Inspection on 01/04/08 for Palm Court Nursing Home

This inspection was carried out on 1st April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Palm Court Nursing Home 05/10/07

Palm Court Nursing Home 01/06/07

Palm Court Nursing Home 24/04/06

Palm Court Nursing Home 03/10/05

Palm Court Nursing Home 27/05/05

Palm Court Nursing Home 26/11/04

Similar services:

Wingham Court

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Springfield 17 - 19 Prideaux Road Eastbourne East Sussex BN21 2ND Lead Inspector Debbie Calveley Unannounced Inspection 08:00 01st April 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Address 17 - 19 Prideaux Road Eastbourne East Sussex BN21 2ND 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) 01323 721911 01323 410244 dfbcareltd@yahoo.com DFB (Care) Ltd Mrs Janis Linda Burch Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (42) Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of fourty-two (42) service users may be accommodated. Service Users must be older people aged sixty-five (65) or over on admission. To have physical disability and/or nursing needs. Only older people with dementia-type illnesses may be accommodated. Service users to have a physical disability and/or nursing needs. Date of last inspection 27th December 2007 Brief Description of the Service: Springfield is registered as a care home providing nursing care for forty-two residents with dementia and physical disability over the age of 65 years old. A new wing has been added to provide twelve single bedrooms with ensuite, a large lounge, two new sluice areas, bathrooms and a nurse’s station. The accommodation consists of twenty-two single rooms, sixteen of which have ensuite facilities, ten double bedrooms, four with an ensuite facility. The kitchen is centralised and serves the entire home and there are three communal areas, two lounge areas and a dining room lounge area for residents There is one laundry room and there are adequate bathing facilities for the residents. There is one clinical room and once again this is central to the whole building. The home has a passenger lift and stair lift which provides access to all areas of the home. There is a large garden area that is well maintained and consists of a patio area, sensory garden and lawn and is assessable to wheel chair users. There is no car park but unrestricted parking is allowed in Prideaux Road. There is a bus route nearby and the home is approximately 15 minutes from the town centre. The Fees charged as from 1 April 2006 range from £509 to £700, which includes basic toiletries. Additional charges are made for hairdressing, chiropody, and newspapers and outside activities. Intermediate care is not provided. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 5 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 was a key inspection that included an unannounced visit to the home and follow up contact with resident’s representatives and visiting health and social care professionals. This unannounced inspection was carried out over 6.5 hours on the 01 April 2008 by two inspectors. There were twenty-eight residents living in the home on the day, of which six were case tracked and met. During the tour of the premises four other residents both male and female were also spoken with. The purpose of the inspection was to check that the requirements of the last inspection had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including the Service Users Guide, Statement of Purpose, care plans, medication records and recruitment files. Four members of care staff and the cook were spoken with in addition to discussion with the provider and manager. Contact was made with visiting professionals following the visit and two relatives were spoken with during the inspection visit. The information received verbally and from four surveys received have been incorporated into this report. The inspectors would like to thank the residents and staff for their welcome and hospitality. What the service does well: The home provides prospective residents and their families, with a good level of information about the services provided at the home. Springfield Care Home provides well-furnished, comfortable and clean communal areas for the people living in the home and for those visiting. The standard of decoration is good with relaxing colours and good quality furnishings. Comments received included: High standard of cleanliness achieved’ All bedrooms have beds suitable for the needs of the people using the service with specialised equipment for protecting those at risk from pressure damage. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 6 The training for staff is good, and covers a wide variety of resident related conditions, which give the staff an understanding of the residents needs. The new sensory garden and patio areas are attractive and assessable to all residents. There is an open-house policy, which welcomes visitors at all reasonable times. Comments received included ‘ Wonderful home’ ‘ always a warm welcome’ ‘ the staff are very kind and caring’. The introduction of regular relative meetings has proved beneficial in promoting good communication between the home staff and families. Comments received from relatives include: ‘My relative was so happy and peaceful there, cared for by the most caring people I have ever encountered’ What has improved since the last inspection? What they could do better: The care documentation including individualised care plans and risk assessments need to be improved to ensure residents receive appropriate and person centred care that meets their assessed needs and to minimise any risks. Further improvement is needed in order to promote meaningful individual social contact and activities in the home. The quality of the food prepared is of Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 7 a good standard, however choice and flexible availability of food could be improved. Staffing levels and skill mix needs to be assessed against the specific needs of the residents and level of activity in the home to ensure appropriate staffing provision at all times. In addition a number of health and safety issues were identified including trip hazards, insufficient monitoring/supervision of residents and lack of individual and environmental risk assessment processes. