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Inspection on 01/06/07 for Palm Court Nursing Home

Also see our care home review for Palm Court Nursing Home for more information

This inspection was carried out on 1st June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Springfield Care Home provides a well-furnished, clean and comfortable environment for the people living in the home and for those visiting. The standard of decoration is good with relaxing colours. The atmosphere at the home was relaxed and many residents were able to choose to spend their time in the lounges or in their own rooms. The gardens are attractive and safe. Communication between residents and staff was friendly and reflected the staffs understanding of their needs and the support they require. Some residents spoken with were positive about the care provided saying the staff are `very nice`. Visitors were equally positive saying the home is very good and the staff are courteous and friendly. The Pre-admission assessment was seen to be thorough and ensures that the home can meet the identified needs before admission. There is an open-house policy, which welcomes visitors at all reasonable times. The introduction of regular relative meetings has proved beneficial in promoting good communication. Satisfactory arrangements are in place to safeguard residents` finances. Good practice was seen throughout the inspection in moving and handling techniques and infection control measures. The plans for the home include the introduction of a sensory garden, which will include water features, lights and strong smelling plants. A snoezellen room is to be created for residents to be supervised whilst inducing calmness and relaxation.

What has improved since the last inspection?

There has been significant improvement since the last key inspection in many outcome areas. The building of a new wing has improved the communal space available to residents and provided a dining room. The old building has new furniture and fittings, which has improved the ethos of the home. Much redecoration work has been undertaken, which has been done to a good standard and creates a comfortable and domestic environment throughout. The maintenance of the home has improved and the home was seen to be safe and well maintained. It was confirmed that the staffing levels are flexible and can be increased if the needs of the residents increase. The training of the staff is on going and a matrix evidenced that the staff are attending courses, which enable them to perform their jobs competently. The introduction of regular audits of the home`s practices has helped to identify areas for future service development and improvements. Relative meetings have been introduced and have been beneficial in creating good lines of communication.

What the care home could do better:

Care planning needs to provide the necessary guidance for staff on how to meet the wide range of residents assessed needs. It is necessary to ensure that all risk assessments are updated regularly to reflect the changing needs of the residents. It was identified that residents` accidents were not being documented correctly and followed through with a risk assessment and plan of action to avoid a reoccurrence. Staff need to follow the policies and procedures in medication practices to ensure the safety of the residents. Although there is evidence of activities taking place for some residents, it did not include some residents that remain in their room with little interaction, and there was little documented in the social care plans to reflect how staff can meet their social needs. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. Staff deployment must be reviewed to ensure there is sufficient staff on duty as is necessary to meet the assessed needs of residents at key times, in particular at meal times. This was highlighted by relatives in the surveys received and from anonymous complaints received. Recruitment practices must improve to ensure the protection of residents. In addition a number of other health and safety issues were identified, and advice was to be sought from the environmental health department.

CARE HOMES FOR OLDER PEOPLE Springfield 17 - 19 Prideaux Road Eastbourne East Sussex BN21 2ND Lead Inspector Debbie Calveley Key Unannounced Inspection 12:00 1st June 2007 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.V339095.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.V339095.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 Vacant 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.V339095.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of forty-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 2nd October 2006 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 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.V339095.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The information contained in this report has been compiled from an unannounced site visit undertaken over 6 ½ hours by two inspectors plus information gathered about the home since the previous inspection. This includes survey questionnaires, discussion with stakeholders involved in resident’s care, records submitted to CSCI, which have included an Annual Quality Assurance Assessment (AQAA) and the notification of accidents and incidents. There were 32 residents living in the home, of which six were case tracked and spoken with. During the tour of the premises a further six residents of both sexes were also spoken with and three relatives. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including care plans, medication records, training records and recruitment files. Surveys were received from eight relatives and verbal feedback received from two Health Care Professionals. The Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at the home will be referred to as residents. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Springfield Care Home provides a well-furnished, clean and comfortable environment for the people living in the home and for those visiting. The standard of decoration is good with relaxing colours. The atmosphere at the home was relaxed and many residents were able to choose to spend their time in the lounges or in their own rooms. The gardens are attractive and safe. Communication between residents and staff was friendly and reflected the staffs understanding of their needs and the support they require. Some residents spoken with were positive about the care provided saying the staff are ‘very nice’. Visitors were equally positive saying the home is very good and the staff are courteous and friendly. