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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

People should get safe and appropriate care that meets their needs and supports their rights (outcome 4)

Not met this standard

We checked that people who use this service

  • Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

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

Care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare and to meet the needs of people using the service.

Reasons for our judgement

Planning and delivery of care did not always meet people's individual needs or ensure the welfare and safety of people using the service was maintained.

We looked at the care records of four of the 22 people living in Cedar unit and two for people living in the nursing unit. Care plans were complex and not user friendly. Each plan of care was recorded on the same document as the care plan evaluations which were completed monthly. The paperwork used a tick box approach meaning that without additional narrative, we had to read the care plan and all the monthly evaluations to get a clear picture of each person’s current care needs. This made it time consuming to find the information staff needed. In addition, care plan evaluations were often vague and not personalised. For example we saw entries such as: ‘[the person] recognises that care is offered in a dignified way’ and ‘care is based on best practice’. The status of the person’s health and welfare needs were not described, and there was limited information about any progress or deterioration the person had made. This meant that staff did not have relevant and current information about each person which could result in unsafe and inappropriate care being provided.

Some entries in the care plans lacked detail, and had not been written in a way that promoted individualised care. For example, we saw evidence that some aspects of people’s healthcare needs had been monitored for depression and pain. This meant that staff could respond in a timely manner if there was a change in people's condition. However, we were not able to evidence that blood monitoring for people with type 2 diabetes (diet controlled) was always being completed. We asked about this for one person whose care we were tracking. We were told that they had recently been informed that this person did not actually have diabetes after all. The care plan had not been updated to reflect this. This was a concern as this exposed them to the risk of inconsistent and inappropriate care.

We looked at four care plans in relation to ‘drug therapy and medicines’. These contained a list of the medicines each person was taking and some generic expected outcomes such as ‘to reduce stress and anxiety’ and ‘to promote general well-being’. However, there was no guidance for staff to follow about how each individual person would like their medication administered. We observed a nurse giving one person their medication with water. The person using the service stated the water was warm and the nurse said she would get more water from the fountain but never did. The person had to take their tablets with what they described as warm water. This meant that the individual did not have their needs met appropriately in relation to taking their medicines.

In addition to the care plans, each person had a separate ‘My Journal’ and health monitoring forms such as food/fluid intake charts and repositioning charts. The ‘My Journal’ had a section to record people’s preferences. Three of the four we looked at in the dementia care unit had not been completed, so staff could not be clear about people’s preferred daily and sleep routines, social routines, significant life events, what they liked to do and wear and their interests.

On the first day of our inspection we went to the dementia care unit, Cedar, at 07:15am. We found most people were asleep in their bedrooms. However, people’s bedroom doors were open and the corridor lights were all on. People using the service could potentially be disturbed by the lights and the noise at night. We were not able to find information in the care plans we looked at that supported this practice.

The environment was not supportive of the needs for people who had dementia. There was little in the way of signage, different settings and features of interest. Toilet and bathroom doors and people’s bedrooms had not been made easily recognisable. The manager told us that there were plans to address some of th