Care Home: Swiss Cottage Nursing Home

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What the care home does well The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully met The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. Contracts are in place for all people who live in this home. All files contained very clear risk assessments for a range of situations including entrapment and use of bed rails. New profiling bed and correct bumpers in place This home offers a wide variety of nutritious meals, with light alternatives available on request The manager is improving and developing systems that monitor practice, however more work is needed. Regulation 37 notices are being managed appropriately, and other health and safety records for water and food temperature testing were evident. Personal money for people who live in this home is managed electronically by the administrator who has worked here for many years. Monthly invoiced and statements are sent out to residents and their families at regular intervals, identifying all transactions. People have access to health professionals both within the home and the local community. What has improved since the last inspection? Fluid charts were being well maintained and a running total was available at all times as it was being continuously added up.Swiss Cottage Nursing HomeDS0000069674.V378815.R01.S.docVersion 5.2On the ground floor, care folders had been put into the bedrooms of those people who agreed. In all four units Medication Administration Record (MAR) Sheets had been appropriately completed, and we were able to reconcile stocks correctly in all areas. The manager is aware there are some gaps in the training programme, and plans to deal with this. The manager demonstrated a keenness to develop community communications both with the local community and other professionals, and he told us it is his intention to do this by initially introducing 6 monthly professional forum meetings and open days, in order to raise the profile of the home in a positive way. What the care home could do better: There are detailed care plans, that are being regularly reviewed, in place for each person who lives in this home, however they are not always consistent with the care that has / is being given. People who live in this home are given the opportunity to take part in a variety of activities both within the home and in the community. Some residents are consulted regarding the choices of daily living. However in one particular area of the home, interaction and engagement between the staff and the residents was very limited. On the ‘dementia nursing unit’ there was little evidence of any interactions and engagement between staff and residents. This home provides a physical environment that meets the specific needs of the people who live there. Residents can personalise their own rooms, however there could be more evidence of choice, autonomy and equality being offered to people who have more limited communication and capacity. The home is generally clean and tidy; however one particular area of the home requires some attention to eradicate offensive odours. People are generally satisfied that the care they receive meets their needs, but there are times when they may need to wait a short time for staff support and attention. The manager understands person centred planning and thinking, however translating this theory into practice is proving more difficult in some areas of the home.Swiss Cottage Nursing HomeDS0000069674.V378815.R01.S.doc Version 5.2 We believe that records and record keeping are being addressed through workshops and training with an emphasis on person centred care and care planning with all staff to ensure there is a clear understanding. This is a major task and is very much work in progress. Key inspection report CARE HOMES FOR OLDER PEOPLE Swiss Cottage Nursing Home Plantation Road Leighton Buzzard Bedfordshire LU7 3HU Lead Inspector Mrs Louise Trainor Key Unannounced Inspection 14th December 2009 10:15 DS0000069674.V378815.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Swiss Cottage Nursing Home Address Plantation Road Leighton Buzzard Bedfordshire LU7 3HU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01525 377922 01525 373791 swisscottage@schealthcare.co.uk Southern Cross Healthcare (Focus) Limited Manager Post Vacant Care Home 85 Category(ies) of Dementia (85), Old age, not falling within any registration, with number other category (85), Physical disability (10) of places Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 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, maximum number of places: 85 Dementia - Code DE, maximum number of places: 85 2. Physical Disability - Code PD, maximum number of places: 10 The maximum number of service users who can be accommodated is: 85 22/04/09 Date of last inspection Brief Description of the Service: Swiss Cottage Care Home with Nursing is situated in a pleasant suburb of Leighton Buzzard within easy reach of the town centre amenities by car or public transport. Extensive gardens and woodlands surround the home. The accommodation is divided into two main areas with separate dementia care areas on the first floor, and a nursing unit on the ground floor. The home provides single accommodation for up to 83 people. In addition, there is a double room within the dementia care unit. Access to the first floor is via a shaft lift or stairs. Various communal areas are located throughout the home. Copies of the homes statement of purpose and service user guide are available in the reception area. A copy of the most recent inspection report is displayed in the entrance of the home and is available to prospective people who may wish to move into the home. Fees for this service currently range from £457.06 to £871.35 per week, dependent on the funding source and assessed need of the person. In all cases where people are entitled to a nursing contribution this is collected and retained by the company. Additional charges are made for hairdressing, newspapers, toiletries and Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 5 chiropody. A copy of the Commission for Social Care Inspection report is available in the foyer. