Inspection on 03/10/05 for Palm Court Nursing Home

This inspection was carried out on 3rd October 2005.

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.

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 24/04/06

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 Unannounced Inspection 3 October 2005 06:50 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.V250540.R01.S.doc Version 5.0 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.V250540.R01.S.doc Version 5.0 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 722052 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.V250540.R01.S.doc Version 5.0 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 27th May 2005 Brief Description of the Service: Springfield is registered as a care home providing nursing care for thirty residents with dementia and physical disability over the age of 65 years old. The accomodation 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 residents 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 residents. 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 residents. 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. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 3 October 2005 from 06:50 am until 2pm. Two inspectors inspected the home and conducted informal interviews with seven residents, one relative and six members of day staff and three members of night staff. The inspection process consisted of a tour of the building, inspection of documentation and records and looked at the delivery of care for eight service users. There have been concerns raised from the previous two inspections in November 2004 and May 2005, regarding the standard of care, recruitment process and staffing levels in Springfield and there have been meetings to discuss the concerns with the Registered Providers. Monitoring visits have been undertaken on a regular basis with action plans and correspondence regarding training and staffing received from the Registered Provider on a regular basis. However, this inspection has identified that improvement is very slow and is not consistent with the plans received from the provider. The inspector would like to thank the staff and the provider for their openness during the inspection and their willingness for reviewing practice in the home. What the service does well: What has improved since the last inspection? Further staff have been recruited since the last inspection, and this will hopefully provide the residents with a consistent level of care. The plans for upgrading and extending the property have been received, and will improve the facilities provided at Springfield. From the records supplied residents are weighed two weekly and are now more stable. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 6 Care is now being taken of the appearance and presentation of the residents; all residents were wearing appropriate clothing and foot wear. An activity programme has been devised; two residents were playing indoor bowls in lounge 19 during the inspection. Training in dementia has been commenced. Some staff were seen interacting more positively with the residents. What they could do better: Care plans, records and risk assessments need to have more detail and outline clear support and risk management guidelines to provide staff with clear directions re care. That they are kept up to date in respect of wound care, nutrition and continence management. The recruitment process needs to be more robust to ensure the suitability of the staff employed and protect the residents. Staff need to attend training in moving and handling, fire safety and infection control to ensure the health, safety and well being of the service users. The medication procedures within the home need to be followed to ensure safety of all service users. Staffing levels need to be assessed against the specific needs of the service users. There needs to be evidence of choice and flexibility to residents lifestyle experienced in the home. Dedicated staff member to organise appropriate activities, and advice sought re stimulation for the withdrawn and frail residents. Staff roles should be clear, with dedicated time for tasks that do not affect the supervision and safety of the residents. A number of health and safety matters need to be addressed; including that call bells are accessible in all rooms, that fire doors are not propped open and that all bedrails are safely in place. Supervision of staff needs to be introduced to ensure good practice guidelines are followed and maintained. The maintenance of the building needs to improve to provide residents with a safe, comfortable and well maintained environment. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 7 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.V250540.R01.S.doc Version 5.0 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.V250540.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, 3, 4 and 5. The homes Statement of Purpose and Service Users guide provide residents/representative and prospective residents/representative with details of the services the home provides enabling them to make an informed decision about admission to the home. Residents receive a written contract/statement of terms and conditions on admission to the home confirming the services agreed. Residents have been admitted to the home without a full and detailed pre admission assessment, thus not ensuring the home can meet their needs. EVIDENCE: The Service Users Guide and the Statement of Purpose were both updated in November 2004. They are written in a user-friendly format and are available to all residents, families and to prospective residents and include information about life in the home, accommodation, staff and facilities available at Springfield. