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Archived: Swiss Cottage Care Home

The provider of this service changed - see old profile

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All reports

Inspection report

Date of Inspection: 14, 22 November 2013
Date of Publication: 4 January 2014
Inspection Report published 04 January 2014 PDF

Before people are given any examination, care, treatment or support, they should be asked if they agree to it (outcome 2)

Not met this standard

We checked that people who use this service

  • Where they are able, give valid consent to the examination, care, treatment and support they receive.
  • Understand and know how to change any decisions about examination, care, treatment and support that has been previously agreed.
  • Can be confident that their human rights are respected and taken into account.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 14 November 2013 and 22 November 2013, observed how people were being cared for and checked how people were cared for at each stage of their treatment and care. We talked with people who use the service, talked with carers and / or family members, talked with staff and reviewed information given to us by the provider.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

Our judgement

Where people did not have the capacity to consent, the provider had not always acted in accordance with legal requirements. We found procedures for obtaining consent from people using the service were not always followed in practice, monitored and reviewed.

Reasons for our judgement

Systems to obtain, and act in accordance with, the consent of people living in the home in relation to the care and treatment provided for them, were not being applied accurately or consistently.

Over the two days, we observed that some people were given choices such as what they would like to eat or drink. We also observed situations where people were not able to provide written or verbal consent, but were able to show their consent in alternative ways, through actions or physical movement. We heard most staff explaining to people what they were going to do before they provided care and support.

Staff we spoke with understood people’s right to refuse care, and told us they would involve people in making decisions about their care and welfare where they had capacity to do so. The manager told us that where someone’s capacity was variable, they would speak to the person as often as possible, and relatives if appropriate, in order to make a decision.

Some records we looked at demonstrated good practice in that they made reference to people’s right to refuse care, and one person had been recorded as providing verbal consent to a continence assessment and written consent to a flu vaccination. Another person had given written consent to the use of bed rails.

We found evidence that people’s capacity was routinely assessed in relation to them giving their consent to the use of bedrails; to prevent them from falling out of bed. However, these had not always been completed accurately. For example, one assessment did not conclude whether the person had capacity or not, or whether a further assessment was required. Another assessment had been signed by the person regarding the use of bedrails, but the form did not make it clear whether they had consented or not consented to their use.

Documentation we looked at did not always make clear whether each person had capacity; to determine their ability to make decisions about all aspects of their lives for themselves, or how this had been assessed. One person told us they did not want to be hoisted because they didn't like it and it was uncomfortable and staff we spoke with acknowledged this. It was recorded in the persons ‘rights, consent and capacity’ care plan that they should be involved in decision making as they had capacity to do so. However there was no record that the need to be hoisted, or whether any alternatives had been explored and discussed with individual.

Care plans were in place in relation to people’s ‘rights, consent and capacity’ however, they lacked personalised information, focusing instead on what generic good practice should look like. For example, we read in one person’s care plan that staff should continue to offer them choices and gain consent, but there was no information about how this should be done, or examples of when this had happened. This did not demonstrate the choices each person had been given, or decisions they had made in respect of how their care needs were attended to.

We read in one person’s care record that their relative was advocating for them, despite staff and the person in question telling us they were not close. Records stated that the person also had capacity to make their own decisions. We spoke with the person and spent time observing the care and support provided to them. Our findings concluded that we could not be certain that some decisions had been made in their best interest's, particularly in relation to their accommodation needs, which they described as a “prison.” There was evidence that their needs were different from the other people they were living with, and they told us the noise levels they experienced on a day to day basis distressed them. We brought this to the attention of the manager and regional manager at the time of our inspection. The regional manager acknowledged the need to improve consent and best interest's evidence for people living in the home. Afterwards, she wrote to tell us that she had arranged f