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for older people that takes account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. This was the second Key Inspection for this inspection year for this service. Regulatory Inspectors Mrs Louise Trainor and Mrs Sally Snelson carried it out on the 14th of December 2009 between the hours of 10:15 and 15:45 hours. Since the last Key Inspection in April this year when the home was rated as a poor service, we have carried out five Random visits, including a Pharmacist visit, in order to monitor progress in a fair and timely fashion, during a period where the management and staffing of this home has been somewhat unsettled. Information from some of these visits has been included in this report. Jo Tomlinson, who is a Project Manager for Southern Cross, and has been seconded to Swiss Cottage for six months, was present throughout this visit. Her secondment is due to finish at the end of this month. Also present was Mr Les Pollard, who has been working in the home as Deputy Manager since September this year, and has recently taken up appointment as home manager. During this inspection the care of three residents, two from the ground floor and one from the first floor were case tracked. This involved reading their records and comparing what was documented to the care that was being provided. Documentation relating to: staff recruitment and training, medication administration, complaints, quality assurance and health and safety in the home were also examined. We also had a tour of the premises and spent some time in the communal areas of the home, talking to the residents and visitors, and observing the care practices and interventions that were carried out during this four and a half hour inspection. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 7 We would like to thank everyone involved for their support and assistance during this visit to the home. What the service does well: The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully met The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. Contracts are in place for all people who live in this home. All files contained very clear risk assessments for a range of situations including entrapment and use of bed rails. New profiling bed and correct bumpers in place This home offers a wide variety of nutritious meals, with light alternatives available on request The manager is improving and developing systems that monitor practice, however more work is needed. Regulation 37 notices are being managed appropriately, and other health and safety records for water and food temperature testing were evident. Personal money for people who live in this home is managed electronically by the administrator who has worked here for many years. Monthly invoiced and statements are sent out to residents and their families at regular intervals, identifying all transactions. People have access to health professionals both within the home and the local community. What has improved since the last inspection? Fluid charts were being well maintained and a running total was available at all times as it was being continuously added up. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 8 On the ground floor, care folders had been put into the bedrooms of those people who agreed. In all four units Medication Administration Record (MAR) Sheets had been appropriately completed, and we were able to reconcile stocks correctly in all areas. The manager is aware there are some gaps in the training programme, and plans to deal with this. The manager demonstrated a keenness to develop community communications both with the local community and other professionals, and he told us it is his intention to do this by initially introducing 6 monthly professional forum meetings and open days, in order to raise the profile of the home in a positive way. What they could do better: There are detailed care plans, that are being regularly reviewed, in place for each person who lives in this home, however they are not always consistent with the care that has / is being given. People who live in this home are given the opportunity to take part in a variety of activities both within the home and in the community. Some residents are consulted regarding the choices of daily living. However in one particular area of the home, interaction and engagement between the staff and the residents was very limited. On the ‘dementia nursing unit’ there was little evidence of any interactions and engagement between staff and residents. This home provides a physical environment that meets the specific needs of the people who live there. Residents can personalise their own rooms, however there could be more evidence of choice, autonomy and equality being offered to people who have more limited communication and capacity. The home is generally clean and tidy; however one particular area of the home requires some attention to eradicate offensive odours. People are generally satisfied that the care they receive meets their needs, but there are times when they may need to wait a short time for staff support and attention. The manager understands person centred planning and thinking, however translating this theory into practice is proving more difficult in some areas of the home. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.2 Page 9 We believe that records and record keeping are being addressed through workshops and training with an emphasis on person centred care and care planning with all staff to ensure there is a clear understanding. This is a major task and is very much work in progress. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5, 6 People using the service experience good quality outcomes in this area. The home understands the importance of having enough information when choosing a care home. Admissions and re admissions are not made until a full assessment of needs has been carried out so that prospective residents and their representatives can be sure that their needs will be fully met We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Information documents for this home, are regularly reviewed, by the Company and correctly reflect the present management structure of the home. As reported at our last inspection on the 08/10/09 “The home had not had any new admissions since our last inspection, and therefore we could not look at any recent pre admission assessments. However for one resident who had Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 12 been in hospital, there was a very clear re admission assessment carried out prior to him being accepted back into the home. This clearly reflected how his needs had changed.” This situation remains unchanged as the home has not been receiving new admissions since it was rated as poor. Contracts are in place for all people who live in this home. This home does not presently provide an intermediate care service. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 People using the service experience adequate quality outcomes in this area. People have access to health professionals both within the home and the local community. There are detailed care plans, that are being regularly reviewed, in place for each person who lives in this home, however they are not always consistent with the care that has / is being given. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: During this inspection we picked two residents on the ground floor with complex needs, to case track. Neither precisely reflected the care that was being delivered. For example one had a healing grade 3 pressure ulcer. The care plan had been updated the previous month and documented that the sore should be reviewed Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 14 and redressed every 3rd day. This had taken place in the beginning but more recently the gap between the renewals of dressings had increased by up to 6 days. The manager and the nurse in charge knew that this was because the wound was healing, but there was nothing to reflect this, or how or by whom the decision to extend the review period had been made. Photographic evidence was available to confirm the healing process. Fluid charts were being well maintained and a running total was available at all times as it was being continuously added up. On the ground floor, care folders had been put into the bedrooms of those people who agreed. We also case tracked one resident in Cedar Unit, the ‘dementia nursing’ unit on the first floor. Generally the documentation was very thorough and this person had a variety of detailed care plans in place, ranging from mobility and medication to activities and sleep, however the detail in these care plans was not always reflective of the care and support that was being delivered. For example the ‘activity care plan’ read. “To promote stimulation of visual /auditory senses. Get sensory equipment for ------- s room for personal use.” However when we visited this persons room, it was bare except for basic furnishings, and there was no evidence of any such equipment. Another care plan identified that this person required chiropody treatment every 2 weeks as he had fast growing nails, however when we looked at the daily logs and the chiropody attendance book, it indicated he had only been seen twice in the last 4 months, once on the 17/08/09 and once on the 16/09/09. We asked the unit manager about this, and she was completely unaware of this care plan, stating. “The chiropodist only comes about every 6 weeks anyway”. When we looked at the care plan evaluation, it indicated that this person was seeing the chiropodist every two weeks. We advised the home manager of this, and he recognised that there was still a lot of work to do with the care plans, and it was work in progress. All files contained very clear risk assessments for a range of situations including entrapment and use of bed rails. New profiling bed and correct bumpers in place Since the last Key Inspection, this home had received a pharmacy visit on the 18/06/08, which resulted in numerous requirements being made. This was followed up by a Random Inspection on the 28/07/09 where compliance had been achieved, with the exception of medication storage temperatures. During this inspection we looked at the medication documentation on all four units to ascertain whether these improvements had been sustained. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 15 In all four units Medication Administration Record (MAR) Sheets had been appropriately completed, and we were able to reconcile stocks correctly in all areas. We did note, however that staff, particularly on the nursing unit were failing to complete the reverse of the charts where anomalies in administration had occurred. Additionally whilst on Pine Unit, we found the medication fridge was continuously bleeping indicating a problem with the temperature. We brought this to the attention of the nurse in charge, and he advised us that it was because the fridge had been opened during a recent medication round. This bleeping continued for the duration of our time on Pine Unit whilst checking the medication, and we were concerned that this nurse did not take any action to check the fridge or attempt to rectify or report the matter. We looked at records for the temperature of this fridge, and prior to our visit temperatures were being recorded appropriately. We were also concerned that on Cedar Unit the 10:00 hour’s medication round was only just starting at 10.30 hours. This is generally carried out by 2 nurses, from two separate trolleys. We were told that this had been delayed due to an incident with a resident earlier in the morning. Although we appreciate incidents must take a priority, we were unsure why both of the nurses started late. We were particularly concerned as the space between the medication rounds in this home are already very close together, and we have suggested that the GP s should be requested to review this. . Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People using the service experience adequate quality outcomes in this area. People who live in this home are given the opportunity to take part in a variety of activities both within the home and in the community. Some residents are consulted regarding the choices of daily living. However in one particular area of the home, interaction and engagement between the staff and the residents was very limited. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the Random Inspection in October, we reported that. “The manager has focused heavily on this outcome area. She has secured 60 hours a week activity staffing, which is now providing both one to one and group activities seven days a week. She has ‘resurrected’ the old mini bus, and produced an ‘Activities Action Plan’ with the new Operations Manager Wendy McDonough. This has been devised in line with the National Minimum Standards, and has been set with target dates for completion. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 17 The activities program has been expanded since our last visit to the home, and now includes frequent mini bus trips to the local town market and local pub. Residents from all areas of the home are being included in these trips, and a ‘gallery’ of photographs is being gradually developed as are individual person centred activity plans for all residents. The home continues to have external entertainers, as well as in house activities.” Photographs indicate that these improvements have been maintained, particularly on the ground floor of this home, and we were told about a recent trip to Whipsnade Zoo. The home is presently focusing on Christmas, and there were posters displayed in the corridors, telling residents about forthcoming parties, meetings and menus. On the ground floor we saw residents being assisted with wrapping presents and writing cards. Visitors were also involved in this activity. One visitor told us. “There have been so many changes here I do believe it is getting better”. However on the ‘dementia nursing unit’ this was not as noticeable. There was little evidence of any interactions between staff and residents. There were two qualified nurses on duty on this unit, and although we appreciate it was the first day for one of them, and office work is an essential part of their job, with the exception of the medication round, we did not see either leave the office to interact with residents at all. There were thirteen residents sitting in the main lounge area on Cedar Unit. There was activity equipment set out on tables, such as a large bag or coloured balls and a large bag of coloured bricks, however the only interactions we witnessed were two care staff doing a jigsaw puzzle with one resident. The television was on in one corner of the room, and there was inappropriate ‘pop music’ playing from the radio. This was a completed contrast to Oak Unit, the ‘dementia residential unit’ where residents were engaged in communication with staff, and activities were generated by daily living tasks that were meaningful to the residents. This home offers a wide variety of nutritious meals, with light alternatives available on request. On the day of this inspection there was a choice of braised liver or lamb casserole at lunch time, and we also saw residents having sandwiches. As we visited Cedar Unit at lunch time, it was disappointing to find one resident with a ‘hot meal’ that had gone cold in front of her, and another resident with her dessert in her lap. We also observed that it was visitors of other residents that came to assist them and not staff. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 18 On the ground floor one visitor told us that she comes in daily to feed her loved one and was not convinced he would be fed if she wasn’t there. She had no evidence to prove this, however just felt that there were a lot of people needing support and staff were very busy. Lunch time was not being ‘Managed’. The nurse in charge on the ground floor was having his break, and some staff were being called away for training. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People using the service experience good quality outcomes in this area. The complaints procedure is supplied to everyone living in the home. Staff working in the home understand the procedures for safeguarding, and know when incidents need to be reported externally. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: This home has a complaints policy, which is easily accessible to residents and visitors to the home. It details expected timescales for responses, and guidance for any complainant that remains dissatisfied with investigatory outcomes. During this inspection we looked at the complaints file. Three complaints had been recorded since our last visit. These were all well documented, and had been responded to appropriately by the home manager, who was able to discuss his rationale behind each investigation and how it had been concluded. We were also shown some letters of gratitude and praise that had been received since the last inspection in October this year. One read. “I would like to place on record my congratulations to you as the new home manager, and at the same time compliment all the staff for the way that they have contributed to making things work. I genuinely feel that things Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 20 at last are going in the right direction and everybody is working as a team”. Another read. “I would be grateful if you could pass on heartfelt thanks to each and every nurse, carer and assistant.” This letter made reference to the “superb care, empathy and professionalism”. Shown by staff, to a resident and his family during the last stages of his life. Safeguarding policies and procedures are in place in this home. At our last inspection in October training statistics identified 87 of staff had completed their safeguarding training. Current statistics show this now to be 92 . The 8 shortfall accounts for new staff who have addressed abuse during their 5 day induction but are still waiting for the full training. The local authority have been approach about further training, however dates are not yet confirmed. Safeguarding issues are being appropriately reported and addressed by the management in this home. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 People using the service experience adequate quality outcomes in this area. This home provides a physical environment that meets the specific needs of the people who live there. Residents can personalise their own rooms, however there could be more evidence of choice, autonomy and equality being offered to people who have more limited communication and capacity. The home is generally clean and tidy; however one particular area of the home requires some attention to eradicate offensive odours. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the last inspection we reported. “During all the Random Inspections over the past few months we have witnessed the refurbishment of this home as an Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 22 ongoing project. It was very encouraging to see this project all but completed and an ongoing decorating programme now being implemented. Vacant bedrooms rooms are being decorated in neutral colours; however some of the current residents and their families are being involved in choosing colour schemes for their rooms. The décor in this home is now clean, homely and comfortable throughout. All areas of the home have been redecorated, and new flooring laid in many areas. There is now no evidence of offensive odours anywhere in this home. There were windows open allowing fresh air in, and we saw residents spending time in the garden. New shower / bathroom facilities have been fitted on the ground floor to accommodate various choices in bathing experiences.” At this inspection, we found the ongoing decorating programme remains active, and generally the home provides a bright and fresh environment, with the exception of the dementia nursing unit, where an offensive odour is again evident. We discussed this with the manager and believe the smell is being caused by repeated soiling of the carpets, despite prompt cleaning when accidents occur. Changing the flooring in the main day area of this unit, maybe the only way to fully eliminate this problem, and should be considered. Generally the temperature in the home was comfortable, with the exception of one area in one of the ground floor units. When this was brought to the attention of staff by visitors in lounge on ground floor, it was addressed immediately. As we toured the home we found that many of the resident’s bedrooms had been personalised and made homely with individuals’ choices in décor and furnishings. However the rooms that we visited in the dementia nursing unit were very bare and lacked any feeling of homeliness. We visited one room as part of our tracking process. The residents ‘activity care plan’ identified the need for personal sensory stimulation equipment to be present in his room. When we visited the room in question, it contained only basic furnishings. There was no evidence of any personalisation, and no evidence of any sensory equipment. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People using the service experience adequate quality outcomes in this area. People are generally satisfied that the care they receive meets their needs, but there are times when they may need to wait a short time for staff support and attention. The manager is aware there are some gaps in the training programme, and plans to deal with this. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: At the Random inspection in October 2009, we looked at the files of three members of staff that had been appointed since the previous inspection. All three had Criminal Record Bureau checks and POVA first checks in place. All had fully completed application forms that detailed employment history and personal qualifications, and two appropriate references. All three had completed, or were presently working through an induction programme. Home Office documentation was in place where appropriate, and contracts of terms and conditions were in place. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 24 We are confident that this home follows a thorough recruitment process, and for that reason only looked at the file of one new member of staff, during this visit. All documentation was present and correct. We also spoke with two new staff, who both advised us that they had completed a five day induction programme, which included mandatory training, prior to starting on the units. The manager advised us that the home now has a full compliment of carers, however qualified nurse recruitment remains in progress. He also explained that he is introducing a ‘flexi staffing system’ whereby staff will undergo rotation from night duty to day duty. It is hoped this will bring all staff, whatever hours they work, into one team all working with continuity. On the ground floor and in the Oak Unit observations of staff and residents interactions indicated that there is a familial, relaxed and friendly atmosphere in this home, staff morale has improved and generally the staff we observed were smiling and were going about their work in a confident and competent manner. However on Cedars Unit, although staff presence was evident, with four care staff and two qualified nurses on duty, there was very limited engagement with residents except when personal care was being carried out, and this was task driven, whereas it could have been integrated to form meaningful activities for many of these residents. We were unsure if this was due to lack of skills or the effect of further changes in the unit manager, who should be effectively leading this team. We did not see the unit manager leave the office during this visit, except to administer medication. We appreciate that paperwork is an essential part of managing a unit, however engagement with these residents is fundamental to their care and well being. The home manager told us that he is in the process of recruiting to the qualified nurse vacancies, including the unit manager post for Cedar Unit, and discussed with us the importance of appointing staff with the