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 10 All residents receive a comprehensive written contract/statement of terms and conditions on admission to the home. On viewing ten residents care plans, it was found that not all pre-admission assessments were completed in full, important information was found missing and the documents were not signed and dated. This was identified on the previous inspection and remains outstanding. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. There is no clear or consistent care planning system in place to adequately provide staff with information they need to satisfactorily meet service users needs. It is not possible to evidence that the health needs of service users are met. The home has failed to improve their procedures for the storing, administration and recording of medication thus placing service users at risk and harm. Observation of poor practice demonstrated that not all service users are treated with respect and their dignity was compromised. EVIDENCE: The care plans of ten residents were viewed and they still lack information regarding action the staff need to follow in key areas. E.g. nutrition and feeding, wound care, communication and continence. It was not evident from the documentation available whether all the health needs of the residents were being met. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 12 The wound care file containing the residents 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 were following treatment. This does not enable staff to track the healing process and request specialist input, if and when required. 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. Fluid charts of four heavily dependent residents had not been completed between the hours of 8pm and 9am on the 2 and 3 October 2005, thus indicating that no drinks had been offered or taken during those hours. The care plans requested drinks to be given two hourly. There is little documentation to support that relatives are consulted and this is an area, which still needs to be addressed. The risk assessments in place did not accurately reflect the resident’s needs and one in use was from the previous home, this would not be an accurate reflection as his condition had deteriorated, hence his admission to Springfield. The CSCI pharmacist visited the home on the 31 August 2005 and there were requirements made as a result of that visit. These are being monitored. On this visit it was found that medication was being stored inappropriately in the domestic fridge, this was removed immediately and placed in the clinical fridge. Further shortfalls were again identified: there were gaps in the medicine administration charts, (MAR) and signatures had been overwritten or scribbled out – this suggests that medications are dispensed into pots and signed for, then signatures changed if the resident refuses. This procedure had been identified as a concern at previous visits to the home. During the inspection, two separate incidents of poor practice in moving and handling were observed which compromised the residents’ dignity. This was brought to the staff and managers’ attention on the day of the inspection and followed by a letter of serious concerns. It was also observed that male residents were about to be shaved in the communal lounge; this again was stopped at the time observed. Two residents were brought down to breakfast in the lounge area, unwashed and still in their nightwear, when asked why, the staff said that those residents were due for a bath later and they should have remained in their room. No action at that time was taken to remedy this lack of dignity. Residents were found restricted by lap trays for long periods of time, giving them no opportunity to move or stand. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 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. The arrangements for leisure and social activities inside and outside of Springfield provide limited opportunity for mental or physical stimulation. Residents are not enabled to exercise choice and control over their lives. The mid-day meals are nutritious and were seen to be enjoyed. EVIDENCE: The morning routine on this inspection was very similar to the inspection performed in May 2005 where concerns were identified. On arrival at 06:50 am in the lounge area of house 19, there were two out of thirteen residents already up, washed and dressed, both were fast asleep in their chairs. Seven other residents were dressed and waiting to come down stairs. The night staff were seen to be getting other residents up and bringing them to the lounge area for breakfast. On talking to two residents at this time, it was not evident that they had been offered a choice of either getting up or staying in bed. Both said they would like a cup of tea and had not been given one since being awake. According to staff it depends on who is on duty if the residents are offered a cup of tea in the morning. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 14 The care plans of these residents did not include any information regarding choice of daily routine. At approximately 07:20 am, in the lounge area of house 17, eight out of twelve residents were up, washed and dressed. Two as previously mentioned were in their nightgowns. Not all residents 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. Breakfast was served at 08:30 am, and by this time all but six residents were downstairs in the lounge areas. All but one resident in the lounge areas received porridge with sugar, this could be their choice, but they were not offered the choice of an alternative at serving time, and the records did not indicate their preference. The morning routine seen at Springfield for those residents in the lounge areas did not offer any choice and little staff supervision or interaction was observed in house 17, house 19 were more pro-active in engaging with residents and the staff were playing carpet bowls with two residents. None of the residents have access to drinks to encourage any independence or choice and receive drinks only at specific times, e.g. morning coffee. This was discussed with senior staff again and it was agreed that jugs of fluids would be provided in the lounge. It was also observed that there was no encouragement given to residents to be mobile. In fact one resident in a wheelchair is actually able to walk, again this was not reflected in the care plan. An activity programme has been introduced but residents in their rooms had little or no positive stimulation or interaction during the morning. It is difficult to ascertain whether residents are helped to exercise choice and control over their lives. There has been no real improvement to the documentation and it remains insufficient at this time to evidence that residents are consulted about how they spend their time, of what they eat and of when they go to bed and get up. One resident who remains in bed said it is her choice, but feels that sometimes she is forgotten and has to wait for her needs to be seen to. There is “open” visiting, and one relative was seen visiting and indicated that he was happy with the care his mother received. Menus were viewed and were seen to offer some choice and variety of wholesome food. The meals observed were breakfast and the midday meal. The breakfast was served at 08:20 am and the residents in the lounge areas were served first, the porridge was warm, but all were served with sugar and milk, the residents upstairs were served, but the porridge by this time was cool, poor practice in respect of basic food hygiene was observed. The staff member serving and feeding the residents had all the breakfasts on one tray and went from room to room putting the dirty/empty plates amongst the full dishes. The staff member wore the same gloves and apron continuously. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 15 The midday meal was seen, the food seen was attractively presented and smelled wonderful. A food diary has been commenced, but does not always reflect individual choices and amounts taken, it also did not correspond with the menu. The cook was aware of the needs of diabetics and she said that she continues to make cakes to go with afternoon tea even though she was told to provide only biscuits. She ensures there is a quiche each day as a vegetarian alternative and is happy to cook anything else if required. She makes homemade soup most days for supper. The kitchen was clean, tidy and functional and the cupboards contained a few tins of beans and spaghetti and bread, the fridge had milk, eggs and yogurts. There was no evidence of snacks or fresh fruit being assessable to the residents so that they can help themselves during the day to promote their independence and improve nutrition. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 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 and 18. Policies and procedures are in place for dealing with complaints, which are accessible to residents and their representatives. Arrangements for protecting residents are not satisfactory at this time, placing them at possible risk or 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 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. The home continues to share with the CSCI, positive complimentary letters regarding the home from representatives of residents. There is evidence of training sessions in respect of the prevention of abuse, and it is confirmed that training will be on-going for all staff. Practice seen during the inspection indicated that further training needs to be scheduled to cover certain areas of staff awareness in regard to POVA, use of restraint and inappropriate moving and handling techniques. It was discussed again the use of tables which are attached to chairs that are used to stop residents getting up. It is understood and evidence seen of a letter that these tables have been discussed with certain families and the G.P to prevent residents falling, but it needs to be used only for those residents Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 17 and only at specific times such as mealtimes and that there should be sufficient staff to monitor the situation and prevent falls, whilst allowing residents to move without restriction. On viewing staff files, two incidents concerning a staff member and the well being of residents were dealt with in-house; these should have been dealt with through the Adult Protection procedures, with referrals to POVA. This was discussed in full. Omissions were again identified in the recruitment process indicate that residents are not protected from abuse. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected 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 and 26. The homes environment needs on going maintenance and renewal in order to create a warm, safe and welcoming environment. The lounge areas are well decorated and comfortable. Residents’ bedrooms are functional rather than homely. EVIDENCE: The environment of Springfield has remained unchanged since the last inspection. The lounge areas are clean and well decorated. There are a number of chairs that need to be replaced or repaired as they are damaged and torn. This is an infection control and health and safety matter. A further visit following this inspection evidenced the arrival of new chairs. There are well-tended garden areas to the rear of the building that are accessible to all the service users. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 19 There are still maintenance issues that need attention, and mostly concern the communal bathrooms. The ground floor bathroom has a hanging shower facility, which contravenes the legionella guidelines, the floor is uneven and could cause a trip or spill and there is evidence of rust and peeling on equipment in the bath. An upstairs bathroom still has a broken bath panel, which was also damp. The bathroom facilities need attention to ensure safety and adequate infection control prevention. Call bell facilities are 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 service users will be able to use a call bell, so there is an identified need for individual risk assessments concerning call bells. There are hoists and other equipment in the home to cope with the needs of the residents, there are still divan beds in use, and some bedrails were found loose and ill fitting, one in particular was brought to the attention of the senior nurse on duty, as it posed a heath and safety risk for the resident. Bedrooms remain functional rather than homely though some rooms do have personal items of residents. Again some furniture needs to be repaired or replaced. Not all rooms have the recommended furniture e.g. bedside tables with lamps, a table to sit at, and two comfortable chairs and a lockable facility. If theses items are deemed unsuitable or not required it needs to be appropriately documented and included in the written contract of that individual resident. Random water temperatures were tested and were found to be between 40°C and 47°C, the temperatures need to be tested and adjusted accordingly. The temperature of the home was suitable for the time of year and was comfortable. The home was adequately clean in the communal areas of the home, there was a malodorous smell in two of the bedrooms, which was reported to the senior nurse. There was evidence of poor disposal of excrement, which was immediately reported to staff. Bed linen seen on some beds was found worn and threadbare, and one resident had dried blood on her sheet, which had not been changed. The sluice area on floor one, in house 19 is still being used as a storage area for hairdressing equipment, hoovers and other miscellaneous items, which is a fire and infection hazard. The sign on the sluice needs to be investigated, as it indicates that the sluice is not working properly. The sluice area on the ground floor in house 17 still has a broken sliding door, which needs to be repaired. The laundry area in house 17 was found to be below the expected level of cleanliness and was also found with fire door tied open. It was left as an Immediate Requirement that the directives from the fire service are followed concerning the use of wedges and ties. The laundry in house 19 was clean and organised. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The staffing levels are insufficient to meet the complex needs of the residents. The recruitment practice is not robust and does not provide sufficient safeguards for the protection of residents. From direct observation and from viewing the training records there is evidence that staff are not suitably trained or competent to perform their jobs. EVIDENCE: The staffing levels for the night shift were two carers and one trained, again it is identified that that the staffing levels are not sufficient for the needs of the residents and for the routine of the shift. Staff members also said that to give the standard of care they wanted to provide and are expected to give they needed more staff. One staff member said she told the acting manager and provider that she could/would not be getting residents up as there was not enough staff to do it. It was said that a carer should have arrived at 07:00 am but they did not turn up. The diary did not evidence the extra carer on a daily basis. The morning shift did not run smoothly and the poor practice seen in moving and handling residents and in serving/ giving breakfast is an indicator of insufficient staff and staff taking shortcuts to get the work done. This has been identified in a serious concern letter following the inspection. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 21 The recruitment process has not improved as required and again it generated real concerns about how the home ensure that residents are supported by staff who had been appropriately vetted. The recruitment files of six staff members were viewed and significant gaps in documentation were found throughout. Of particular concern was the lack of current mandatory checks from the Criminal Records Bureau (CRB) and the fact that some new staff were employed with transferred CRB checks, which is not allowed. In addition these files did not contain two written references and in some cases the references were provided from friends rather than colleagues and former employers. Not all had a photograph, and issues regarding suitable work permits was also identified. There were also trained nurses who were working without up to date evidence of their PIN (personal identification number) renewal from the NMC. It was requested that these staff do not work unsupervised until all the necessary checks are done. A training programme for staff has been commenced and there was evidence of training in dementia, tissue viability and food and hygiene. The records for moving and handling, infection control and fire safety need to be updated as most of the staff listed have left and they were found to be inaccurate. The manager/provider is proactive with ensuring that all staff receive the opportunity for training pertinent to their jobs, however all staff including the night staff need to also attend and an appropriate training matrix developed for an accurate reflection of training undertaken. Staff need to be appropriately trained to competently perform their job. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Residents would benefit from the employment of a designated Registered Manager to run the home efficiently and effectively, including providing support to staff. The ethos of the home is becoming more open and some improvements to staff and resident’s/representatives consultation have been made. All aspects of resident’s health, safety and welfare need to be protected and promoted. EVIDENCE: The home has been without a registered manager for ten 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 Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 23 administrational side of the business. As a result he does not have time to support and supervise staff and ensure the home is properly managed. It is a lot of work for one person to be responsible for and to be successful at. At the present time the home is failing to meet requirements and the concerns identified. 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 Manager and an appropriate support system to delegate work to e.g., training, supervision and recruitment. Resident and relative meetings do not appear to be happening regularly. Such meetings should be held more frequently to give relatives/residents further opportunity to comment on all aspects of the service. Staff meetings are undertaken regularly, but staff feedback indicates they are not always given the opportunity to have a say in how the home is run or how things could be improved from their experiences in the home. The introduction of formal quality assurance and quality monitoring systems would enable the provider to critically evaluate the service and ensure it is run in residents best interests. Formal staff supervision is not provided in accordance with the regulations and this is because the acting Manager does not have sufficient time to provide this one-to-one support to staff. Documents relating to safe working practices and Health and Safety were available and found to be satisfactory as were accident records. Throughout the inspection, a number of issues regarding health and safety and fire safety were identified and need addressing. • • • • • • • • • • • • • • • • Fire doors propped or tied open. Wheelchairs being used without the appropriate foot rests. Gaps between the bedrails and bed head of identified resident. Inaccessible call bells. No accompanying risk management found. Poor practice observed of lifting a resident up the bed. Poor practice seen with ‘bumping resident up four steps in a wheel chair’. Hanging showerheads in relation to a risk of legionella. Broken side to bath resulting in damp. Variable water temperatures found in bedrooms, between 40°c-47°c Lack of qualified first aiders in the home and first aid boxes. Residents’ bedroom being used to store three hoists in. Back doors found open despite note being displayed that door should be locked, and entry to maintenance room unsecured. Fire extinguishers last apparent service 03/04. Risk assessments for individual residents found to be poor and inaccurate, in respect of managing challenging behaviour, moving and handling and nutrition. Top step outside clinical room is a trip hazard due to lifted floor covering. Resident’s chairs found taped with duck tape and not fit for use. DS0000059836.V250540.R01.S.doc Version 5.0 Page 24 Springfield • • Laundry floor and walls not impermeable. Bed sheets very worn and threadbare on some beds. These areas identified were fully discussed at feedback with the acting manager and were left as immediate requirements. A follow up serious concern letter was sent following this inspection. Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x 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 1 2 3 3 2 2 2 2 2 STAFFING Standard No Score 27 1 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x 2 x 2 1 Springfield DS0000059836.V250540.R01.S.doc Version 5.0 Page 26 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14(1)(a) Requirement That all service users have a full pre-admission assessment completed, signed and dated before admission to ensure the home can meet their needs. That the care plans accurately reflect 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 not met.) 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 not met.) That a suitable activity programme be developed and that facilities are provided for recreation and fitness.(Previous timescale of 31/01/05 & 31/07/05 not met.) Medication administration record DS0000059836.V250540.R01.S.doc Timescale for action 03/10/05 2 OP7 15(1)(2) 12(1)(a) (b) 30/11/05 3 OP8 14(1a) 2(ab)13 (1b) 30/11/05 4 OP8OP12 16(1)(2) (n) 30/11/05 5 OP9 13(2) 03/10/05 Page 27 Springfield Version 5.0 6 OP9 7 OP9 8 OP14 9 OP15 10 11 OP15 OP18 12 OP18 charts must reflect current medication profile and must be a true and accurate record. (Previous timescale of 31/05/05 not met.) 13(2) That policies and procedures are followed in the administration of medication as set by the NMC.