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Inspection on 11/05/05 for Spring House

Also see our care home review for Spring House for more information

This inspection was carried out on 11th May 2005.

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

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

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

Previous inspections have identified that the home provides a good standard of care and support particularly to people with dementia. Service Users spoken with said that the care staff are caring and kind. The atmosphere in the home is relaxed and service users talk to each other, not just to staff. The meals are of a very high standard, fresh ingredients are used. Most importantly individual preferences are taken into account- for example in the length of time an egg should be boiled.

What has improved since the last inspection?

Over the last few months a major extension to the home has been started. When completed this will provide additional lounge and dining space, accessible bathrooms, proper office space and additional en-suite bedrooms. However until the work is completed there is a some reduction in space, and the inevitable disruption of being adjacent to a building site. One area of improvement has been the rearrangement of the dining areas and lounge space. Service Users are now eating in smaller groups in different rooms, and this has improved the space available and people appear to enjoy eating in smaller groups.

What the care home could do better:

This unannounced inspection identified that during the building works over the summer, temporary garden space and ventilation needs to be created. Mrs Luckham, the registered provider, has reduced the staffing some mornings as part of a plan to re-organise how staff work. Staff expressed concern aboutthis and Mrs Luckham is to discuss this further with staff and to provide a review of staffing to CSCI. Some of the Service User Plans and risk assessments seen were inaccurate or lacked detail. These documents are important as they explain to staff what they need to do to meet individual needs and to keep people safe.

