Inspection on 24/04/06 for Palm Court Nursing Home

This inspection was carried out on 24th April 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Palm Court Nursing Home 01/04/08

Palm Court Nursing Home 05/10/07

Palm Court Nursing Home 01/06/07

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 Key Unannounced Inspection 24th April 2006 07:00 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.V289443.R01.S.doc Version 5.1 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.V289443.R01.S.doc Version 5.1 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 722052 DFB (Care) Ltd Mrs Molly Chisholm Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Maximum number of service users to be accommodated at any one time should not exceed 30 (thirty) Service users to be aged 65 (sixty-five) years or over on admission Service users to have a dementia type illness Date of last inspection 3rd October 2005 Brief Description of the Service: Springfield is registered as a care home providing nursing care for thirty service users with dementia and physical disability over the age of 65 years old. The accommodation includes with ten single rooms, four with ensuite facilities and ten double rooms, three with ensuite facilities. However they have changed three of the double rooms to single so the amount of service users taken at any one time is twenty-six. The home comprises of two houses joined by a link way and each has its own staff allocation and service users. The kitchen is centralised and serves both groups and there is a large lounge area for both houses either side of the kitchen. Each house has its own laundry and this prevents any confusion over the clothing. There are adequate bathing facilities for the service users. There is one clinical room and once again this is central to both houses. 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 mostly 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.V289443.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out over two consecutive days 24 and 25 April 2006 and totalling 12 hours. There were 24 service users in residence, of which six were case tracked and spoken with. During the tour of the premises six service users of both sexes were also spoken with. 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. Seven members of care staff, three trained nurses, the carer/activity co-ordinator and the cook & kitchen assistant were spoken with in addition to discussion with the Registered Provider and one health professional that visits the service. Comment cards received from three relatives service users and were generally positive and were satisfied with the services provided. Surveys have been sent to G.P’s and other health professionals, but at the time of writing this report had not been received back. What the service does well: What has improved since the last inspection? The recruitment process in place has improved considerably since the last inspection. All staff are thoroughly vetted before commencement of employment. Staff training is now provided on a number of key topics such as infection control, moving and handling, dementia and adult protection, including whistle blowing ensuring that staff have the skills to meet service users needs. Staff roles are now clear, with dedicated time for tasks that do not affect the supervision and safety of the service users. A dedicated staff member has begun to organise appropriate activities and stimulation for the withdrawn and frail service users. Health and safety requirements from the last inspection have been rectified which protects service users from possible harm, Supervision of staff needs has been introduced which is beneficial to staff and re-in forces good practice guidelines. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 6 Improvements have been made in respect of the testing and recording of equipment such as emergency lighting, water temperatures and fire equipment and fire alarms. What they could do better: 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. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 7 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.V289443.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is evidence that the pre-admission procedure is followed therefore ensuring that Springfield Care Home can meet the prospective service users needs. EVIDENCE: The Service Users Guide and the Statement of Purpose were last updated in November 2004. They are written in a user-friendly format and include information about life in the home, accommodation, staff and facilities available at Springfield. However, whilst they are available to all service users, families and to prospective service users on request, they are not routinely supplied. Two relatives said they were not aware of these documents and had not read the last inspection report, three service users when asked, could not remember if they had seen a brochure/Service Users Guide of the home. Two staff members were also not aware of the Statement of Purpose and Service Users Guide or of where to locate the last inspection report. Whilst it is understood that not all the service users admitted to Springfield will have use of these documents, it would benefit the relatives and visitors if Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 9 copies are more readily available, displayed by the visitors book or kept in the service users rooms for easy access to pertinent information. All service users receive a comprehensive written contract/statement of terms and conditions on admission to the home. The pre-admission assessment of five recent admissions to the home were viewed, it was found that the pre-admission assessments were completed in full, and were of an improved standard. However the staff performing the assessment must ensure that they are signed and dated on completion as it forms an important part of the assessment process and as a benchmark for the progression of an illness. The provider is aware of the registration category of the home. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users health, social and care needs are at risk of not being met due to lack of documentation and care plans. EVIDENCE: The new care plan system has been commenced, but as yet not fully implemented for all of the service users. The transition of changing the care plan system, would have been more successful if they had started to transfer details and fully complete one care plan at a time, rather than bits of each service user. A new time scale was discussed at the inspection for completion of the transition to the new system. The main concern however, was that four service users admitted over the past month had not had a needs assessment, accompanying risk assessments or care plans completed, which means that staff are not fully aware of the specific needs of these service users and therefore it is not assured that their needs are being met by the home. It was an immediate requirement that these assessments and care plans are completed as a matter of urgency. Fluid charts for frail service users had not been completed between 1730 hours on the 23/04/06 and 0800 hours on the 24/04/06. The care plans still request drinks Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 11 to be given two hourly, hence this does not give a true reflection of the care being given. The wound care file containing the service users wound information were viewed and again the information was poor with no clear recording that the wounds were redressed and at what stage the wounds are following treatment. This does not enable staff to track the healing process and request specialist input, if and when required. This has been an on-going identified problem, which hopefully will be addressed with the new recording system. Continence assessments with an accompanying care plan were not in place and staff when asked said that they take them to the bathroom after meals, this may suit some service users, but not all. It was noted that service users are not offered to be taken to the bathroom at all during the inspection, this needs to be addressed and care plans put in place. In all the care plans viewed, there were no plans found as to how staff could communicate with the resident and how to interpret certain behaviour patterns which may indicate pain, enjoyment, sadness or fear. This would be very beneficial for the staff and for visitors and would improve the outcomes for the service user. It was not evident from the documentation available at this time whether all the health needs of the service users were being met. The care planning and documentation of the service users has been identified on previous inspections as a concern as it does not reflect accurately the hard work staff do to meet the service users’ needs. Two relatives said they had not been involved in the care plan, whilst one relative said that he was told on a daily basis how his mother was, he is extremely happy with the care and thinks the staff are marvellous. One relative, whose husband has only been in the home a short time, said everyone was really nice and the care was very good. The clinical room has a dual purpose as it is also the staff office and contains the service user care plans. The medication cupboards and medicine trolley were found clean, well organised and locked. Staff need to ensure that all liquid medicines are in-date and those that are out of date are to be disposed of. The room temperature is recorded daily, but the clinical fridge is not and it was found to be too warm during the inspection especially for liquid antibiotics and insulin. This was discussed in full and alternative storage discussed. All eye drops need to have an opening date on, as they have a short life once opened. The controlled medication stock book was viewed and found to be correctly completed, one query raised was the disposal of a former service users temazepam, this was to be investigated by the nurse in charge. A large amount of diazepam is stored in bottles in the store cupboard; a system of regular auditing of amounts and usage was discussed. The medication administration records were also viewed and there were no gaps identified, however verbal orders by the G.P need to be signed and dated. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 12 It was noted that “Thick and Easy” beverage powder for specific service users are being ticked as given on a regular basis, but those service users were observed not having it added to their fluids. When staff were asked, it was said that they did not always need it. If this is the case, then it needs to reviewed by the Speech and Language Therapists and G.P, and the care plan and medication administration records need to be amended and updated to reflect the service users needs. One serious discrepancy found needs to be followed up by the Registered Provider and appropriate action taken in respect of a disciplinary meeting and further training provided for the staff involved. The staff were seen treating the service users with respect and dignity and the degree of interaction observed between the staff and service users was more positive and conservational. The staff have gained confidence and were caring in their approach, which the staff spoken with said, was due to the training they had recently received. However, it was noted that two service users were brought to the lounge area in their nightwear, and staff said that they were due for a bath later in the morning. This needs to be explored further to ensure that the service users do not mind being seen unwashed and in their nightwear. Policies and procedures are in place concerning last rites and caring for service users that are dying. Letters of appreciation were seen of recently bereaved families that evidenced that they had felt supported and the care given to their family member was good at this time. . Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals remain good in respect of both quality and variety that meets service users tastes and choice. The lifestyle experience by service users does not always match their expectations, choice or preferences. EVIDENCE: The morning routine on this inspection was very similar to the inspections performed in May and October 2005 where concerns were identified. On arrival at 07:00 am in the lounge area of house 19, there were four service users already up, washed and dressed, three were fast asleep in their chairs. In the lounge area of house 17, three were up, washed and dressed. By 0720 am, seven service users were up, two as previously mentioned were in their nightgowns and five were fully washed and dressed. By 7:30 am, in house 17 six-service users were up, washed and dressed, three were fast asleep. Not all service users were able to converse with the inspector; therefore it was not possible to establish if this was their choice or the routine of the home. To ensure that all service users are offered choices and that their personal individual preferences are considered, the needs assessments and care plans need to reflect this information. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 14 Breakfast was served at 08:30 am, and by this time all but four service users were downstairs in the lounge areas. Daily activities are provided, however there was no evidence as to personal preferences and interests of service users in the care plans and there was no evidence to demonstrate how service users are encouraged to participate in activities. A new member of staff that has recently been employed has experience in promoting activities for this particular category of service users, has some very good ideas that she is introducing and she has already had positive reactions from the service users. This will be a positive step forward in improving the outcomes for the service users living in Springfield. Staff were seen playing ball games on the first day of the inspection, however as discussed only a few service users can take part in this activity and many just remained isolated. Two service users were seen colouring in very contently. There needs to be more exploration in encouraging service users, within a detailed risk assessment framework to walk or be more mobile. One service user newly admitted talked about how she finds it difficult to walk, but “was given a zimmer thing in hospital which has helped”. The zimmer was not with her, and staff had to go to her room to get it when asked, the staff spoken with had automatically used a wheelchair since admission, thus confusing the service user in her ability to be mobile and decreasing her ability and confidence in walking. One service user when getting restless was helped by two staff members to walk, which it would be beneficial for all service users to have this input in their care plans. One service user was observed singing along with a staff member, which meant a lot to his wife who was visiting at the time, “ that is his favourite song”. One service user who has lived at Springfield for a long time, declared, “I do get bored, because I have to sit here”, when asked what she would like to do, said “go outside and buy some food”. This is an area that could be developed to see if there are more service users that may benefit from outside visits. Visitors were seen within the home and several service users told the inspector that their families and friends visit and are made welcome by staff. Two visitors also said they were made welcome and invited to have tea by staff. One service user told the inspector she is happy to remain in her room with her own things around her, but does enjoy a chat when staff have time. The kitchen was found clean and tidy, there are some areas of maintenance that are waiting to be attended to, one item (a trolley) is on order. There has been a recent environmental health inspection, which asked for a regular cleaning programme to be introduced, which was evidenced as having been done. The meals are recorded daily in the kitchen diary, the cook is told by staff when someone has not eaten or did not appear to like the meal, however a more formal system is asked for. This will enable staff to track appetite trends, Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 15 identify a potential risk and provide information for the G.P or Specialist when a problem arises. 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 sometimes it might not be available. It would be beneficial for the cook to have the preferences of the service users, that information may be sought from family and friends if the service user is unable to state their likes and dislikes. The cook was unaware that a new admission was a diabetic, this information needs to be recorded and communicated to all staff as it could be putting the service user at risk if not receiving the correct diet. The staff were seen assisting the service users in the lounge areas in a dignified manner, the service users also seemed to enjoy their meal. One service user said he “thought the food was good, nice choice, but missed his wife”. Another said she didn’t know what she was eating, but it was nice. The staff would benefit from further training in the positions service users need to be in to receive food and drinks whilst in bed. There was no evidence of snacks or fresh fruit being assessable to the service users, so that they can help themselves during the day to promote their independence and improve the nutrition intake. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints system with evidence that service users felt confident their views would be listened to. Staff have been trained in the protection of adults. 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 manager is aware of the timescales set down for dealing with complaints and a complaints register is available. There have been no formal complaints made since the last inspection. Two relatives confirmed that they would be confident to raise their concerns if they had any with the staff on duty. None of the service users were able to confirm their awareness of the complaint system. The home continues to share with the CSCI, positive complimentary letters regarding the home from representatives of service users. There is evidence of training sessions in respect of the prevention of abuse, and staff spoken with confirmed that they had received training. Staff whose first language is not English, may benefit from the whistle blowing procedure being translated to understand the procedure in full. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of decor within the home continues to improve as part of an ongoing programme with all areas homely and comfortable for service users. EVIDENCE: The environment of Springfield was found to have been maintained to good standard, many of the previous maintenance issues have been attended to. The décor in the service users bedrooms and communal areas was also of a good standard. The lounge areas are clean, comfortable and well decorated with good quality chairs and furniture, which have arrived since the last inspection. The furniture has made a big difference to the comfort and positioning of the service users. The lounges are quite crowded, due to a change of service users, but the new extension is due to start in July 2006, which will improve the communal space and allow more movement and interaction. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 18 The maintenance issues in the communal bathroom areas have been attended to and suitable toilet and bathing facilities are in place for all service users. Hot water temperatures were randomly tested throughout the communal areas of the building and were found to be 42 C Call bell facilities are in place, though not always accessible to service users, the lounge areas need a facility that the service users/relatives or staff can reach. It is acknowledged that not all service users 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 services users in their rooms are checked regularly. There are hoists and other equipment in the home to cope with the needs of the service users, there are still a few divan beds in use, but new beds are being purchased on a regular basis. The position of one identified bed and bedrail were brought to the providers attention again as it continues to pose a heath and safety risk for the service user. Appropriate mattresses are in place for the service users, a link needs to be in place so staff ensure that appropriate cushions are also in place for those identified at risk to pressure damage and do not move themselves. Bedrooms remain functional rather than homely though some rooms do have personal items of service users, which does make a difference to the ambience. There is evidence of brightly coloured bed covers, which have brightened up the rooms. Again some chairs in bedrooms are identified as needing to be repaired or replaced, as they are a health and safety risk. Not all rooms have the recommended furniture e.g. bedside tables with lamps, a table to sit at, two comfortable chairs and a lockable facility. This was discussed in depth with the Provider. If these items are deemed unsuitable or not required for individual service users, it needs to be appropriately documented and included in the written contract of that individual resident. The home was adequately clean in the communal areas of the home; there was a malodorous smell in one of the bedrooms, which was reported to the Provider during the inspection. The first floor sluice room was found to be used as a storage area, and there was evidence to suggest that it was not being used for its given use. The commodes were stained, and there was no soap or towels available. The route to the mechanical sluice was also blocked. The staff were observed to be following good practice concerning the use of gloves and aprons, and when asked were aware of the infection control procedures and how to access them. An area that was raised was the disposal of soiled pads when staff are going room to room and this will be reviewed and discussed with staff at the next staff meeting. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 29 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff training has improved, and service users are now protected by robust recruitment practices. A review of staffing levels based on service users dependency levels needs to be implemented. EVIDENCE: There is no clear staff rota, and it is currently being written in a diary, which is not easy to follow. The staffing levels at present are one trained and two carers working the night shift, with a day carer arriving at 0700 hrs to help. The morning shift comprises of one trained nurse and five carers. The afternoon shift is one trained nurse and four carers. Staffing levels need to remain under review as staff spoken with said that the shifts are rushed due to the high needs of some service users. The increased dependency levels of some service users, especially those who have become increasingly physically frail as well as having advanced dementia. The night shift with just three staff until 07:00am still get the majority of service users up, washed and dressed, and down to the lounges. It raises the question that service users are not being enabled to be as independent as they could be because it takes more time. It is also noticeable from direct observation that the staff do not have the time to sit and chat with service users, there are periods of the day where some Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 20 service users are isolated, with little interaction, especially those confined to bed. The student nurses now seconded to the home for a short time do make a noticeable difference to quality time given to service users, and to the meal times, where they were observed helping service users to eat. The recruitment process has improved significantly as required and it now ensures that service users are supported by staff who have been appropriately vetted. The recruitment files of six staff members were viewed and contained all the necessary information required, apart from some did not have a recent photograph. All staff have mandatory checks from the Criminal Records Bureau (CRB) and a Protection of Vulnerable Adult (POVA) check before commencing employment. All staff now receive a formal induction programme, which is very comprehensive on paper, but it was a recommendation that it combines with practical sessions to prove that they are competent in practice as well as verbally. All new staff have evidence of an induction booklet. A training programme for all staff has been commenced. The records for moving and handling, infection control and fire safety have been updated for all staff currently employed. There was also evidence of training in dementia, tissue viability and food and hygiene. It was discussed of ways to evidence training completed by staff, and receiving a certificate would also be beneficial for staff curriculum vitaes and professional portfolios. The manager/provider is proactive with ensuring that all staff receive the opportunity for training pertinent to their jobs, and feedback from staff say they enjoy the training sessions. All staff have received the codes of practice for social care workers and employers in their first language. