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Inspection on 05/10/07 for Palm Court Nursing Home

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

This inspection was carried out on 5th October 2007.

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

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

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

What the care home does well

Springfield Care Home provides well-furnished, comfortable and clean communal areas for the people living in the home and for those visiting. The standard of decoration is good with relaxing colours. The new sensory garden and patio areas are attractive and assessable to all residents. There is an open-house policy, which welcomes visitors at all reasonable times. ` I feel comfortable visiting and always get a cheerful welcome` ` the staff are friendly and courteous`. The introduction of regular relative meetings has proved beneficial in promoting good communication The plans for the home include building a snoezellen room for residents to be supervised whilst inducing calmness and relaxation.

What has improved since the last inspection?

The approach to care planning continues to improve and is becoming more person centred. The continuation of regular audits of the home`s practices has helped to identify areas for future service development and improvements. The inspection process confirmed that standards relating to medicines have been improved and ensure medicines are dealt with safely.

What the care home could do better:

The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Residents and staff would benefit from clear leadership, guidance, direction and management. There are identified shortfalls in care planning, meeting of resident`s health care needs, risk assessments, and in supporting and enabling residents to live a lifestyle based on their individual preferences and choice. Although there is an activity programme, which demonstrates that activities are scheduled on a daily basis, it was confirmed by staff that this does not always happen. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. The quality of the food prepared is of an adequate standard, however poor supervision and management of the meal service was observed. Staffing levels and skill mix needs to be assessed against the specific needs of the residents living in the home. The staff on duty are at present also cooking, which affects the staffing ratio to residents and leaves insufficient staff to care for and supervise the residents. Recruitment practices must improve to ensure the protection of residents. Direct supervision of staff needs to be introduced to ensure staff have the required care skills and empathy to provide appropriate support and care for residents living in the home.In addition a number of health and safety issues were identified including the need for accurate record keeping, appropriate up to date policies and procedures and robust individual and environmental risk assessments.

CARE HOMES FOR OLDER PEOPLE Springfield 17 - 19 Prideaux Road Eastbourne East Sussex BN21 2ND Lead Inspector Debbie Calveley Key Unannounced Inspection 5th October 2007 09:30 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.V352610.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Address 17 - 19 Prideaux Road Eastbourne East Sussex BN21 2ND Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01323 721911 01323 410244 dfbcareltd@yahoo.com DFB (Care) Ltd Vacant Care Home 42 Category(ies) of Dementia - over 65 years of age (42), Old age, registration, with number not falling within any other category (42), of places Physical disability over 65 years of age (42) Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. A maximum of fourty-two (42) service users may be accommodated. Service Users must be older people aged sixty-five (65) or over on admission. To have physical disability and/or nursing needs. Only older people with dementia-type illnesses may be accommodated. Service users to have a physical disability and/or nursing needs. Date of last inspection 1st June 2007 Brief Description of the Service: Springfield is registered as a care home providing nursing care for forty-two residents with dementia and physical disability over the age of 65 years old. A new wing has been added to provide twelve single bedrooms with ensuite, a large lounge, two new sluice areas, bathrooms and a nurse’s station. The accommodation consists of twenty-two single rooms, sixteen of which have ensuite facilities, ten double bedrooms, four with an ensuite facility. The kitchen is centralised and serves the entire home and there are three communal areas, two lounge areas and a dining room lounge area for residents There is one laundry room and there are adequate bathing facilities for the residents. There is one clinical room and once again this is central to the whole building. The home has a passenger lift and stair lift which provides access to all areas of the home. There is a large garden area that is well maintained and consists of a patio area and lawn and is assessable to wheel chair users. There is no car park but unrestricted parking is allowed in Prideaux Road. There is a bus route nearby and the home is approximately 15 minutes from the town centre. The Fees charged as from 1 April 2006 range from £509 to £700, which includes basic toiletries. Additional charges are made for hairdressing, chiropody, and newspapers and outside activities. Intermediate care is not provided. