CARE HOMES FOR OLDER PEOPLE
Springfield 14 Elms Road Bare Morecambe Lancashire LA4 6AP Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 28th October 2005 14:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Springfield Address 14 Elms Road Bare Morecambe Lancashire LA4 6AP 01524 426032 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) michelle.grossetinternet.com Springfield Retirement Home Ltd Mrs Michelle Grosse Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. All radiators and pipework within the home must be covered with suitable guards by December 31 2004. A suitably qualified and experienced manager must be employed at all times who is registered with the Commision for Social Care Inspection. The home must not accommodate any more than 15 people in the older person (OP) category at any one time. 28/02/05 Date of last inspection Brief Description of the Service: Springfield is registered with the Commission for Social Care Inspection to provide care and accommodation for up to 15 older people. The home is situated in the Bare area of Morecambe. It is close to a number of facilities and amenities and the Promenade is within walking distance. Accommodation is provided over two floors and there is a chair lift available for the use of residents. All the accommodation at the home is offered on a single room basis. Two of the fifteen bedrooms have en-suite facilities. Care is provided on a 24 hour basis including waking watch care throughout the night. Some of the carers have National Vocational Qualifications in care at level two or above. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection which meant that the manager, staff and residents did not know it would be taking place until the inspector arrived. As the owner of the home was on a rest day the inspector was assisted by a senior carer – Diane Keywood. Discussions took place with regard to the running of the home and a number of documents were examined. A tour of the home was undertaken and the inspector consulted several residents and staff members. As part of the inspection, a case tracking exercise was carried out. This involved the inspector closely examining the care of selected residents from the point of their admission to the home. What the service does well:
Springfield is a home where people are looked after well. During this and previous visits the inspector has received very positive feedback from residents about all aspects of life at the home. During this visit residents were without exception, very positive about the standards of care at Springfield. One resident said ‘’This place would really take some beating.’’ Another resident said ‘’ You can inspect this home any day of the week and you will never find anything wrong!’’ All the residents consulted or observed during the visit appeared very content and comfortable in their surroundings. When the inspector arrived several residents were having a game of dominoes and told the inspector that this was a pastime they enjoyed quite regularly. In addition to very positive feedback received from residents, staff consulted also expressed satisfaction with the standards of care and accommodation provided by Springfield. All the carers consulted spoke of good teamwork and a happy working atmosphere. This is also reflected in the fact that there has been no turnover of staff since the last inspection. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 6 The fact that the turnover of staff is extremely low is of great benefit to the residents. It means that residents have continuity of care and receive support from people they know very well. When consulting staff members and in viewing records held within the home, it was apparent that carers had a very good knowledge of their roles. Residents’ care plans and daily diary notes provided evidence that staff were very quick to identify any problems and acted upon them immediately. For instance, when one carer noticed that a resident was developing reddened areas on her skin, she immediately implemented a pressure care chart and requested the district nurse to come and visit. All care homes are expected to make a written record of each resident’s care needs and then state how these needs will be met. This process is known as care planning. The inspector viewed a number of written care plans which were found to be of a very good standard. Care plans were very comprehensive and addressed all areas of a resident’s needs including emotional support and hobbies and activities. It was also evident that all residents’ care plans had been regularly reviewed to ensure that any changes to their needs were addressed. The owner of Springfield works within the home on a full time basis and it was apparent during this visit that the home benefits from effective management. In particular, systems for ensuring quality are of a very good standard with a number of processes in place to constantly monitor standards. In addition, residents are regularly given the opportunity to express their views about the running of the home. For example, within the residents’ meetings which are held on regular basis. ‘ What has improved since the last inspection?
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 7 Following the last inspection of the home a number of requirements were made. It was confirmed during this inspection that all these requirements had been met. The medication within the home is stored in the kitchen area and as such, the manager was advised to monitor the temperature of the room to ensure it did not get too warm to store the medication safely. It was confirmed during this inspection that a daily temperature check is now made. In addition, the temperatures recorded were found to be within the recommended guidelines on each occasion. All radiators and pipework within the home are now covered with suitable guards to ensure that residents are not at risk from burns or scalds. Since the last inspection, a number of areas within the home had been redecorated. The home uses a rolling programme to ensure that all areas are kept well maintained. What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 8 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 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 Springfield DS0000062334.V260489.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. The home obtain adequate information about prospective residents to ensure they can plan their care properly from the point of their admission. EVIDENCE: In discussion, it was confirmed that any person wanting to come into the home would be visited either at their own home or their current circumstances, for instance, in hospital. At this point a pre-admission assessment is carried out. The inspector looked at several residents’ assessments and found these to be very comprehensive. Assessments covered lots of different areas such as what help a person needed with bathing or walking. This means that it could be determined that a prospective resident’s needs would be properly met at the home before they were admitted. As well as a standard assessment, carers from the home carry out a personal profile which looks at things such as favourite pastimes and what job a person
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 11 used to do. Information of this kind assists carers to plan care in a more individual way. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Residents’ care is carefully planned and staff closely monitor their health. When a concern is identified prompt action is taken. EVIDENCE: The inspector was able to confirm that there was a care plan in place for every resident. A selection of care plans were viewed and found to be of a very good standard. Care plans were very comprehensive and covered all areas of daily life such as getting washed and dressed, walking about and eating. In addition, all the care plans viewed had been regularly reviewed to make sure that residents’ changing needs were being addressed. In viewing residents’ daily care notes, it was apparent that their health and general well being is closely monitored. Where concerns had been identified carers had acted quickly to ensure the resident get the support they required. For example, one resident had developed reddened areas on her skin. The carer noticing this was clearly aware that this was a sign the resident may be at risk of developing pressure sores and as such, a number of measures were carried out.
