Archived: Swiss Cottage Care Home

Below is a summary of what we found. The summary is based on our observations during the inspection discussions with people using the service, the staff supporting them and looking at records.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that the format of the care plans had not been changed but all the care plans had been reviewed to reflect people's individual needs. Daily report sheets and personal care checklist sheets had also been introduced to enable staff to report on people's well-being. This meant that staff were able to evidence all aspects of personal care they provided to people on a daily basis.

Staff spoken with were aware of the home's safeguarding and whistleblowing policies. The policies were displayed in accessible areas of the home to ensure that people who used the service, staff and visitors would be able to access the information if they needed to report any potential incident of abuse.

We found that the home was kept clean and there was good odour control. Staff had access to personal protective equipment such as disposable gloves and aprons.

The home had introduced robust monitoring systems to protect people against the risk associated with unsafe use and management of medicines. As a result of these stringent monitoring checks the home had been able to identify errors and addressed them with the staff members involved.

We found significant improvements had been made to employ permanent staff. This had resulted in the reduction of agency staff working in the home.

Care plan records and other records were stored securely and could be located promptly when required. It was evident that records were stored securely to ensure that confidentiality was not breached.

Is the service effective?

We found that people were consulted about their care and treatment and were provided with choices. Where people did not have the capacity to consent best interest meetings were held.

The home had made improvement to ensure that staff had been provided with appropriate training to deliver care and treatment safely and to an appropriate standard to people who use the service. We were not able to assess fully the quality of the home's supervision and appraisal framework. This was because it had not yet been fully embedded and was still work in progress. For example, staff had not yet been appraised and only ten staff had received bi-monthly one to one supervision. We felt that the risk of staff not being supported to deliver care and treatment safely and to an appropriate standard had been reduced to a minor impact.

Is the service caring?

We found that staff spoke with people in a kind and compassionate manner. People looked comfortable in staff company. Staff were able to describe the positive outcomes that people had achieved with their support and support from other health care professionals.

Is the service responsive?

We found where complaints had been made these were responded to by the manager and resolved where possible to people's satisfaction.

Is the service well led?

We found that people and their relatives had been asked for their views about the care provision and these had been addressed. We saw evidence that regular staff meetings were held. Monthly and daily audits relating to people's care and treatment were undertaken to ensure that people received appropriate and safe care and treatment.

Staff spoken with said that the manager was supportive and approachable. It was evident that staff felt well-led and informed about people's care and treatment.

During our inspection we spoke with two relatives of people using the service and seven people who use the service, about their care. We found procedures for obtaining consent from people using the service were not always followed in practice, monitored and reviewed.

Care plans were complex and difficult to follow. Information contained within the plans of care lacked essential information about people's individual needs and preferences in relation to their care needs. In addition changes to people's care and treatment had not always been updated.

From the information we received from the service and from our observations on Cedar unit we noted there were gaps in staff training and development. In addition, systems in place were not robust enough to ensure that a quality service was provided to the people living at this home.

Personal documentation was not stored securely and was not always completed and up to date as people needs had changed. This meant that records about people's care, treatment and support did not maintain the dignity and confidentiality of the people using the service.

We spent time on Cedar unit observing the care and looking at the way people's care was planned. We found evidence that people's care needs were met but the care plans were not always consistent in documenting their needs. On the other units we found that plans were completed in a much more consistent way with people's needs reviewed and changes made where necessary. People looked clean and well cared for and a relative visiting Cedar unit told us that they were very happy with the care that the staff gave.

On the Cedars unit we observed that people were very dependent and relied on staff to meet all their needs. Staffing levels were reflective of people's levels of dependency and staff were very busy. Staff told us that days were varied and there were times when an additional staff member would mean they would have more quality time with people. We observed that staff were very caring and spent time with people over the mealtime assisting them to eat, and this was unhurried and focused on meeting the needs of the person they were caring for. One person we spoke with told us that they sometimes had to wait for staff to come when they called but this did not cause them any concern.

We looked at seven care files and saw evidence of appropriate assessments and reviews for each individual. One person said 'They look after me very well' and another said there was 'Nowhere better'.

We observed that interactions between staff and people using the service were considerate and respectful, and people's diversity, values and human rights were respected. One relative said 'So far, very impressive, they are going to go through all the paperwork with us today.'

On our visit on 10 December 2012 we arrived at 7am. We found that staffing levels were able to meet the needs of people at the service. Staffing issues were mainly at weekends when we noted care staff often rang in sick at short notice making cover difficult. One relative told us the staff worked very hard and they had no concerns with the care but felt "they need more incentives to work at weekends."

There were systems in place to provide staff with training. A new clinical lead nurse had been appointed and she was able to support nursing staff in a supernumerary role. The provider had a system to monitor the quality of the service and engaged with people and their relatives to obtain their views.