CARE HOMES FOR OLDER PEOPLE Spring House Peter Tavy Tavistock Devon PL19 9NP Lead Inspector Helen Tworkowski Unannounced 11 May 2005 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 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. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Spring House Address Peter Tavy, Tavistock, Devon PL19 9NP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01822 810465 01822 810465 Mrs B Luckha, Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (19), Old age, not falling within any other category (19), Physical disability over 65 years of age (19) Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 5th and 6th October 04 Brief Description of the Service: Spring House provides care for up to 19 older people in the small village of Peter Tavy, three miles from the market town of Tavistock. The home offers care and support to older people including people with dementia and mental health needs. All of the bedrooms expect one are single, and all have en-suite toilets and hand basins, two also have en-suite showers. The home has a stair lift to the first floor. There is a through lounge/diner, which the only communal space in the home. The home has a small garden and patio area to the rear of the home.The home is registered to care for people with a range of needs including dementia and mental disorder. The home is staffed 24 hours per day; at night there is a waking night staff and a sleep in staff. The home employs cooks who prepare all the meals in the home. There is a small laundry on the premises. A major extension to the home is being built. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an Unannounced Inspection and took place between 8.15 am and 3.45pm, on Wednesday 11 May 05. One meal was eaten with Service Users and time was spent talking with four individuals. The records of three Service Users were looked at. A full tour of the building was not possible, as part of the building was shut off for the day, whilst work was undertaken between the existing building and the new building. What the service does well: What has improved since the last inspection? What they could do better: This unannounced inspection identified that during the building works over the summer, temporary garden space and ventilation needs to be created. Mrs Luckham, the registered provider, has reduced the staffing some mornings as part of a plan to re-organise how staff work. Staff expressed concern about Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 6 this and Mrs Luckham is to discuss this further with staff and to provide a review of staffing to CSCI. Some of the Service User Plans and risk assessments seen were inaccurate or lacked detail. These documents are important as they explain to staff what they need to do to meet individual needs and to keep people safe. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 Mrs Luckham the Registered Provider has asked for additional time to complete the Statement of Purpose, a requirement that was made at the last inspection. This information is part of a package of information that could assist prospective Service User in making an informed choice about moving to the home. EVIDENCE: No Service Users have moved to the home since the last inspection. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 9 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 standard(s) 7 and 10 Some of the Service User Plans and Risk Assessments lack detail or are inaccurate. These documents are important as they explain to staff what they need to do to meet needs and keep people safe. Service Users are treated with respect and treated as individuals. EVIDENCE: The records relating to three individuals were looked at during this inspection. The Service User Plan and risk assessments for one person were detailed and up to date. However the Plans and risk assessments for the other two people were not complete. The Service User Plan should describe how an individuals needs will be met, and specifically detail the actions staff are to take. These documents should ensure that no needs are missed and that staff provide a consistent service. The incomplete documents described what the person’s needs were, but not what staff were to do in response or were vague lacking in detail. For example one person was described as being very anxious at times, and staff were to offer reassurance. Staff need to be told specifically how to offer reassurance though an agreed approach, for example by routines, by familiar activities or interests or by the sitting an talking through concerns. Service Users said that that they were well cared for and that they were treated with respect. Observations over the day were that this was the case. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 10 Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 11 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 standard(s) 12 and 15 Service Users are provided with a good range of activities. The meals provided are of a very good standard, and improvements have been made to the dining areas so that Service User are able to enjoy their meals greater comfort. EVIDENCE: A range of activities are provided for Service Users both in the home and through trips out. These include trips to a local tea dance and to Painton Zoo. On the day of the Inspection some Service Users enjoyed a game of dominoes whilst others did some knitting. A few people went out for a short walk in the local village. The meals provided in the home are of a very good standard, on the day of the inspection the lunch was roast chicken with fresh vegetables, followed by bread and butter pudding. Some Service Users enjoy a glass of wine or sherry with their meal. Service User’s individual preferences are taken into account, alternatives offered, second helpings provided and particular preferences taken into account. The dining room and lounge space have been re-arranged to provide space where small groups of people can eat together. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 12 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 standard(s) These standards were not inspected, no complaints have been received by CSCI. EVIDENCE: Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 13 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 standard(s) 19,20,21, 25 and 26. When the extension is complete the accommodation in the home will be much improved. The home is clean and comfortable. The home has incomplete risk assessments which could potentially place Service Users at unnecessary risk. EVIDENCE: A major extension is being build to extend the accommodation at Spring House. This will provide additional lounge and dining space, as well as improving facilities for existing Service Users, so that the home meets the National Minimum Standards. These building works have necessitated some disruptions. On the day of the unannounced inspection some of the Service Users were not able to go to their bedrooms in the daytime, there was some dust and intermittent noise. Staff confirmed that this was exceptional and for the most part the work did not affect Service Users so significantly. The building works have meant that the lounge-diner has no proper ventilation and there is no space for Service Users to sit outside in fine weather. The home has therefore been required to improve the ventilation in the lounge, and to provide a outside seating area for Service Users. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 14 The areas of the home seen were clean and well maintained. One person had recently had their room redecorated and thought had been given not only to the colours she liked, but to the lighting in the room. Requirements have been made that the home risk assess the dangers posed scalding from hot water and burns from hot radiators or pipes. Where these have been completed they are not accurate. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 Recent reductions to staffing levels in the mornings are causing concerns to staff and are to be reviewed a copy of this sent to the Commission. EVIDENCE: The home has until recently had four staff on during the morning and three on throughout the rest of the day. Recently on some mornings there have been only three staff on duty. Mrs Luckham, the registered provider, said that she felt this was sufficient if staff planned their work and worked as a team. Staff spoken to during this inspection felt that there was insufficient time to provide a good level of care. Mrs Luckham is to set up a meeting with staff to discuss their concerns, and to these staffing levels. Service Users raised no concerns around these changes however these had changes had just been implemented so they may not have become aware of them. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 Spring House is managed by Mrs Luckham, who has substantial the experience in running care homes. Service Users benefit from a stable and experienced management regime. EVIDENCE: Mrs Bridget Luckham and two other staff in the home have completed their registered managers awards. Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 17 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x x 2 x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 x x x x x x x Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 18 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The Registered Person must compile a “Statement of Purpose”, supply a copy to the NCSC, and make available to Service Users and their representatives. (This requirement was made at the last inspection on 5/10/04) The Registered Person must ensure that there are comprehensive, detailed and accurated Service User Plans and risk assessments to guide the care provided. The Registered Person must continue to work towards implementing the plan to extend the building so that it provides sufficient space in the home including:- Communal Space (lounge and dining)- Space for service users to meet visitors in private.- Separate staff accommodation for staff to sleep in.- Storage Space- Adequate Laundry and sluicing facilities. The Registered Person must ensure that risk assessments are completed, this must include in relation to hot surfaces. The Registered Person must Timescale for action 1/8/05 2. OP7 15 1/9/05 3. OP20, OP25 16,23 1/11/05 4. OP19,OP20 13 1/7/05 5. OP20,OP25 23 1/7/05 Page 19 Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 6. OP27 18 ensure that adequate ventialtion is provided in the lounge/dining area, and that a temporaty garden/ paito area is provided for the use of Service Users, until the extension is complete. The Registered Person review the staffing levels and provide a copy of this review to the Commission. 1/8/05. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 20 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Spring House D54 -D54 S3807 Spring House V218410 110505 Stage 4.doc Version 1.20 Page 21 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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