Inspection on 09/01/07 for Spring Lane Care Home

This inspection was carried out on 9th January 2007.

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.

Other inspections for this house

Spring Lane Care Home 27/11/08

Spring Lane Care Home 31/10/05

Spring Lane Care Home 20/07/05

Spring Lane Care Home 02/11/04

Spring Lane Care Home 06/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Spring Lane Care Home 168 Spring Lane Lambley Nottingham NG4 4PE Lead Inspector Stephen Benson Unannounced Inspection 9th January 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 Spring Lane Care Home DS0000008765.V326223.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. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spring Lane Care Home Address 168 Spring Lane Lambley Nottingham NG4 4PE 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) 0115 967 0341 0115 9674928 Spring Lane Nursing Home Limited Ms Nicola Jane Harrison Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One named Service user may be under the age of 65 years. Service users shall be within category OP Date of last inspection 31st October 2005 Brief Description of the Service: Spring Lane is a care home providing personal care and accommodation for 60 older people. The home provides short term, long term and respite care. The home is owned by Spring Lane Care Homes Limited, which is run as a family business. The home is located in a rural area between Mapperley and Lambley where there are shops, pubs, the post office and other amenities. The home was opened in May 1996 and consists of a purpose built building. 52 of the home’s bedrooms are single, and 11 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. The home has large gardens that are well maintained and easily accessible. There is ample car parking available. The manager said in the pre inspection questionnaire that the fees for the service range from £277 - £475 per week depending on dependency needs. There are additional charges for hairdressing and chiropody. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. Prior to the visit an analysis of the home was undertaken from information gathered over the last year including a pre inspection questionnaire. The site visit lasted for 4 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, a senior care, care staff, catering staff, the activities coordinator and care practices were observed. No visitors were seen during the visit. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. Survey forms sent to the home by The Commission for Social Care Inspection had not been completed by residents and/or their relatives. What the service does well: An assessment is carried out of any prospective new resident’s needs before they come to the home. Staff are made aware of the needs of any new resident. Residents said they visited the home before moving in. The evidence shows that new residents are assessed before they come to live at the home. Residents well being is monitored and they are able to see a doctor if needed. There are arrangements in place to provide routine healthcare checks such as dentist and optician check ups. Residents said staff knew about their health needs. The evidence shows that residents’ health care needs are fully met. Care staff find out how residents like to be assisted and encourage them to do as much for themselves as they are able. Residents were happy with the support they receive. Good practices are followed when providing personal care. The evidence shows that residents’ privacy and dignity are promoted. There are regular activities provided and entertainers visit the home. New activities are tried out as well as old favourites. There is a regular church service held. Residents said there is plenty to do and they enjoy the activities. The evidence shows that resident’s lifestyle matches their expectations. Visitors are welcome daily and can take residents out. Residents can suggest any outings into the local community. Residents said they have visits from Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 6 their families. The evidence shows that residents maintain contact with family, friends and the local community. Details of residents’ preferences were included in their care plans and care staff described how they promote residents’ autonomy and choice. Residents said they can do what they want to. The evidence shows that residents have control over their lives. The home has a four week menu which offers a choice of meal. Residents said they like the food and get enough to eat. The evidence shows that residents receive a wholesome appealing balanced diet. Staff knew to report any complaint made and residents felt confident to raise anything they were not happy about. The evidence shows that residents are confident that their complaints will be listened to. There have been two recent allegations of abuse, which have been reported through the Adult Protection procedures. One was not substantiated and the other is subject to a criminal prosecution. The evidence shows that measures are in place to protect residents from abuse. The home was clean, tidy and fresh and residents said it is always kept clean. The evidence shows that the home is clean, pleasant and hygienic. The rota shows that there is a minimum of five staff on duty during the day and four at night. Residents said there are enough staff to respond to their needs. The evidence shows that residents’ needs are met by the numbers and skill mix of staff. Some staff have completed National Vocational Qualification training levels 2 and 3 and further staff are working towards these qualifications. The evidence shows that residents are in safe hands at all times. The manager has worked at the home for a number of years and is currently working towards the Registered Manager’s award. Residents felt the home is well run. The evidence shows that there is a suitable manager employed to run the home. Regular safety checks and tests are carried out and there are contracts in place for servicing equipment. The evidence shows that the health, safety and welfare of residents are protected. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Care plans provided clear details as to how residents’ needs should be met, however these were not being regularly reviewed and residents have not been consulted about these. The evidence shows that residents are not involved in setting out their needs in an individual plan of care and these are not kept under regular review. More recently admitted residents do not have photographs on Medicine Administration Records to assist with identification and the person responsible for giving out medication does not always observe this being taken. The evidence shows that residents are not fully protected by the homes’ procedures for administering medicines There were some unreported repairs identified during the inspection. There were broken tiles on the kitchen floor and a broken en suite door. The central heating system was making loud noises that residents found disrupting. The evidence shows that the home is not being properly maintained. The required Criminal Records Bureau or Protection of Vulnerable Adult checks could not be found for all staff. Some staff had started working in the home before two satisfactory references had been obtained. The evidence shows residents are snot protected by the home’s recruitment policy and practices. Training records did not clearly show what training staff have undertaken and when these need to be updated. The evidence shows that staff are trained to do their jobs. The home does not have a quality assurance programme in place. The evidence shows that residents express their views on how the home is run. The home will help residents with their personal allowances if wanted and a record is made of expenditure made, but only one person signs this. The evidence shows that residents’ financial interests are not being safeguarded. Please contact the provider for advice of actions taken in response to this Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 8 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. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 9 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 Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 10 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): 3 and 6 Quality in this outcome area is good. New residents are fully assessed prior to moving into the home to ensure that their needs can be met. The home does not offer an intermediate care service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home offers a respite care service and a sample of files were seen for these residents as well as a file for a recently admitted resident. There was a copy of the Community Care Assessment seen on file dated prior to the admission of the resident. In addition the home had carried out a further assessment on the day of admission covering the activities of daily living. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 11 The manager said that where a resident does not have a Community Care Assessment as they are self funding she will go and visit the person in their home and carry out an assessment of their needs and then invite them to visit the home. The manager said that a resident would not be admitted without a copy of the Community Care Assessment where one has been undertaken. Care staff said they read the care plan of any new resident and get told about new admissions in the daily report meeting. A senior care said that new residents are continually observed when the come to the home to see how they are doing and whether the original assessment is still accurate. A resident said, “I came for a visit with my family and they explained my needs to the staff”. Assessments included details of any specialist assistance a resident requires. The manager said that anyone is welcome to apply for a place providing they fall within the registration category for the home. There is no arrangement made for the home to provide an intermediate care service. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. Residents are not involved in setting out their health, personal and social needs in an individual plan of care and these are not kept under regular review. Residents’ health care needs are fully met. Residents are not fully protected by the homes procedures for dealing with medicines. Residents are treated with respect and dignity. This judgement has been made using available evidence including a visit to this service. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 13 EVIDENCE: A sample of care plans were seen and this included one that had been prepared in a new format, which the manager said that they are about to change over to. Care plans seen were generally well completed and gave specific instructions, which were clear for staff to follow to meet the residents’ needs. Care plans seen did not show any involvement of residents and/or their relatives and had not been reviewed since August 2006. Care plans include details of resident’s gender, ethnic origin, religious beliefs and any disability. They also included a moving and handling assessment, an assessment of any risk identified and an assessment of any hazard posed by the environment. Care staff said they refer to care plans for information and gave an example of looking to see when a resident had last had their nails done, and the senior care said they record any changes. A resident said, “No one has discussed a care plan with me, I just leave it to them, they are very caring”. There were references seen within care plans to promoting residents’ health care, including eye tests and chiropody. There was also a mental and psychological assessment. There were separate files seen to record opticians and dental visits, which take place in the home. The manager said that residents’ health is closely monitored and care provided is altered accordingly. Families are encouraged to comment on any concerns about a resident’s health. Care staff said they promote residents’ healthcare by ensuring they receive the physical care they require and they tell a senior if a resident is, or seems to be, unwell. A senior care said anyone who is not well is observed and a doctor called if necessary. A resident said, “If I need to see a doctor I only need to say and they will get one for me” and “Staff know about my health problems and how to deal with them if they occur”. The home has a separate medication room and storage arrangements for medication appeared good. There was an assessment seen in care plans to assess whether a resident is able to self medicate. At present no residents are assessed as being able to do so, however some have done so in the past. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 14 There were reviews of the medication taken by residents also seen in the care plan. Medicine Administration Records were fully completed and some had photographs of the resident attached, however those that did not were of the more recently admitted residents and the manager said this was because they had not yet got round to taking the photographs. A senior care said that they don’t watch every resident take their tablets, some they leave for care staff in the vicinity to observe. The manager said that this is not the practice she expects and the person giving out medication is responsible for observing all residents take their medication. A resident said, “I get given my tablets three times a day, staff stand there while I take them”. There was reference made in care plans to maintaining residents’ privacy and dignity when providing personal care. The manager said that all appointments and visits take place in private, normally the resident’s bedroom. The manager said staff ask residents how they like things to be done. Care staff said they always explain to residents what they are going to do before providing them with assistance and encourage them to be as independent as possible when helping them. Care staff also said that they try to ensure that residents look presentable and how they would like to look. Care staff described good practices in promoting residents privacy and dignity including making sure they are properly dressed. A resident said, “I still dress myself, staff just keep an eye on me, I am happy with the way I am helped”. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. Residents find the lifestyle experienced in the home matches their expectations. Residents maintain contact with family and friends and the local community. Residents are helped to exercise choice and control over their lives. Residents receive a wholesome and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was an activities notice board outside the main lounge, which included details of forthcoming activities. There are two activities coordinators employed who share organising activities from Monday to Friday. There was reference made in care plans to encouraging residents to take part in the home’s activities. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 16 A church service is held in the home every three weeks and a priest had come to provide communion to a resident. One resident goes out to a local church. Staff were seen discussing activities and heard encouraging residents to join in a game of cards. The manager said that activities are provided during the week leaving weekends free for families to visit. There are also regular outside entertainers who come in. The activities coordinator said they had tried a game of ‘Play your cards right’ the previous week and there are plans to make a seasonal wall display. There is not a record kept of what activities have been provided and what activities residents have taken part in. A resident said, “Someone comes in and does things like knitting, sowing, cards and dominoes and someone else does skittles and plays the guitar. There is quite a lot going on but it is left to you whether you join in or not”. Another resident said, “We enjoy playing the games”. All Christian festivals are celebrated There were references seen in care plans to maintaining links with families. The manager said that families are able to take residents out when they visit. Residents have been told in residents’ meetings to suggest any outings they would like organised. It was suggested that a notice could be displayed on the activities board about this as well. A resident said, “My family can come when they please, visitors can come up until 8.00pm when they have to lock the doors for security”. There were details seen in care plans of residents’ preferences including what they like to wear and do. Care staff described giving residents choices about such things as the clothes they wear, whether to take part in activities, using the garden in nice weather and the food they eat. A resident said, “You make your own mind up here about what you want to do”. The home has a four week menu which provides a choice of meal and residents are asked daily to select their choice. In addition alternatives can be provided if someone fancies something different. There is a section within the care plan to record any special dietary needs and there were lists of these seen in the kitchen. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 17 The manager said she occasionally will ask residents if there is something special they fancy and arrange for this to be provided. One lady had recently requested some smoked salmon and this had been provided and others asked for bread and dripping which is on the menu for later in the week. New dishes are tried out and some residents have enjoyed having things such as curries and spaghetti bolognaise. Residents were seen having lunch and there were differing sized portions provided. Some residents had a soft diet and staff were seen assisting residents that needed assistance. A choice of drinks were provided with the meal. A resident said, ”The food is very good, you get a pudding with your dinner. Anyone who has trouble feeding themselves is helped” and “there is always something I like, today I am having gammon, you get all the trimmings with it”. The manager said that any special diet for personal choice, religious or health reasons would be accommodated. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is good. Residents are confident that their complaints will be listened to, taken seriously and acted upon. Residents are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission for Social Care Inspection received an anonymous complaint in November 2006, which the provider was asked to investigate. This was not substantiated, however the report prepared by the provider did not provide sufficient detail to support this conclusion and ways of doing this were discussed with the manager. Staff knew about the home’s complaints procedure and said they have to report any complaint made to them to the person in charge or the manager. A resident said, “If I wasn’t happy about anything I would just have to tell the boss and she would put it right”. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 19 There have been two alleged incidents of abuse since the last inspection, both of which were appropriately referred through the Adult Protection procedures. One was unfounded and the other, which involved financial abuse of a resident, is currently the subject of a Police investigation. The manager said the person concerned no longer worked at the home and had been placed on The Protection of Vulnerable Adults register. Care staff said they were aware of the Adult Protection procedures and that training has been provided recently at the home. A resident said, “You don’t get badly treated here, everyone is happy”. The manager said that any form of abuse or discrimination would not be accepted and would be dealt with by following the Adult Protection Procedures. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 20 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 and 26 Quality in this outcome area is good. The home is not being properly maintained. The home is clean, pleasant and hygienic. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well laid out and has wide corridors and everywhere is accessible to wheelchair users. Handrails are provided, although these are only on one side. There is a maintenance book to record any repairs in and members of the provider’s family then carry these out. The manager said that repairs are promptly attended to, although the date of completion is not included in the maintenance book. There were some repairs identified that were not recorded Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 21 in the maintenance book. There were some broken tiles on the kitchen floor that require replacement and a broken door to one resident’s en suite. The central heating system was heard making a loud noise and staff said that this was a problem in some bedrooms. A resident said, I have to turn my hearing aid of when it starts”. There are housekeepers employed to keep the building clean and tidy and everywhere seen was a good standard of cleanliness. The laundry was well organised. Staff said they have had training in infection control and protective clothing and anti bacterial hand wash are always available. A resident said, “My room is cleaned everyday and the sitting rooms are cleaned when we are having our meals”. Spring Lane Care Home DS0000008765.V326223.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 Quality in this outcome area is adequate. Residents’ needs are met by the numbers and skill mix of staff. Residents are in safe hands at all times. Residents are not protected by the home’s recruitment policy and practices. Records do not clearly show what staff training is required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota shows the home provides a minimum six care staff during the morning shift and five in the afternoon. There are four care staff at night. In addition the home employs a chef, kitchen assistant, housekeepers, laundress, activities coordinators and a secretary. Staff confirmed the minimum staffing levels and said they can call on other staff if needed. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 23 A resident said, “There are always plenty of staff on duty, they come promptly if I use my call bell” and “if they are short staffed they get someone in from an agency”. The home does not employ any male carers, although the manager said they have done so previously. The manager said this is due to a lack of male applicants for any job vacancies and any suitable male applicants would be considered for any vacancy. Staff are of varying ages and from differing ethnic backgrounds. There are three staff who have completed National Vocational Qualification level 2 and five are working towards it. Three staff have completed National Vocational Qualification level 3. There are some staff working in the home who have not yet had their Criminal Records Bureau checks returned. For most of these a Protection of Vulnerable Adults check was seen, however there were some that could not be located. The manager phoned the provider who was away on holiday, who said these have all been obtained and no one is working in the home without at least one of these checks. There were some staff who have started work prior to two satisfactory references being obtained. The file for a member of staff who started today could not be located. There was a training record for each member of staff, but these did not easily show when staff were due training updates. A resident said, “Staff seem to be trained to do their jobs”. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38 Quality in this outcome area is good. There is a suitable manager employed to run the home. Residents do not express their views on how the home is run. Residents’ financial interests are not being safeguarded. The health, safety and welfare of residents are protected. This judgement has been made using available evidence including a visit to this service. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager is working towards the Registered Managers Award and expects to complete this in April 2007. The manager has worked in the home for over five years and was described as approachable by staff. A resident said, “I think the home is very well run”. The manager said that there are not any quality assurance systems in place at present but the provider is currently working on one to put into place. The home will hold money for residents to pay for hairdressing, chiropody and other incidentals. A record is made of each transaction and signed, but not witnessed. Receipts are kept when available. The manager said that all the required health and safety checks are carried out at the required frequency and there are service contracts in place for servicing all the equipment. Dates of tests were recorded in the pre inspection questionnaire showing they are regularly carried out. A sample of these were looked at and found to be correct. The manager said there are contracts in place for the servicing of equipment and testing the home’s water supply. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 26 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 2 X 3 Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered person must ensure that residents are consulted about their care plans and these are regularly reviewed. The registered person must ensure that safe practices are followed in administering medication at all times The registered person must ensure that all required repairs and maintenance are carried out. The registered person must ensure that the correct recruitment procedures are adhered to. The registered person must ensure that an accurate record is kept of staff training undertaken. The registered person must ensure that the home has an effective quality assurance programme in place. The registered person must ensure that all financial transactions made on behalf of residents are witnessed. Timescale for action 01/03/07 2. OP9 13 01/02/07 3. 4 OP19 OP29 13 19 01/03/07 19/01/07 5 6 OP30 OP33 18 24 01/03/07 01/04/07 7 OP35 17 19/01/07 Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP16 Good Practice Recommendations The registered person should keep a record of the activities residents take part in. The registered person should prepare a detailed record of any complaint investigation. Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Spring Lane Care Home DS0000008765.V326223.R01.S.doc Version 5.2 Page 30 - 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!