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 8 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 Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides prospective residents and relatives with a good level of information about the home, its facilities, services and the costs involved. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission. EVIDENCE: There is now a range of well-documented information about the home and the services it provides. The home has a comprehensive Statement of Purpose and a Service Users Guide and copies of these are available along with the last inspection report and a copy of the homes terms and conditions of residency in the entrance hall of the home and on request. It would however benefit the residents if the documents were written in a more user-friendly format. There are plans to develop a CD rom for prospective residents and their families in the near future. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 10 The registration certificate is clearly displayed and was found to be accurate. The last two admissions to the home were identified and the records relating to the admission procedures for one was followed and reviewed. This confirmed that pre admission assessments are completed and provide an adequate assessment of prospective residents care needs. These are completed by the manager or the provider and confirmed that these are used to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. It was discussed that the document used at this time does not allow for the people involved in the assessment to be documented and would benefit from more detailed information. The admission document is currently under review. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. It was confirmed that the home now confirms in writing that the home can meet the assessed needs of the prospective resident. Short- term respite care is offered and the pre admission procedures followed are the same as for a long-term admission. Intermediate or rehabilitative care is not provided at Springfield Care Home. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans provide an adequate framework for the delivery of care, which give guidance to care staff on all the care needs of all the residents. However, further improvements are needed in order that they more accurately reflect current needs, are easier to follow and provide clear evidence that agreed actions to meet needs are being carried out. The home was found to be meeting resident’s health and general needs with accessed additional specialist support when needed. Procedures and practices in the home allow for the safe administration of medicines and on the whole the privacy and dignity of residents to be promoted. EVIDENCE: Six individual plans of care were reviewed in depth as part of the inspection process and these identified that plans of care are written according to residents individual needs giving guidelines to care staff on how to care. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 12 However it was noted that the care plans did not reflect all the care needs or accurately reflect the care to be provided as the information was misleading. There is a lot of information not all relevant included and it was difficult to track residents care. It would therefore be difficult for new staff to pick out the necessary information to care for their residents. For example, one resident’s care plan indicated some behavioural issues but there was some contradictory advice for staff to follow. It was also noted that resident’s social emotional and psychological needs and communication needs were not thoroughly assessed or addressed within the care records. It would improve interaction between the residents and staff if there was clear guidance on the best ways to communicate with individual residents. Systems for assessing resident’s risk of developing pressure sores are in place alongside input from specialist nurse notes, however these need to be followed up thoroughly within the homes care documentation. There was evidence of nutritional risk assessments and residents are weighed monthly, however as discussed the weights evidenced erratic losses and increases, some on a monthly basis and the system in use needs to be reviewed to ensure that it is used consistently to provide accurate recording. Recording and staff direction for food supplements and fortifying drinks needs to be clearer. There was evidence to confirm that staff are recording the care provided, and when spoken to said that they read and understood the plans of care, although having time to read them could be difficult. Staff receive a report on each resident daily and felt that their views were taken into account when planning resident’s care. There was however little evidence that the plans of care are written in consultation with residents or their representatives. It was also noted that the use of risk assessment was very limited; for example ‘bed rails’ were in use without appropriate risk assessment and the use of call bells and medication and review of medications are not documented. Those risk assessment completed for nutritional screening, falls and moving and handling need to be based on clear criteria and followed up within the care documentation. Records indicated that local Doctors are called regularly and are involved in the care of residents. The home manager and the registered provider confirmed that specialist external advice is sought as necessary and included the Dietician and regular visits from a privately employed Tissue Viability Nurse. It was noted that residents once placed in a chair in the lounge areas were not moved or stood for some hours, this needs to be addressed. The clinical room has been refurbished and is well equipped with appropriate lockable cupboards. There is a small fridge and temperatures of the room and Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 13 fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts were found in the main to be competently completed, however a few gaps were noted. Medications that have been refused or omitted need to be documented as instructed by the dispensing chemist on the back of the administration chart. The comparison signatures of staff able to administer medication need to be updated to provide a clear audit trail. Verbal orders need to be signed and dated as do changes to medication. ‘As required (PRN) medication for various health needs did not have any guidelines in place for when to use the medication. These areas of practice were discussed with the senior nurse on duty during the inspection. The staff were seen being respectful and kind to the residents, there were called by their preferred names and were dressed in clean appropriate clothes. Staff need however to explain/talk to residents when using equipment such as hoists. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. Activities need to be developed and residents enabled to have greater opportunities to make choices. EVIDENCE: There are no planned activities in the home at this time. From discussion with staff, it is stated that a member of the team is delegated activities on a daily basis. On the day of the inspection there were no activities observed. The board in the lounge stated ball games in house 17 and reminiscence in house 19. Discussion with the management team and information taken from the Annual Quality Assurance Assessment completed by the provider stated that improvements planned include ‘Develop further activities for physical and psychological motivation’. At present the staffing levels are insufficient to allow the staff to ensure that the residents are involved in stimulating activities. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 15 The site visit evidenced that the residents and staff interact positively when time allows, however staff need to ensure that when moving residents they talk to them and explain the manoeuvres undertaken. At times during the site visit there were insufficient staff to appropriately supervise and monitor the residents well being. Residents were seen to be left sitting in one position for long periods of time, either dozing or just sitting. This was discussed with the manager during feedback. The staff confirmed that visitors are welcome at any time and there are regular relatives and friends that visit the home. There were two visitors at the time of the inspection to talk to, and their comments included ‘ every thing is fine, they look after people well and are friendly and caring’ ‘ no problems that I know of, all seems very good’. A new chef has been appointed since the last inspection, although he has only been at the care home about two months. He has already identified some menu choices that are not popular, resulting in food being wasted. He intends to work with the manager and provider who has responsibility for the menu planning and food ordering, to provide a menu that includes more food that residents enjoy. Another improvement since the last inspection is that residents are offered a choice at all meals, with this being recorded daily and passed to the chef each morning. Care staff also complete a form to record how much each resident consumed for each meal, in order to more closely monitor the food intake for all residents. This will quickly identify residents who may not be eating sufficient. Whilst choice has been extended at meal times, a member of care staff was observed putting sugar in all residents’ tea without checking whether all wanted this. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to record and investigate complaints. Training in adult protection is provided for staff to protect residents from abuse. EVIDENCE: The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. There have been no complaints received by the home or CSCI since the random inspection on the 27 December 2007. Relatives spoken with said that they were confident that the management of the home would respond positively to any concern raised. The surveys received all indicated that they were confident that there complaints if they had any would be dealt with appropriately, one survey stated ‘ no need !’. There are policies and procedures in place in regard to protection of vulnerable adults (POVA) and staff spoken with were aware of the policies and confirmed they had received appropriate training. Records also confirmed that the Registered Provider and staff have received appropriate training on safeguarding adults and the home has a whistle blowing procedure. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 17 There has been two level 3 Adult Protection investigations raised since the last key inspection and these were investigated by Social Services. The concerns raised in one were care practices in respect of tissue viability and the quality and quantity of food. These were substantiated and the home have taken advice from a private tissue viability consultancy, the hospital dietician and have employed a new chef. The second investigation is still awaiting a closure meeting. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Springfield provides residents with a comfortable, clean and safe environment for those living there and visiting. There is a choice of communal rooms and a shaft lift that enables them to have access to all parts of the home. EVIDENCE: A tour of the home confirmed that the home is well-maintained, shortfalls previously identified have been addressed. Bedrooms in the older part of the building are being decorated when they become vacant. The new building is furnished and decorated to a high standard. During discussion with the manager and maintenance person it was stated that there is an ongoing maintenance programme at the home, with repairs carried out when the need arises. The records of routine safety checks were available for viewing, and were all up to date. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 19 The garden is of a good size and has an attractive patio and a sensory garden with a seating area and is accessible to all residents during the warmer weather. The communal areas are light and decorated in quiet colours and allow for different uses as required by the people who use the service. There are sufficient communal bathrooms and shower rooms in the home, with specialist equipment to ensure all residents can have a bath or shower. The wet room in Tulip unit however is cold and this needs to be monitored when in use. There are call bell facilities in place, however it was identified again that they are not always accessible to residents. As discussed at previous inspections it is acknowledged that not all residents will be able to use a call bell, so there is an identified need for individual risk assessments concerning call bells and a document to ensure that all residents in their rooms without access to a call bell are checked regularly. This was a requirement at the last inspection and therefore remains outstanding. There are hoists and other equipment in the home to cope with the needs of the residents. The new building has wide corridors with rails, which will encourage the residents to mobilise. All the residents have suitable height adjustable bed with bed rails if required. There are airflow mattresses in place for residents at risk from pressure damage, regular checks of equipment needs to be maintained to ensure they are functioning properly. The inspection took place from 08:00 am and the communal areas of the home were clean and welcoming. As discussed there are rooms that have a malodour and this is being addressed, but other action may be required. Some rooms visited did not have paper towels and liquid soap, this is necessary in order to promote good hygiene and prevent cross infection. Bins in bathrooms were found to have no tops and were being used for the disposal of incontinence pads. There is one laundry room to cope with the homes laundry; The resident’s clothes looked well cared for and clean. The surveys received confirmed that the cleanliness of the home was always good: ‘ very clean, good’ ‘high standards achieved, rooms especially kept very clean’. Good practice was seen during the inspection in respect of the use of gloves and aprons, and all equipment in use was in good condition and clean. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A review of staffing levels based on residents’ dependency levels needs to be implemented to ensure there are sufficient skilled staff to meet residents needs. Robust recruitment procedures are in place to protect residents, and staff training ensures they are aware of their roles and are able to provide the support and care the resident’s need. EVIDENCE: The staffing rota in place was viewed, it identified that the staffing levels for the day and night shift are inconsistent and on occasion falls to just two carers and one trained at night and five staff on a day shift A follow up telephone conversation confirmed that the staffing rota viewed was not correct and did not reflect the actual staff working. This will be reviewed at the next key inspection. From direct observation and from talking to staff there are not enough staff to meet the complex and varied needs of the residents, Staff had little time in the morning to interact with residents because they were very busy. There are also a number of residents that are mobile and it was not possible to monitor these residents adequately. On two separate occasions during the site visit, it was noted that more staff were needed to meet the needs of the residents and Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 21 promote their well being. An audit of the accidents and falls recorded may be beneficial in identifying times of the day or night that may require more staff. Staff spoken with said that they felt more staff would enable them to spend more time with individual residents, they also confirmed that they did not have time to provide activities or one to one sessions. Surveys received stated ‘have noticed staff shortages, but they all work hard’. From information received from the provider the home employs seventeen carers; of those two have the National Vocational Qualification (NVQ) level 2 or 3 in care and fourteen are currently enrolled on NVQ courses. The recruitment practice and records were inspected for four staff members working in the home as part of the inspection process. This review identified an improvement in the recruitment processes in the home. From the records seen and from talking to new staff, not all staff have undertaken their ‘skills for care’ induction programme, all new staff undertake the homes induction process and it was confirmed that they will all also undertake ‘skills for care’ in the future. There is a training matrix in place that ensure that staff receive the necessary mandatory training in moving and handling, infection control, POVA and fire safety. Records produced also demonstrate that staff are receiving training in dementia, tissue viability, medication and health and safety. The training matrix needs to be kept updated. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management approach at Springfield is open and encourages residents, relatives and staff to be actively involved in the lifestyle provided in the home. The health and safety of residents are promoted through an ongoing training programme for staff and up to date policies and procedures. EVIDENCE: Since the last inspection a manager has been recruited to the vacant post. She has been in post for one month and is due to be registered by the CSCI in the near future. She is a dual registered general and mental health nurse with experience in working in the care home setting as a manager. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 23 The registered provider is working alongside the manager in this introductory period. The manager is aware of the problems that the home have experienced in the past and is already introducing new documentation and supervising practices in the home. There are systems in place to monitor the quality in the home and include the use of questionnaires and relative meetings. There was evidence of an audit of responses and of action to be taken to address the issues. It was recommended that the use of questionnaires is extended to staff and visiting professionals. The provider confirmed that Regulation 26 visits are being performed, but not formally documented. As discussed this needs to be implemented. A copy was received from the provider following the site visit so therefore a requirement has not been made at this time, however it will be reviewed at the next key inspection. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. A sample of residents’ personal allowance finance records were viewed, and errors were identified in that not all transactions were supported by a receipt, this was fully discussed. The Registered Provider confirmed that formal documented supervision has commenced with all staff, staff spoken with confirmed that they had received supervision sessions. Records and discussion with the management confirmed that staff receive the necessary mandatory training, however the system used needs to be kept current. Policies and procedures to ensure best practice and the health and safety of staff and residents have recently been updated, they however need to be easily accessible to staff and kept in the clinical room or ground floor office. The health and safety of residents are in the main promoted, however as previously mentioned all residents need to have access to a call bell or a system in place to check on residents safety and well being. There were also certain trip and fall hazards noted and these included loose fitting rugs in ensuite bathrooms that pose a risk to mobile residents and those that use walking frames. From direct observation staff were seen using safe moving and handling techniques during the inspection. Risk assessments still need to be developed for the individual residents, premises and the garden areas. The accident book was viewed and it was identified that there had been a large amount of accidents in January and February 2008, (very few in March) Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 24 accidents need to be audited and signed off by the manager/provider and the results used to promote the safety of the residents living in the home. Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 25 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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X 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 3 3 3 2 3 3 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 2 3 3 2 Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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(1)(2) 12(1)(a)( b) Requirement That the registered person ensures that all the care plans reflect the specific needs of service users in respect of behavioural traits, nutrition and social interaction and give clear guidance for staff to follow to deliver consistent care. That when possible the relatives or representatives are involved in the care planning process and monthly review. 2. OP8 14(1a)(a) (b) 13(1b That the registered person ensures that nutritional assessments to be completed in full for all residents and linked to the care plan with reference to their documented weights. That suitable risk assessments are completed in all areas of risk and cover the use of bedrails, medications, risk of choking and risk of falls to promote resident safety. 3. OP9 13 (2) That the registered person DS0000059836.V361215.R01.S.doc Timescale for action 01/07/08 01/07/08 01/07/08 Version 5.2 Page 27 Springfield ensures records relating to medicine are completed and accurate. This must include details of all deviations from the norm and ensure that verbal changes and new orders are signed and dated. That the staff signature recognition list is updated to provide a clear audit trail. 4. OP12 16(1)(2) (n) That the registered provider ensures that all service users have a social care plan that is designed to meet their interests and preferences, especially the service users isolated in their bedrooms to ensure that they receive interaction and stimulation. That the registered provider ensures that service users are supported and enabled to exercise personal autonomy and choice and this is demonstrated in individual care plans. That the Registered Provider ensures that the specialist equipment is appropriately provided and risk assessed for individual service users. This pertains to the call bell facility. That the Registered Provider ensures that malodours are investigated and eliminated. That all rooms have liquid soap and paper towels. That all bins used for the disposal of incontinence pads have tops. 8. OP27 18 (1) That the Registered Provider ensures that there are sufficient DS0000059836.V361215.R01.S.doc 01/07/08 5. OP14 12 (2) (3) 01/07/08 6. OP22 16 (2) ( C) 01/07/08 7. OP26 13 (3) 16 (2) 01/07/08 01/07/08 Page 28 Springfield Version 5.2 staff on duty to meet the needs of the service users at all times. (Previous timescales of 24/10/07 & 28/12/07 not met.) 9. OP35 17 (2) That the registered person ensures that the processes in place to safeguard service users monies are transparent and robust and all transactions have receipts. That all accidents recorded have an appropriate action plan devised to prevent reoccurrence of accidents as required under Regulation 17 Schedule 3 and 4. That risk assessments of the environment are undertaken which includes the regular inspection of all parts of the building to which residents have access, ensuring that any unnecessary risks are identified and so far as possible eliminated. These include identified trip hazards- flexes of portable heaters, mats and access to bathing lotions. That risk assessments regarding access to the call bell facility are in place. (Previous timescales of 24/10/07 & 28/12/07 not met.) 01/07/08 10. OP38 13(4)(c) 01/07/08 Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield DS0000059836.V361215.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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