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 6 The Pre-admission assessment was seen to be thorough and ensures that the home can meet the identified needs before admission. There is an open-house policy, which welcomes visitors at all reasonable times. The introduction of regular relative meetings has proved beneficial in promoting good communication. Satisfactory arrangements are in place to safeguard residents’ finances. Good practice was seen throughout the inspection in moving and handling techniques and infection control measures. The plans for the home include the introduction of a sensory garden, which will include water features, lights and strong smelling plants. A snoezellen room is to be created for residents to be supervised whilst inducing calmness and relaxation. What has improved since the last inspection? What they could do better: Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 7 Care planning needs to provide the necessary guidance for staff on how to meet the wide range of residents assessed needs. It is necessary to ensure that all risk assessments are updated regularly to reflect the changing needs of the residents. It was identified that residents’ accidents were not being documented correctly and followed through with a risk assessment and plan of action to avoid a reoccurrence. Staff need to follow the policies and procedures in medication practices to ensure the safety of the residents. Although there is evidence of activities taking place for some residents, it did not include some residents that remain in their room with little interaction, and there was little documented in the social care plans to reflect how staff can meet their social needs. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. Staff deployment must be reviewed to ensure there is sufficient staff on duty as is necessary to meet the assessed needs of residents at key times, in particular at meal times. This was highlighted by relatives in the surveys received and from anonymous complaints received. Recruitment practices must improve to ensure the protection of residents. In addition a number of other health and safety issues were identified, and advice was to be sought from the environmental health department. 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.V339095.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.V339095.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. Pre admission assessments are completed to ensure the home can meet the needs of prospective residents, and they are encouraged to visit the home. EVIDENCE: The Statement of Purpose was available for viewing and contains most of the information required in the regulation; some areas were discussed as in need of expanding. The Registered Provider has agreed to review this document immediately to ensure it contains the necessary information. Therefore it will not be a requirement. The Service Users Guide is in draft form at present. A copy was provided for viewing. It is now in a brochure format and is colourfully presented with photographs of staff and residents. It also contains information regarding the sister residential home. It is written in plain English and includes information about life in the home, accommodation, staff and facilities available at Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 10 Springfield. It does not however mention the availability of the last inspection report. Relatives spoken to during the inspection visit said they were not aware of these documents and were not aware of the last inspection report. Staff members that were working in the home were not fully aware of the Statement of Purpose and Service Users Guide. The contracts and terms and conditions of residency were seen, there were inconsistencies noted. On the basis of this evidence, it is necessary for the provider to review the contract with specialist advice to ensure that any amendments made are clear and transparent. The Provider was agreeable to review any inconsistencies. The pre-admission assessments of three new residents were seen and were found informative and completed in full. A recommendation of good practice would be to document who was present at the assessment as part of the process to gain relevant information. The staff spoken with are aware of the registration category of the home and feel confident that they have the necessary skills and training to meet those of the residents living in the home. One member of staff spoke positively of the training she has received since working at the home. The home is committed to improving the outcomes for residents suffering from a dementia- type illness. The home does not provide intermediate care. Springfield DS0000059836.V339095.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. Not all care plans provided pertinent information and guidance for staff on the range of individual residents assessed needs. Relatives felt that their relatives were treated with respect and sensitivity. EVIDENCE: The present system of care planning has been in place now for six months and It was clear that much work has gone into the development of care plans. However not all contained the information necessary to ensure all staff are aware of the specific needs of the residents. Examples were noted in care plans where not all of the residents needs had been recorded with the necessary guidance provided for staff to follow. One resident had dressings on both shins from an alleged accident but there was no care plan with any information regarding skin damage or a risk assessment to prevent a reoccurrence. There was a good standard of recording daily events by the nursing staff. However the care plan needs to be promptly updated Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 12 with any significant events and observations in order to inform the care staff of changes in the needs. Some care plans contained out of date information. The care plans all contained risk assessments on the main risks faced and posed by residents. These included the action needed to manage or reduce any risks. Examples were noted whereby these had not been