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Springfield Care Home will be referred to as ‘residents’. The information contained in this report has been compiled from an unannounced site visit undertaken over 6 ½ hours on the 5 October 2007 by two inspectors plus information gathered about the home since the previous inspection. This includes discussion with stakeholders involved in resident’s care, records submitted to CSCI, which have included an Annual Quality Assurance Assessment (AQAA) and the notification of accidents and incidents. There were 38 residents living in the home, of which five were case tracked and met with. During the tour of the premises a further six residents of both sexes were also spoken with and two relatives. The purpose of the inspection was to check that the requirements of previous inspections had been met and inspect all other key standards. A tour of the premises was undertaken and a range of documentation was viewed including care plans, medication records, training records and recruitment files. In order that a balanced and thorough view of the home is obtained, this inspection report should be read in conjunction with the previous inspection reports. The Inspectors would like to thank the residents, staff and management for their assistance and hospitality during the visit. What the service does well: Springfield Care Home provides well-furnished, comfortable and clean communal areas for the people living in the home and for those visiting. The standard of decoration is good with relaxing colours. The new sensory garden and patio areas are attractive and assessable to all residents. There is an open-house policy, which welcomes visitors at all reasonable times. ‘ I feel comfortable visiting and always get a cheerful welcome’ ‘ the staff are friendly and courteous’. The introduction of regular relative meetings has proved beneficial in promoting good communication The plans for the home include building a snoezellen room for residents to be supervised whilst inducing calmness and relaxation. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home needs to confirm in writing to the prospective resident or their representative that with regard to the needs assessment completed the home can meet the needs of the prospective resident. This ensures that decisions around admission to the home are informed. Residents and staff would benefit from clear leadership, guidance, direction and management. There are identified shortfalls in care planning, meeting of resident’s health care needs, risk assessments, and in supporting and enabling residents to live a lifestyle based on their individual preferences and choice. Although there is an activity programme, which demonstrates that activities are scheduled on a daily basis, it was confirmed by staff that this does not always happen. Therefore an appropriate programme of activities needs to be created that is realistic and based on the residents preferences to ensure that their social and leisure needs are met on an individual basis. The quality of the food prepared is of an adequate standard, however poor supervision and management of the meal service was observed. Staffing levels and skill mix needs to be assessed against the specific needs of the residents living in the home. The staff on duty are at present also cooking, which affects the staffing ratio to residents and leaves insufficient staff to care for and supervise the residents. Recruitment practices must improve to ensure the protection of residents. Direct supervision of staff needs to be introduced to ensure staff have the required care skills and empathy to provide appropriate support and care for residents living in the home. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 7 In addition a number of health and safety issues were identified including the need for accurate record keeping, appropriate up to date policies and procedures and robust individual and environmental risk assessments. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admission procedures allow for the needs of prospective residents to be assessed by a competent person before admission, however little information is documented thus not ensuring their needs can be met. EVIDENCE: The Statement of Purpose was not available for viewing at the site visit and therefore also not available for prospective residents and families. The Service Users Guide is now in a brochure format and is colourfully presented with photographs of staff and residents. It is however, not easy to read as the font used is small. The Service User Guide also contains information regarding the sister residential home. It is written in plain English and includes information about life in the two homes, accommodation, staff and facilities available, but it is not personal to Springfield and does not Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 10 highlight what is specific to the home, such as sensory gardens, staff qualifications, dining areas and facilities; the photographs do not identify which home they relate to. This was discussed with the Registered Provider and he is agreeable to review the document and brochure. The registration certificate is clearly displayed and was found to be accurate. Five pre-admission assessments were viewed which included the last three admissions to the home and the records relating to the admission procedures followed were reviewed. This confirmed that pre admission assessments are completed and provide an assessment of prospective residents care needs. However as discussed more information needs to be recorded to ensure new admissions to the home are appropriate and that the