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been some progress in the management of the home, the appointment of a registered manager would consolidate the improvements made. EVIDENCE: The home has been without a registered manager for eighteen months, and the registered provider has been taking on the responsibility of the day-to-day running of the home, staff supervision and training along with the administrational side of the business. There is also a lack of full time senior nurse support to deputise in his absence. As a result some of the work that has been commenced has not been as successful as it could have been still leaving areas of improvement to be maintained and completed. There needs to be a structured management approach to meeting the areas identified and one of these needs to be the appointment of a Registered Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 22 Manager and deputy manager and an appropriate support system to delegate work to e.g., training, supervision and recruitment. The introduction of formal quality assurance and quality monitoring systems would enable the management to objectively evaluate the service and ensure it is run in service users best interests. There are no service users 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 service users. The accident book was viewed and were not completed correctly as requested. Records were available to demonstrate that fire alarms, water temperatures and emergency lighting systems are regularly tested and fire drills undertaken. Testing of portable electrical appliances has been carried out. Certificates to demonstrate that bath hoists, gas appliances, electrical systems and appliances are safe are in place. The lift was out of action for a period of time, thus preventing the service users from accessing communal areas of the home. Regulation 26 visits need to be documented and sent to the CSCI area office, it was discussed that Mr Durgahee would perform the visit for the sister home Keller House and Mrs Durgahee would perform the visit for Springfield on a monthly unannounced basis. Staff supervision of six staff was evidenced in the staff recruitment files viewed and staff spoken with said they had received regular supervision from the Registered Provider/acting manager. Since the last inspection all staff have received the mandatory training the moving and handling and fire safety therefore safety for staff and service users is maintained. Safe moving and handling techniques were observed throughout the inspection. Risk assessments need to be developed for the individual service users, premises and the garden areas. Springfield DS0000059836.V289443.R01.S.doc Version 5.1 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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 2 2 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 X 3 3 3 2 Springfield DS0000059836.V289443.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? 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. 2. Standard OP1 OP7 Regulation 4(1) 5(1) 15(1)(2) 12(1)(a)( b) Requirement That the Service Users guide is given to each service user or their representative. That all service users have a full needs assessment on admission. 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. (Previous timescales of 26/11/04, 31/07/05 & 31/11/05 not met.) 3. OP8 14(1a)(a) (b)13(1b) That records pertaining to nutrition, wound care, continence and communication are developed and accurately reflect the service users needs. (Previous timescale of 26/11/04, 31/07/05 & 30/11/05 not met.) That all service users have a social care plan, that is designed to meet their interests and DS0000059836.V289443.R01.S.doc Timescale for action 31/07/06 28/04/06 31/07/06 4. OP12 16(1)(2) (n) 31/07/06 Springfield Version 5.1 Page 25 preferences. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. 5 OP9 13(2) Medication administration record charts must reflect current medication profile and must be a true and accurate record. That policies and procedures are followed in the administration of medication as set by the NMC. (Previous timescale of 31/05/05 & 03/10/05 not met.) 6. OP9 13(2) That the clinical fridge temperature are recorded daily and of the correct temperature to keep medication. 31/07/06 31/07/06 7. OP14 12(2)(3) That all service users are 31/07/06 enabled to make choices and exercise their personal autonomy within a structured risk assessment framework. (Previous timescales of 26/11/04 & 30/11/05 not met.) That furnishings are of a good quality and repair and suitable for the needs of the service users. (Previous timescale of 31/07/05 & 30/11/05 not met.) That appropriate height adjustable beds are provided for those receiving nursing care. (Previous timescales of 31/03/05 & 30/09/05 not met) That furnishings provided in bedrooms are as per standard 24.2, unless otherwise agreed (Previous timescales of 31/03/05 & 30/09/05 not met) DS0000059836.V289443.R01.S.doc 8. OP19 16(1)(2) (c) 31/07/06 9 OP24 16(c) 31/07/06 10 OP24 23(2)(e) 31/07/06 Springfield Version 5.1 Page 26 11 OP26 16(1)(2) (j)(k) That systems are in place and followed to ensure the prevention and control of cross infection. That the sluice is used for the proposed use. That staffing levels are appropriate to the assessed needs of the service users, the size, layout, and purpose of the home at all times. That the vacancy for registered manager be filled. 31/07/06 12. OP27 18(1)(a) 25/04/06 13. 14. 15. OP31 OP32 OP33 Sch 2 24(1) (a&b) 12 (2)(3) 24(1)(a) (b)(2)(3) 26 (1)(2)(ac)(3)(4) 12(1)(a) 31/07/06 That service user/relative 31/07/06 meetings be carried out monthly. That formal quality monitoring and quality assurance systems be created and implemented. That the registered provider visits the home unannounced at least once a month and writes a written report. That all bedrails in use are appropriately fixed to prevent injury. (Previous time scale of 27/05/05 & 03/10/05 not met.) That hoists are not stored in service users bedrooms. (Previous timescale of 03/10/05 not met) 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 a formal monitoring of service users appetites and amount consumed is kept. DS0000059836.V289443.R01.S.doc 31/07/06 16. OP33 25/04/06 17. OP38 25/04/06 18. OP38 13(4) 25/04/06 19 OP38 12(1)(a) 25/04/06 20. OP15 16 (1) (a) 31/07/06 Springfield Version 5.1 Page 27 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.V289443.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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.V289443.R01.S.doc Version 5.1 Page 29 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!