updated to reflect major changes in needs and provide staff with the necessary information to manage the risks. Staff consulted showed a good working knowledge of how to manage the challenging behaviour of several residents, however this was not always recorded in the care plan as information for the whole of the staff team. Particular areas that were found in need of robust inclusion in care plans were continence management, skin damage, communication and social needs. It was not evident from the documentation available at this time whether all the health, social and personal needs of the residents were being met. In line with good practices in dementia care it was discussed that the care planning documentation should also include the strengths of the individual and be person centred based. Four surveys received from relatives were all positive regarding the care given by the staff at Springfield Care Home. ‘ an excellent home’ ‘staff are wonderful’ ‘ very good’. The clinical room was clean and tidy though rather crowded now there are two medication trolleys in the room. The medication cupboards and medicine trolley were found clean, well organised and locked. The room temperature and clinical fridge are recorded daily and documented. A medication round was observed and good practice in administration was noted. The medication administration records (MAR) were also viewed and there were no gaps identified, however verbal orders and changes prescribed by the G.P need to be signed and dated. A discrepancy was found in the MAR and this was fully discussed during the inspection, it needs to be followed up by the Registered Provider and fully investigated. It was also brought to the Registered Providers attention that prescribed topical creams and drink thickeners are being used inappropriately. The staff were seen treating the residents with respect and dignity and the interaction observed between the staff and residents was positive and friendly. The staff continue to gain confidence in dealing with the residents that live in the home and are enjoying the training provided. Relatives spoken with during the inspection were complimentary regarding the patience and commitment of the staff. Two health professionals that visit the home were impressed with the improvements made to the home. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 13 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. Meals remain good in respect of quality, however the choice is limited. The lifestyle experienced by residents does not always match their expectations, choice or preferences. EVIDENCE: Care plans evidence some residents past histories and social preferences, but they are not linked constructively to the activity programme. From direct observation, the morning shift did not evidence any activities and when asked the staff said that the activity co-ordinator was on holiday. The staff said that they were doing activities with the residents. The afternoon activities were undertaken in the main lounge area and involved a small percentage of residents catching and throwing a ball. A little later on, a member of staff put on some sing a long music for the residents to participate in. The negatives to these activities were that it was very warm, the residents had not long had lunch and many were asleep, the music came on suddenly with no verbal comments from staff so many residents did not participate. The positives were that the staff demonstrated enthusiasm and patience. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 14 There is an activity log, which was viewed and did demonstrate some individual residents participation in a selection of various activities. However the care plan activity sheet indicated that all residents sung everyday, which for some residents would not be possible and indicated very little choice or stimulation. The Activities were discussed in depth and the provider is to review the current programme to ensure that it meets all the resident’s preferences and capabilities. There are plans for making more use of the garden area in the near future. A relative survey received stated ‘no organised activities, need more’ another said ‘ I worry that they do not do very much’. Visitors are welcome at any time, those spoken with said they feel comfortable visiting their relatives and friends, they are sure ‘they are well looked after’, and feel that they can talk to the staff if they want to know anything or have any concerns. The staff said residents are encouraged to make choices about all aspects of their day to day lives, and three residents said they are able to choose how they spend their time, in their own room or in one of the lounges, and the staff are there to help them as necessary. From information gathered from surveys, from talking to residents, staff and relatives, there is a more flexible life style than previously found. Residents choose their preferred routine for waking, breakfast and going to bed. The residents choose where they spend their time from a wider choice of communal areas. There is a need though to evidence the choices regarding meals and activities. The care plans of residents unable to make choices need to reflect how the staff enable and support residents in making choices. The kitchen and storage areas were found clean and well organised. There has been a recent environmental health inspection, which did not raise any concerns. The meals prepared are recorded daily in the kitchen diary, the cook does not keep a record of amount eaten or who did not eat the meal, it was thought that the care staff do. This was found not to be happening staff and a formal system is required. This will enable staff to track appetite trends, identify a potential risk and provide information for the G.P or Specialist when a problem arises. The Provider states that staff would pick up on poor appetites, but as demonstrated during the inspection it had not been identified that a resident had eaten very little. The menus were viewed and demonstrated a variety of plain wholesome food, there seemed to be some diversion to the menu when examined alongside the diary, and the cook said that that it depended on what was available. It would be beneficial for the cook to have the preferences of the residents, that information may be sought from family and friends if the resident is unable to state their