appropriate knowledge, skills and experience to improve this service for the people who use it. He also told us of his plans to involve specialists such as Parkinson’s nurses and Multiple Sclerosis (MS) specialists in the home. Training statistics for this home are produced electronically on a weekly basis, and allow the manager to see at a glance where staff are due for refresher courses and updates. At the inspection on the 08/10/09 these statistics showed percentages exceeding 70 in most of the mandatory subjects, including Safeguarding 89 , Moving and Handling 80 and 80 safe medication. The projects manager explained to us that these percentages were actually ‘an under reading’, as she does not include staff in the data input for the statistics until Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 25 she has seen the certificate on completion of training, which often takes some time to be issued. The only training statistics we followed up on at this inspection were those for safeguarding training, which had increased from 89 to 92 . Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36, 37, 38 People using the service experience adequate quality outcomes in this area. The manager is improving and developing systems that monitor practice, however more work is needed. The manager understands person centred planning and thinking, however translating this theory into practice is proving more difficult in some areas of the home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 27 Since the last visit to this home when we reported that. “The administration in this home remains stable and consistent, and the present management reflected a positive approach throughout this inspection. Jo Tomlinson and Les Pollard are both very visible in the home, and are accessible to staff, residents and visitors.” To date this has continued, and staff spoke to us in a very positive way about how improvements have been implemented over the past few months. However the Projects Manager Jo Tomlinson is due to move from this service on the 04/01/09. We are therefore keen to see this management style maintained, and the foundations for these improvements become established practices throughout the home. Mr Les Pollard has now been appointed as Home Manager, and plans to submit his application to the Care Quality Commission (CQC) for the Registered Managers post in the near future. He told us of his vision for the next two years. This included employing a physiotherapist 15 hours a week, and the installation of a hydro therapy pool which will be used to help maintain well being and improvement in individual’s medical / physical conditions. He told us that the home has also employed an external councillor to attend the home once a fortnight. This is a facility available for residents, families and staff, giving everyone the opportunity to discuss concerns or worries in an unbiased confidential way. Informal coffee mornings also continue to run each week for relatives. He demonstrated his keenness to develop community communications both with the local community and other professionals, and he told us it is his intention to do this by initially introducing 6 monthly professional forum meetings and open days, in order to raise the profile of the home in a positive way. Relatives are also being encouraged to become more involved with the home through a Relatives Action Group (RAG) We look forward to seeing how these projects progress. We believe that records and record keeping are being addressed through workshops and training with an emphasis on person centred care and care planning with all staff to ensure there is a clear understanding. This is a major task and is very much work in progress. As reflected in the Health and Personal Care outcome area of this report, improvement is still needed to bring this up to National Minimum Standards. Regulation 37 notices are being managed appropriately, and other health and safety records for water temperature and food temperature testing were evident. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 28 We were told a full supervision structure is now in place, whereby the manager supervises the heads of departments in the home, and they in turn supervise the more junior staff in their department. However some staff were still unsure of whom their supervisor was, or whether they had received any. We will review this at the next inspection to how effective it is when it is firmly established. Personal money for people who live in this home is managed electronically by the administrator who has worked here for many years. Monthly invoiced and statements are sent out to residents and their families at regular intervals, identifying all transactions. As we had looked at these accounts at the last Key Inspection and found them to be in order, we did not access them during this visit. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 3 3 2 2 2 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X X 2 2 3 Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(2)(b) Requirement People who live in this home must have care plans that clearly reflect the care they require and receive. People who live in this home must be as far as practicable be given the opportunity and assistance to make decisions with respect to the care they are to receive and their health and welfare. Timescale for action 30/01/10 2. OP14 12(2) 15/01/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP26 OP12 Good Practice Recommendations The registered person should consider alternative flooring in Cedars Unit, in order to eradicate the offensive odours. The registered person should consider further training for staff regarding person centred care and engagement with residents who have dementia. Swiss Cottage Nursing Home DS0000069674.V378815.R01.S.doc Version 5.3 Page 31 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: 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. Copyright © (2009) Care Quality Commission (CQC). 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. 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