home have the staff, equipment and environment to meet their care needs. Prospective residents’ are seen either in their home or hospital before admission and the input from relatives and other professionals is used whenever possible. This approach should be more clearly recorded on the assessment documentation to demonstrate the procedure followed. It was however noted that the home does not confirm in writing, having regard to the assessment that the home can meet the assessed needs of the prospective resident. This was discussed with the Registered Provider who was advised that this should be completed in writing in accordance with the required documentation. Senior staff were able to verbally demonstrate their knowledge and awareness of the different specialities required in the home and stated that the training provided is pertinent to the residents they care for. Trial visits to the home can be arranged. It was confirmed that residents are invited to a trial period to ensure suitability of the home; this is clearly stated in the terms and conditions of residency. Intermediate or rehabilitative care is not provided at Springfield. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although care documentation provides a framework for the delivery of care it needs to be developed to provide clear guidance to care staff on all the care needs of the residents, along with robust systems for risk assessment to ensure individual person centred care is delivered. The homes practice ensures resident’s medicines are stored and administered safely. EVIDENCE: The care documentation pertaining to five residents were reviewed in depth as part of the inspection process, a further four were selected for review of certain areas identified during the inspection. The care plan system in use includes plans of care, nutritional assessments, assessments to monitor and identify tissue damage, personal histories and an evaluation sheet, which evidenced monthly review. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 12 The care plan documentation in some areas continues to improve; however the inspection process identified a number of important shortfalls in the care documentation. For example, not all resident’s social emotional and psychological needs were assessed or addressed within the care records. The records for those with pressure sores did not clearly identify the first signs of tissue damage, and did not evidence the steps taken by the staff to prevent further damage or to promote healing. From information received prior to the inspection visit and from viewing the documentation, specialist advice was not sought regarding residents’ pressure damage. The Residents with communication problems did not have any guidance in the documentation to facilitate this vital need; it was also found that social histories and social care plans are not completed on all residents. Risk assessments for health needs are included in the care planning format used by the home, and all risk assessments were found to be completed, but not all followed through with an appropriate plan of action when identified as required. In particular nutrition and pressure damage. Fluid and turning charts for those that are in need of monitoring were not completed consistently and for two residents had not been completed since the previous day. Two residents were identified from incident records as absconding and this was not reflected in their care plans and did not demonstrate how staff would ensure their safety. During discussion it was stated that only two residents had tissue damage, but in fact on further discussion there were six residents with pressure damage. Staff spoken with confirmed that they received a full report on each resident daily and read the care documentation when they can, that is kept in the main nurses station. Relatives and residents spoken with were satisfied with the care provided at the home one saying that the home ‘its very nice here’ ‘ I have no complaints regarding the care’’ ‘my relative receives good nursing care and care workers are kind, considerate and supportive’ ‘Staff seem very kind’. The clinical room is also the staff office. There is a small fridge and temperatures of the room and fridge are recorded daily. There are policies and procedures in place for staff to refer to regarding the safe administration, storage, disposal and recording of medication. The systems for recording and checking controlled drugs were found to be thorough. Medication Administration Charts were found to be competently completed and safe administration of the midday medications were observed. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 13 Staff were seen to be respectful and considerate to all residents and visitors, whilst attending to their needs. However staff were seen entering bedrooms without knocking during the inspection. The residents were found to be well presented in clean clothing, but it was noted that not all residents had had a shave, and some hand nails were unclean. One relative mentioned ‘ he does not seem to have been shaved today’. It was also noted that not all residents were wearing socks/stockings with their day shoes. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents would benefit from a more robust and stimulating activity programme. The lifestyle experienced by residents does not always match their expectations, choice or preferences. EVIDENCE: The activity co-ordinator has left employment at Springfield since the last inspection and staff said that they ‘do’ activities with residents in the afternoon. On the afternoon of the inspection visit activities were to be undertaken in the main lounge area and was to be painting. However no residents were interested in this activity and therefore the television was switched on. The layout of the large lounge was discussed and would benefit from review. The Service Users Guide states that there are therapeutic activities, but there was no evidence to support that these take place. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 15 The Activities were discussed in depth and the Registered Provider is to review the current programme to ensure that it meets all the resident’s preferences and capabilities. The sensory garden was seen and is full of herbs, water features and good quality garden furniture. Despite being a warm day though there were no residents outside enjoying this facility. There are plans for a sensory room to be developed in the future. A relative visiting said ‘ not much happens, but they had a really wonderful barbeque a while ago’. Visitors are welcome from 10am –12 midday, 1pm to 5pm and 6 pm to 8 pm, but these are said to be flexible. Relatives spoken with said they feel comfortable visiting their relatives and friends. From direct observation the relationships between staff and relatives were positive. The staff said residents are encouraged to make choices about all aspects of their day to day lives, this however needs to be reflected in the individual care plans and there is a need to evidence the choices regarding meals and activities. The care plans of residents unable to make choices need to demonstrate how the staff enable and support residents in making choices. The kitchen and storage areas were found clean and fairly well organised. Due to concerns raised by family and friends of residents regarding the quality and quantity of food a new chef/cook has been employed and is currently off sick. The Registered Provider confirmed that the menus are under review. A senior carer had taken over the role of cook on the site visit, which unfortunately left the day shift short of one senior carer. The menus were viewed and demonstrated a variety of plain wholesome food, however as found at the last key inspection, the menus are not followed when examined alongside the diary. It was not clear whether the residents’ preferences are taken into consideration when planning the daily menus. The choice of meals available on the day of the inspection was limited, fish pie or fish and only one desert. The cook was not informed until 11:00 am of residents’ preferences and then only because she went and asked the care staff. By 10 30 am, the vegetables were cooked. The kitchen diary has not been kept up to date and there is still no record of residents’ appetites being recorded. One resident who did not eat his main meal, was not offered an alternative and when asked of an alternative meal for him, staff said he would eat his sandwiches for tea. This does not ensure a nutritionally balanced diet. There was confusion regarding whether two residents who are frail and require assistance with feeding had had breakfast as their charts were not completed, the senior carer stated they had not, and that due to staff shortages they had not been able to feed the residents, this was brought to the Registered Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 16 Providers immediate attention, later however, it was said they had been fed breakfast, but it had not been recorded. This situation needs to be monitored and communication between staff improved. The dining room has a homely atmosphere for the residents to eat their meals. There were not sufficient staff available to assist and support residents with their mid day meal There are a high number of residents needing assistance, which meant some residents were seen struggling with their meal for some time, their food getting cold and one member of staff was seen assisting four residents at the same time in the large lounge area. Fresh fruit is not readily available and the only fresh fruit in the home was five bananas, one relative said ‘I bring in fresh fruit, as there is not always any here, and other times I bring in chocolate’, another said’ the food looks nice’. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to record and investigate complaints. Training in adult protection is provided for staff to protect residents from abuse. EVIDENCE: The home has a written complaints procedure and this is displayed in the home and provided within the Service Users Guide. There have been a number of anonymous complaints and these have been investigated under the homes complaint policy and procedures. Relatives and visiting professionals said that they were confident that the management of the home would respond positively to any concern raised. There are policies and procedures in place in regard to protection of vulnerable adults (POVA) and staff spoken with were aware of the policies and confirmed they had received appropriate training. Records also confirmed that the Registered Provider and staff have received appropriate training on safeguarding adults and the home has a whistle blowing procedure. One level one Adult Protection investigation has been raised since the last key inspection and was investigated by the Registered Provider and Social Services Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 18 were happy with the Registered Providers response and plan of action to employ a chef and improve the catering in the home. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 23, 24, 25 and 26. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Springfield provides residents with a homely and comfortable environment with communal rooms and a shaft lift that enables them to have access to all parts of the home, however the residents are not fully protected by the poor maintenance and use of specialist equipment. EVIDENCE: A tour of the home confirmed that the home is generally adequately maintained, there were some issues identified in the older building that the Registered Provider confirmed that he would address immediately, therefore a requirement has not been made. These included: a blocked sink in a residents room, broken ceiling and a shower room that is unusable due to a broken hose and bracket. Bedrooms in the older part of the building are being decorated Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 20 when they become vacant. The new building is furnished and decorated to a high standard. During discussion with the Registered Provider it was stated that there is an ongoing maintenance programme at the home, with repairs carried out when the need arises, they are behind at present as the maintenance person is on holiday. The records of routine safety checks were again not available for viewing, however it was stated by the Registered Provider that all they were all up to date. Water temperatures are not recorded, but ticked and it was discussed that it would be beneficial to record the temperatures, door guards are not checked regularly and recorded and this needs to be introduced. The garden has been transformed in to an attractive patio and sensory garden with a seating area and is accessible to all residents. The communal areas are also attractive and allow for different uses. There are adequate communal bathrooms and shower rooms in the home, with specialist equipment to ensure all residents can have a bath or shower. However in the older building, the top floor, one bathroom has been closed and one shower room was not in working order and on the ground floor the bathroom whilst functional is not attractive and welcoming and is in need of attention. There are call bell facilities in place, however it was identified again that they are not always accessible to residents, the lounge areas need a facility that the residents/relatives or staff can reach. It is acknowledged that not all residents will be able to use a call bell, so there is an identified need for individual risk assessments concerning call bells and a document to ensure that all residents in their rooms without access to a call bell are checked regularly. This was a requirement at the last inspection and therefore remains outstanding. There are hoists and other equipment in the home to cope with the needs of the residents. The new building has wide corridors with rails, which will encourage the residents to mobilise. All the residents have suitable height adjustable bed with bed rails if required. There are airflow mattresses in place for residents at risk from pressure damage, however three were not functioning properly and the alarm lights were illuminated. This was identified to the staff and the Registered Provider. The inspection took place from 09:30 am and the communal areas of the home were clean and welcoming. The cleanliness of the bedrooms in the older part of the building was difficult to assess, as the cleaning was not completed, however there are some bedrooms that had a definite malodour and very dusty and were not as clean as other areas of the home. Staff need to ensure Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 21 that all rooms have the necessary liquid soap and paper towels for staff to use to promote good hygiene and prevent cross infection. There is one laundry room to cope with the homes laundry; the floor is a risk of cross contamination as it is badly torn. The resident’s clothes looked well cared for and clean. Two relatives said that they appreciated the care taken with the clothes and the cleanliness of the home was always good. Good practice was seen during the inspection in respect of the use of gloves and aprons, but commodes were found full and uncovered in rooms. Sluice areas were clean, however the new building sluice room was being used as a storage area for walking frames and wheelchairs, which is not good infection control practice. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A review of staffing levels based on residents’ dependency levels needs to be implemented to ensure there are sufficient skilled staff to meet residents needs. The recruitment practice at present does not protect and support residents living in the home. EVIDENCE: The staffing rota in place was viewed, it was inaccurate for the day of the inspection visit, it also identified that the staffing levels for the night shift is not kept to a constant number and on occasion falls to just two carers and one trained, which is not sufficient to care for and monitor the residents. There was also a large amount of changes to the rota, which were not signed and dated and as demonstrated during the inspection causes confusion. The amount of Registered Nurses employed on a full time basis is low, just two and one part time, the other shifts are covered by bank staff. From direct observation and from talking to staff there are not enough staff to meet the complex and varied needs of the residents, residents were still being washed and dressed just before lunch was served. As mentioned previously it was not clear if all the frail residents that remain in bed were washed and fed appropriately. Staff had little time in the morning to interact with