(Previous timescales of 26/11/04 & 31/05/05 not met) 13(2) That all medicines kept in a domestic fridge are stored in a locked box or stored in the clinical fridge.(Previous timescale of 31/05/05 not met.) 12(2)(3) That all service users are enabled to make choices and exercise their personal autonomy within a structured risk assessment framework. ( Previous timescales of 26/11/04 not met.) 16(2)(i)12 That there is sufficient staff to (1)(2)(3) assist the service users in eating their meal.(Previous timescales of 26/11/04 & 27/05/05 not met) 16(2)(i)12 That the breakfast service is (1)(2)(3) reviewed. (5)(a)13 If a method of restraint is used(7)(8) it is a requirement; That it is to be discussed in full with families, the G.P, and with the placement authority and recorded. That it is appropriately risk assessed and only used to ensure the safety and welfare of the service user and not for the convenience of staff.( Previous timescales of 26/11/04 & 27/05/05 not met.) 13(6) That all staff receive training in the prevention of abuse, and are aware of the multi-discilpinary guidelines and the different categories of abuse. That all incidents regarding the safety DS0000059836.V250540.R01.S.doc 03/10/05 03/10/05 30/11/05 03/10/05 03/10/05 03/10/05 03/10/05 Springfield Version 5.0 Page 28 13 OP19 16(1)(2) (c) 14 OP21 16(1)(2) (c) 15 OP24 16(c) and well being of service users is referred as directed by the Adult Protection guidelines.(Previous time scale of 31/07/05 not met.) That furnishings are of a good quality and repair and suitable for the needs of the service users. (Previous timescal of 31/07/05 not met.) That all bathrooms are suitable for the use of the service users and in good repair (Previous time scale of 31/07/05 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 furnishnings provided in bedrooms are as per standard 24.2, unless otherwise agreed (Previous timescales of 31/03/05 & 30/09/05 not met) That bedside lighting is provided.(Previous time scale of 27/05/05 not met.) That hot water is delivered close to 43 °C, and that the guidelines are followed for the prevention of legionella. (Previous time scale of 27/05/05 not met.) That the home is clean, hygenic and free from offensive odours. 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 two written references are DS0000059836.V250540.R01.S.doc 30/11/05 30/11/05 01/01/06 16 OP24 23(2)(e) 30/11/05 17 18 OP25 OP25 23(2)(p) 13(3)(4) (a)(c) 30/11/05 03/10/05 19 20 OP26 OP26 16(1)(2) (j)(k) 16(1)(2) (j)(k) 03/10/05 03/10/05 21 OP27 18(1)(a) 03/10/05 22 OP29 Sch2 7 03/10/05 Page 29 Springfield Version 5.0 9,19(1)(a bc) received before commencement of employment. That gaps in the employment history are explored and work permits are in place. That evidence of PIN numbers updates are in place. That a criminal record check and POVA check is applied for and received before confirmation of post, and are not transferred from their previous employment. (Previous timescales of 26/11/04 & 27/05/05 not met) That all staff receive appropriate 30/11/05 supervision and training and there are clear records kept. (Previous time scale of 31/07/05 not met) That the vacancy for registered 01/01/06 manager be filled. That service user/relative 03/10/05 meetings be carried out monthly. 01/01/06 01/01/05 23 OP30 18(1)(2) (a)(c)(i) 24 25 26 27 OP31 OP32 OP33 OP36 Sch 2 24(1) (a&b)12 (2)(3) 24(1)(a) (b)(2)(3) 28 OP38 29 OP38 30 OP38 That formal quality monitoring and quality assurance systems be created and implemented. 18(1)(2) That all care staff receive formal 19(1)(a-c) supervision at least six times a year.(Previous time scale of 31/07/05 not met.) 13(2)(3)1 That the mandatory training 6(2)(j) records of all staff now employed in the home are available for inspection and up to date. (Previous time scale of 31/07/05 not met.) 23(4) That the practice of propping/tying open doors ceases in line with the latest guidence from the fire service. (Previous time scale of 27/05 /05 not met.) 23(2)(4) That footrests are in place on wheelchairs when in use to DS0000059836.V250540.R01.S.doc 30/11/05 03/10/05 03/10/05 Page 30 Springfield Version 5.0 31 OP38 12(1)(a) 32 OP38 13(5) 33 34 OP38 OP38 23(4)(1v) 13(4)(a) (b)(c) 13(4) 35 OP38 36 37 38 OP38 OP38 OP10 13(4) 13(4) 12(4) prevent injury to service users. (Previous time scale of 27/05/05 not met.) That all bedrails in use are appropriately fixed to prevent injury. (Previous time scale of 27/05/05 not met.) That all residents are moved appropriately and safely. (Previous time scale of 27/05/05 not met.) That all fire extinguishers are checked yearly and by a registered authority. That the security of the home is reviewed to ensure the safety of the service users. (Previous time scale of 27/05/05 not met.) That there are trained first aiders in the home and an adequate number of first aid boxes accessable. (Previous time scale of 27/05/05 not met.) That the trip hazard on the top of the stairs outside the clinical room is fixed. That hoists are not stored in residents bedrooms. That all residents are treated with dignity and respect at all times. 03/10/05 03/10/05 03/10/05 03/10/05 01/01/06 03/10/05 03/10/05 03/10/05 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.V250540.R01.S.doc Version 5.0 Page 31 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.V250540.R01.S.doc Version 5.0 Page 32 - 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!