was a recommendation at the last inspection and remains in place. When we spoke to the nurses who administered medication, one stated that since their training they had done a distance learning course when they had been employed at the home previously. There was no certification to verify this or an assessment of any of the nurses competency for dealing with medication. We looked at five peoples care plans because of two previous requirements that were made in respect of improving care plans in regard to monitoring peoples nutritional needs and people who had diabetes. We found these requirements to have been satisfactorily met. This was because: One survey from someone using the service stated they always received the care and support they needed, three that they usually did and they all stated they always received the medical care they needed. We spoke with a dietician who was attending the home to review three people. They told us they had no concerns about their care and information was available to confirm their nutritional needs were being met. We spoke with nurses on both the dementia unit and unit for people with enduring mental health needs. They could describe in detail the actions they took to meet peoples needs and where the information about this could be found. We looked at five case files and this confirmed peoples needs were being met. In all but one instance, a nutritional risk assessment was in place, everyone was having their weights maintained and a plan of care was in place for peoples nutritional and diabetic needs if necessary and the plan was being followed. However, discussions with staff and the cook identified there was no clear procedure in place for the cook to receive information about peoples diets and this needs attention. We discussed with the area manager that the daily record should be more detailed and include when staff have carried out the interventions identified in the care plan to demonstrate the care has been carried out. It should also describe how each person has spent their day to give an indication of the quality of their life. We inspected the environment because of a previous requirement to make the environment on the units for people with dementia and enduring mental health needs to be made more suitable for their needs, including, appropriate orientation for people, making the environment brighter, replacing the carpet on the enduring mental health unit Care Homes for Older People Page 6 of 13 in the dining room/lounge and arranging furniture in a non-institutional way. Sufficient action has been taken to remove this requirement. This includes: A new floor in the kitchenette on the enduring mental health unit being laid and a breakfast bar put in place to give more work space for people in the kitchenette. Blackboards had been put in place for displaying menus, but we noted they werent being used by staff. The manager needs to address this, otherwise there is no point having them. Communal areas on the enduring mental health unit had been painted making it much brighter and a soft settee placed in the lounge area, making the environment look much less institutionalised. Some recognisable signage had been applied to doors explaining what people might find behind the door, for example, a toilet. We also looked at staffing arrangements because of a previous requirement, the deployment of staff must be reviewed to increase the levels of staffing on Balmoral, the enduring mental health unit and that nursing staff are based in the areas where the most people have nursing needs. This was to ensure suitably qualified nurses and competent staff were in sufficient numbers to maintain the health and welfare of people. This requirement has been removed, but further requirements and recommendations made because: Information received from the local authorities contracting department in April 2010 told us a dependency tool was now being used to determine staffing levels. The services own improvement plan stated staffing levels had increased to three nurses in a morning and afternoon and two nurses at night. However, on our visit today, there was only two nurses on duty, but they were deployed on the units where people needed the most nursing care. They were appropriately qualified to provide general nursing care, but neither had received any training to meet the mental health needs of people. When we spoke to staff they told us there were normally three nurses on duty. Staff rotas did not confirm this. Currently, the service do not have any registered mental nurses employed. Because of this, the administrator stated the manager has voluntarily suspended admissions to the unit for people with enduring mental health needs. The contract department had visited the week before and put in place an action plan in respect of training. This was because although a training programme had commenced it was being delivered by staff who had themselves not been trained to deliver the training. We found on the visit that nurses had commenced work without a robust induction. Any previous training had not been verified and where there were shortfalls, had not received this training before they started work. This meant in some areas they were not competent in their role, or had appropriate training for their role, for example, keeping people safe from harm and abuse and meeting peoples mental health needs. What the care home does well: Individual plans of care were provided that met peoples health and personal care needs. Complaints were taken seriously, investigated and the complainant informed of the outcome of the investigation. Care Homes for Older People Page 7 of 13 The service had taken some action to orientate people better to their environment, so that where people lack capacity, it helped them to understand the layout of their space and maintain their independence. In addition, the unit for people with enduring mental health needs has been redecorated, making it a much brighter environment for them. The service were making a better attempt at providing staff in sufficient numbers to meet peoples needs. 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 8 of 13 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 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 9 13 Staff must sign the medication administration record immediately after they have administered the persons medication. So that people are protected by the homes procedures for the administration of medication. 17/06/2010 2 18 18 Staff must receive training in 17/08/2010 the Mental Capacity Act and Deprivation of Liberty Safeguards. To make sure they are up to date with current practice to ensure peoples choices and human rights are only affected following assessments, best interest meetings, risk assessments and discussion with the person concerned and/or their advocate. 3 18 18 Staff must receive adult safeguarding training. So that they are competent 17/08/2010 Care Homes for Older People Page 10 of 13 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 in the procedures to follow should an allegation of harm or abuse be made. 4 30 18 Staff must receive training in 17/08/2010 dementia and other aspects of mental health. So that they are appropriately trained and competent to do their jobs. 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 7 A specified procedure should be in place that staff are aware of, that informs the cook of the nutritional needs of people to minimise the risk of people receiving a diet that could place them at risk of harm. Staff should record in the daily record when they have carried out the interventions identified in the care plan to meet peoples needs. This would demonstrate the care has been carried out. It should also describe how each person has spent their day. Staff should have regular assessments of their competency to deal with medication, so that the service can be confident they are safe to continue with their practice. The medication policy and procedure available to staff should be updated in line with current professional guidance so that staff understand exactly what is expected of them. The medication administration record should contain the medication carried forward from one month to the next to help confirm that medication is being given as prescribed and when checking stock levels. Handwritten entries and changes to medication administration records should be countersigned by another Page 11 of 13 2 7 3 9 4 9 5 9 6 9 Care Homes for Older People 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 person to verify the entry is correct and people receive the correct amount of medication. 7 9 There should be an accurate record of when creams have been applied, or if people administer the cream themselves, to demonstrate the effectiveness of the cream is being monitored. Staff should record on the medication administration record when supplies are used in maintaining peoples health, so that they do not run out or re-order more when it isnt necessary. Staff rotas should be much better maintained to demonstrate which staff are on duty at any time and in which capacity. 8 9 9 27 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. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 13 of 13 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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