residents Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 23 because they were very busy. There are also a number of residents that are mobile and it was not possible to monitor these residents adequately. Staff spoken with said that they felt there were insufficient staff on duty to give a good standard of care and to spend time with residents on a one to one basis. Relative’s feedback included ‘ staff are very busy, but they are good’, ‘ nice staff, they work hard’. At present the home employ twenty one carers; of those three have the National Vocational Qualification (NVQ) level 2 and 3 in care and nine are currently on NVQ courses. The recruitment practice and records were inspected for seven staff members working in the home as part of the inspection process. This review identified a number of areas of concern: • • • • • The staff files are difficult to track. One member of staff did not have a completed application form. The newly introduced staff record checklist did not detail when references had been received so it was not possible to see if all the checks were completed prior to starting in the home. References from abroad did not evidence that the references have been checked. A student from Brighton University did not evidence any recruitment checks. The Registered Provider stated the university had completed the necessary checks; however evidence needs to be kept in the home that these checks are in place. The employment histories found in application forms are not always adequately completed. • From the records seen and from talking to new staff, not all staff have undertaken their ‘skills for care’ induction programme. There is a training matrix in place that ensure that staff receive the necessary mandatory training in moving and handling, infection control, POVA and fire safety. Records produced also demonstrate that staff are receiving training in dementia, tissue viability, medication and health and safety. The training matrix produced following the site visit did not have dates of attendance and it is a recommendation of good practice that dates are included so as to ensure that updates are provided within the recommended time frames. There are nine new members of staff that have yet to receive the necessary training, it was confirmed that training sessions have been organised. One carer who is working nights is not on the training matrix. The practices observed during the inspection were good in respect of the use of gloves and aprons, however from direct observation not all staff are using safe Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 24 moving and handling techniques for moving a resident up the bed, this needs to be appropriately risk assessed and reflected in the care plan, staff were concerned that the new hoist does not fit in the bathroom. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. People who use this service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and staff would benefit from a consistent managerial approach that provides leadership and promotes the health and safety of the residents. Staff must be appropriately supervised to ensure good care practices are consistent throughout. EVIDENCE: The home has been without a registered manager for over two years, the Registered Provider has been taking on the responsibility of the day-to-day running of the home alongside a prospective manager. However the prospective manager is currently on long-term sick leave and to ensure that the residents and staff benefit from a clear management approach and strong leadership, it is now necessary to fill this vacancy. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 26 During the inspection visit it was found that the Registered Provider was not fully aware of changes to the staffing rota, the incidence of residents with pressure damage and changes to the daily routine of the home. There are systems in place to monitor the quality in the home and include the use of questionnaires and relative meetings. There was evidence of an audit of responses and of action to be taken to address the issues. It was recommended that the use of questionnaires is expanded to staff and visiting professionals. There are no residents at present who are responsible for their own finances; relatives and solicitors support the majority, while the home does not handle the financial affairs of residents. A sample of residents’ personal allowance finance records were viewed, and errors were identified in that not all transactions were supported by a receipt and the tally of money held was not always correctly recorded. The Registered Provider confirmed that he has informal chats with staff but has not commenced the necessary formal supervision sessions discussed at the last key inspection. At present not all staff have received the mandatory training in moving and handling, health and safety and fire safety as they have only recently been employed, however there is evidence of planned training sessions that will address this. There was unsafe moving and handling techniques observed during the inspection; risk assessments still need to be developed for the individual residents, premises and the garden areas. The accident book was viewed and it was identified that there had been three incidents where residents had left the building unnoticed, these incidents had not been reported to the CSCI as required and the residents care plans did not reflect what actions the staff must take to ensure the continued safety of these residents. Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 27 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 2 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 2 2 1 3 3 3 2 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 2 1 X 1 Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 28 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 OP1 Regulation 4 (1) (c) Requirement That the Registered Provider ensures that a Statement of Purpose is available for the service users and their representatives in accordance with the Regulation and Schedule 1 of the National Minimum Standards. That the Service User Guide is reviewed and be specific to Springfield Care Home. 2. OP3 14 (1) That the Registered Provider ensures that the pre-admission assessment has sufficient detail to ensure the home has the necessary facilities and skills to meet the prospective needs. That registered person confirms in writing that having regard to the assessment made on any prospective service user that the home can meet those needs. 3. OP7 15(1)(2) 12(1)(a)( b) That the Registered Provider ensures that care plans accurately reflect the specific needs of the service users. DS0000059836.V352610.R01.S.doc Timescale for action 24/12/07 24/12/07 24/12/07 Springfield Version 5.2 Page 29 4. OP8 That service users and/or their representatives are consulted regarding the formation of the care plans. (Previous time scale of 01/09/07 not met.) 14(1a)(a) That the Registered Provider (b) 13(1b) ensures that all risk assessments are updated regularly and include an action plan for staff to follow. That accurate records pertaining to nutrition, wound care, continence and communication are further developed and accurately reflect the service users changing needs. (Previous time scale of 01/09/07 not met.) That all service users have a social care plan that is designed to meet their interests and preferences. That service users isolated in their bedrooms have a plan of care to ensure that they receive interaction and stimulation. (Previous time scale of 31/07/06 and 01/09/07 not met.) That the Registered Provider ensures that service users are supported and enabled to exercise personal autonomy and choice and this is demonstrated in individual care plans. (Previous time scale of 07/06/07 not met.) That the Registered Provider ensures that service users are offered a varied and nutritious choice of meal. That a formal monitoring of service users appetites and 24/10/07 5. OP12 16(1)(2) (n) 24/12/07 6. OP14 12 (2) (3) 24/12/07 7. OP15 16 (1) (a) 24/10/07 Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 30 8. OP21 23 (2) (j) 9. OP22 16 (2) (c) 10. OP25 23 11. OP26 13 (3) 16 (2) amount consumed is kept. (Previous time scales of 31/07/06 and 01/09/07 not met.) That the Registered Provider ensures that there are adequate bathing facilities are available for use in the home. That the Registered Provider ensures that the specialist equipment in the home is maintained and in good working order. This pertains to: • Air flow pressure relieving mattresses- daily check • Call bell facility to be in reach of service users, staff and visitors. That the Registered Manager ensures that records relating to routine safety checks are in place and available for inspection. • Door guard. • Water temperatures. • Lift. That the Registered Provider ensures that the necessary repairs are made to the laundry floor to prevent cross infection. That all staff follow the homes policies and procedures in the standard of cleanliness and infection control measures. 24/12/07 24/10/07 24/12/07 24/10/07 12. OP27 13. OP29 That the soap dispensers and paper towels are full and ready for use. 18 (1) That the Registered Provider ensures that there are sufficient staff on duty to meet the needs of the service users at all times. 19(4)(a-c) That the Registered Provider ensures that a thorough recruitment process is followed and includes: • That all prospective DS0000059836.V352610.R01.S.doc 24/10/07 24/10/07 Springfield Version 5.2 Page 31 • • • employees complete an application form That all prospective employees employment histories are in place. That all references are applied for and evidence that they are received before commencement of employment. That all new staff receive an appropriate induction programme. 01/02/08 14. OP31 Sch 2 That the vacancy for registered manager be filled. (Previous timescales of 31/07/06, 01/04/07 and 01/09/07 not met) 15. OP35 17 (2) 16. OP36 18 (2) 17. OP38 13(4)(c) That the Registered Manager 24/10/07 ensures that service users personal allowances are correctly documented with the related receipts. That the Registered Provider 01/02/08 ensures that care staff receive the necessary six formal supervision sessions a year. That all accidents recorded have 24/10/07 an appropriate action plan devised to prevent reoccurrence of accidents as required under Regulation 17 Schedule 3 and 4. That a risk assessment of the environment is undertaken which includes the regular inspection of all parts of the building to which residents have access, ensuring that any unnecessary risks are identified and so far as possible eliminated. That all service users have access to a call bell, or a method of recording that the staff are Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 32 regularly checking those service users who cannot use this facility. (Previous timescale of 01/09/07 not met.) 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.V352610.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield DS0000059836.V352610.R01.S.doc Version 5.2 Page 34 - 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. 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