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Archived: Swiss Cottage Care Home

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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

The service should have quality checking systems to manage risks and assure the health, welfare and safety of people who receive care (outcome 16)

Not met this standard

We checked that people who use this service

  • Benefit from safe quality care, treatment and support, due to effective decision making and the management of risks to their health, welfare and safety.

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

The provider had failed to identify, asses and manage the risks related to the health, welfare and safety of people using the service. This was because the quality assurance systems in place were not robust or effective.

Reasons for our judgement

As part of our inspection on 14 and 22 November 2013, we reviewed the quality monitoring systems in place within the service.

On arrival in Cedar unit, we found the environment was dirty with food on the floor, dust and spilt drinks on paintwork and radiators and dirty cutlery and cups on the floor and window sills. The fridge in the kitchen in Cedar unit was dirty, and the dustbin was full with some rubbish on the floor. We observed staff making some efforts to clean up, but we noted that some of the dust and dirt was still there on the second day of our inspection. Relatives we spoke with told us they also had concerns about the cleanliness of the environment. On the first day of our inspection the deputy manager was undertaking audits. She told us that there was a different audit for each month which was required to be completed. These included care planning, medication, the environment, nutrition, training and supervisions. We were told that these had not been completed monthly because the deputy manager had been on a secondment at another home. However, whilst internal quality audits were in the process of being completed, it was evident that on a wider level, the systems in place had not identified areas of concern which we found during our inspection. For example, the provider had failed to identify the issues with the cleanliness of the environment, gaps in staff training, the lack of detailed and personalised care records and incomplete records on people’s preferences in relation to their care and a lack of meaningful activities for people using the service.

Complaints records showed that the manager took account of complaints and comments to address any concerns people raised. However, the concerns raised with us by people using the service regarding the noisy environment, the laundry and the cleanliness of the premises had not been identified or addressed. The provider had therefore failed to identify, assess and manage the risks related to the health, welfare and safety of people using the service.

This meant that the provider was not able to evidence robust quality monitoring practices within the service.