likes and dislikes. Diabetic diets are catered for and it was found that they are not routinely offered the same puddings as shown on the menu Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 15 and it was discussed that low fat cooking ingredients could be used to explore the choices available. The choice of meals available was limited, and only one meal was prepared, this would be more understandable if there was a comprehensive list of likes and dislikes of each resident. The introduction of a dining room has proved beneficial in creating a homely atmosphere for the residents to eat their meals. Staff deployment at meal times was seen to be difficult as there are a number of residents needing assistance, which meant some residents were seen struggling with their meal for some time. Staff however were seen assisting the residents in the communal areas in a dignified manner and respectful manner. One resident said he “thought the food was really nice’ another said ‘very tasty’. Feedback from a relative survey highlighted that ‘morning and afternoon tea and cakes are often stale or hard to eat’. Springfield DS0000059836.V339095.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: A policy and procedure is in place for dealing with complaints and this is also outlined in the Statement of Purpose and Service Users Guide. The Provider is aware of the timescales set down for dealing with complaints and a complaints log is available. There have been no formal complaints made to the home since the last inspection. There have however been four anonymous complaints received by the CSCI, which were fully investigated by the Registered Provider. Relatives spoken with confirmed that they would be confident to raise their concerns if they had any with the staff on duty. None of the residents were able to confirm their awareness of the complaint system. The introduction of regular relative meetings has improved communications in the home. 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 training. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 17 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 safe, homely and comfortable environment with communal rooms and a shaft lift that enables them to have access to all parts of the home. Training in the control of infection is provided for staff to protect residents. EVIDENCE: Springfield Care Home provides a comfortable, clean, homely and wellmaintained environment for the residents that live there and for relatives and fiends visiting. The new wing has provided an extra twelve single ensuite bedrooms, communal bathrooms and a large lounge area. The home has refurbished all the bedrooms to a high standard, they are homely and comfortable with furniture that is appropriate for the residents Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 18 individual nursing needs. The residents are encouraged to bring their own possessions with them, and there was evidence of pictures and ornaments in some rooms. There is an ongoing maintenance programme at the home, with repairs carried out when the need arises. The records of routine safety checks were not available for viewing, and it was explained that there is a new maintenance person who had the records. It was stated by the Provider that all they were all up to date. There is now a choice of two lounges, a smaller lounge within the older building, and a large new lounge in the centre hub of the home. The lounges areas are attractive, comfortable with good quality furniture. There is a need to review the positioning of the chairs in the main lounge to make maximum use of the light airy pleasant room. There are attractive garden and patio areas to the rear of the property for the resident’s to enjoy in the good weather. There are call bell facilities in place, though not always accessible to residents, the lounge areas need a facility that the residents/relatives or staff can reach. 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. 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. The standard of cleanliness in the home was of a good standard, only one room was malodorous, and that was discussed with the Provider. There is now one laundry room to cope with the homes laundry. The resident’s clothes looked well cared for and clean. Two relatives said that they appreciated the care taken with the clothes and the cleanliness of the home was very good. Surveys received were complimentary regarding the cleanliness of the home. Good practice was seen during the inspection in respect of infection control measures. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 19 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. The staffing levels and skill mix of staff ensure that the needs of the residents living at Springfield are met. EVIDENCE: There is now a staffing rota in place. The staffing levels were seen as satisfactory to meet the needs of the residents at this time. Staffing levels are said to be flexible in that if identified needs increase, then extra staff will be brought in. Meal times are busy and this area needs to be monitored to ensure enough staff are available to offer support to frail residents. Staff spoken with said that they felt there were sufficient staff on duty to give a good standard of care and to spend time with residents on a one to one basis. Relative’s feedback was mixed in that three said staffing levels seemed to be good, whilst two felt that the staff were stretched at times. At present the home employ seventeen carers; of those only one has the National Vocational Qualification level 2 in care and two are currently on the course. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 20 The recruitment records of six new staff members were viewed. They were difficult to follow and only four staff evidenced that the recruitment process had been fully completed. An audit trail needs to be developed. One did not have a copy of an application form, two did not have written references, and only two had evidence of an induction programme. All of the six had had a Criminal Record Check (CRB) and Protection of Vulnerable Adults (POVA) Check, but not all had a start date documented to clarify the checks. There is now a training programme 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 produced did not have dates of attendance and it is a recommendation of good practice that dates are included so as to ensure that updates are provided within the recommended time frames. The practices observed during the inspection were good, safe moving and handling techniques were used as were appropriate use of gloves and aprons. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 21 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. Additional management is needed to help improve the effectiveness of the management team at the home. Staff must be appropriately supervised to ensure good care practices are consistent throughout. The health, safety and welfare of residents and staff is being promoted and protected. EVIDENCE: The home has been without a registered manager for two years, and the Registered Provider has been taking on the responsibility of the day-to-day running of the home alongside a prospective manager. The prospective manager has been in post for six months and has yet to submit her application. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 22 There is a more structured management approach to managing the home and that has been proven by the improvements seen since the last key inspection. However this needs to be formalised by the appointment of a Registered manager. A full time administrator has recently been employed to assist with the running of the home. The introduction of formal quality assurance and quality monitoring systems has enabled the management to objectively evaluate the service and ensure it is run in the residents best interests. The introduction of relative meetings has improved the communication and has had an impact on the amount of complaints received in the home. The quality assurance results have yet to be audited. 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 four residents personal allowance finance records were viewed, which evidences lists of money in and out with receipts. During a discussion with the Registered provider, staff supervision was discussed and instead of individual formal staff supervision, it was confirmed that formal group supervision is now being held. At present not all staff have received the mandatory training in moving and handling, health and safety and fire safety. However, there is evidence of a rolling plan of training that will address this. Safe moving and handling techniques were observed throughout the inspection. Risk assessments need to be developed for the individual residents, premises and the garden areas. The accident book was viewed and staff are not following the correct procedures in the safekeeping and completion of the accident forms. Not all residents’ accidents had been recorded and one resident who had had multiple falls since his recent admission had not been reassessed to promote and ensure his safety. During the tour of the building a few concerns were raised regarding window restrictors on the ground floor, locks on sluice doors and an identified residents door that is held open in an inappropriate way. The Registered Provider has agreed to seek advice from Environmental Health Department. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 23 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 2 2 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 2 2 Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 24 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 care plans accurately reflects the needs of the service users and are updated on a regular basis. That service users and/or their representatives are consulted regarding the formation of the care plans. That all risk assessments are updated regularly and include an action plan for staff to follow. That accurate records pertaining to nutrition, wound care, continence and communication are further developed and accurately reflect the service users needs. Medication administration record charts must reflect current medication profile and must be a true and accurate record. That the discrepancy found is fully investigated. That prescribed topical creams are used appropriately. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 25 Timescale for action 01/09/07 2 OP8 14(1a)(a) (b)13(1b) 01/09/07 3 OP9 13 (2) 07/06/07 4 OP12 16(1)(2) (n) That all verbal orders and changes to medications are signed and dated. That all service users have a social care plan, that is designed to meet their interests and preferences. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. 01/09/07 5 OP14 12 (2) (3) 6 OP15 16 (1) (a) (Previous time scale of 31/07/06 not met.) That service users are enabled to 07/06/07 exercise personal autonomy and choice and this is demonstrated in individual care plans. That service users are offered a 01/09/07 choice of meal. That a formal monitoring of service users appetites and amount consumed is kept. 7 OP29 (Previous time scale of 31/07/06 not met.) 19(4)(a-c) That a thorough recruitment process is followed. All staff to receive terms and conditions of employment, have a copy of the GSCC code of conduct, a photograph, a completed job application with appropriate references. That the vacancy for registered manager be filled. (Previous timescales of 31/07/06 and 01/04/07 not met) 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 a risk assessment of the 07/06/07 8 OP31 Sch 2 01/09/07 9 OP38 13(4)(c) 01/09/07 Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 26 environment is 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. That all service users have access to a call bell, or a method of recording that the staff are regularly checking those service users who cannot use this facility. That fire extinguishers are attached safely to the walls. That advice is sought from environmental health regarding the following issues. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 3. Refer to Standard OP1 OP3 OP27 Good Practice Recommendations That the service users guide and statement of purpose are accessible to residents and visitors. That the pre-admission document states all persons that are involved in the process. That staffing levels are appropriate to the assessed needs of the service users, the size, layout, and purpose of the home at all times. Springfield DS0000059836.V339095.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local 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.V339095.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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