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 13 The carer started a pressure care chart to remind all other staff to ensure that the resident was regularly turned. The district nurse was contacted and requested to visit the resident and monitor her skin changes. Also, a special mattress which reduces the risk of pressure sores developing was obtained for the resident. The inspector viewed the homes policies and guidelines in relation to medication. The guidelines were thorough and helped carers to manage medication safely. The medication store was viewed and found to be adequate. As medication is stored in the kitchen it had been previously recommended that the temperature of the room be checked regularly to ensure that tablets were being kept at the right temperature. This was confirmed as being in place and staff had checked the temperature of the medication cupboard every day. The inspector views some medication administration charts which were found to be well kept. There were no errors or unexplained omissions. At the time of the visit there was one resident who was managing his own tablets. Carers had carried out an assessment to identify the risks involved and the resident had signed a disclaimer agreeing to keep his tablets safely put away. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14 & 15. Residents at Springfield are assisted to make choices in their everyday lives. The home provides good quality meals which are prepared in line with residents’ wishes. EVIDENCE: In all the care plans viewed, carers had written about promoting residents’ choice and independence, and how this could be achieved. In discussion, residents said that they were able to make every day choices such as when to get up in the morning and when to go to bed. The owner of the home manages it on a full time basis and as part of her role, keeps lots of contact with the residents. It was confirmed that the owner makes daily contact with all the residents and offers them the chance to express any views they may have about the running of the home. In addition, meetings are held for residents on a regular basis. During these meetings residents are able to talk about any issues, and in viewing minutes of the meetings it was found that these issues were generally ones such as menus and activities. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 15 In viewing menus, it was apparent that residents are provided with a varied and nutritious diet. Residents confirmed that they were always able to have a choice of what to eat and were complimentary about the meals provided. One resident said ‘’The food is always good, and they go out of their way to get you what you want.’’ In observing the evening meal it was noted that there were a number of different meals being served. Staff advised the inspector that a list was made of all residents’ requests each day and attempts made to meet all the requests. Care plans confirmed that residents’ dietary requirements are addressed. When carrying out a pre-admission assessment, staff list the food that residents like or dislike and also list any special needs such as a soft or diabetic diet. A list is maintained in the kitchen with this information on. It was also noted that when concerns are identified in relation to a resident’s food intake these are acted upon quickly. For example, one resident had appeared to lose her appetite and carers had immediately noticed this. A chart was started which meant that all the food taken by the resident was recorded. In addition, careful monitoring of the resident’s weight was carried out and advice sought from her GP. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Residents are assured that any complaints they make will be taken seriously and thoroughly investigated. The manager and staff have a good understanding of their role in protecting vulnerable adults from abuse. EVIDENCE: The home has a procedure in place which tells residents and their families how to complain and explains what will happen in this event. In viewing the records of complaints held within the home it was confirmed that there had been none made since the last inspection. The Commission for Social Care Inspection has not received any complaint about this home since its registration in 2002 There are very good guidelines in place which tell staff what they must do if an allegation of abuse is made. It is a flow chart which is helpful to follow and also includes telephone numbers of relevant agencies, for instance local Social Service Departments and the Commission for Social Care Inspection. In discussion, staff demonstrated a good understanding of the procedures and were confident that in the event they raised any concerns with the owner of the home, she would ensure that they were thoroughly investigated. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Accommodation at Springfield is pleasant and homely. There are good procedures in place to stop the spread of any infections. EVIDENCE: At the time of the unannounced visit the home was found to be warm and comfortable. All areas of the home are well maintained and furnished to a good standard. When taking a tour of the home, the inspector noted that some floorboards felt loose on the first floor and requested that this be investigated. All areas of the home were found to be clean and free from offensive odour. The home has good infection control policies in place which advise staff in how to reduce the risk of cross infection. There are dedicated, well equipped laundry facilities which are located on the ground floor. The location of these facilities means that you would generally
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 18 walk through the dining area to get to them. However there are procedures in place which direct staff to take an alternative route around the outside of the home when carrying soiled lined. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 & 30 Residents benefit from a very stable staff team. Carers are professional and have a very good understanding of their roles. EVIDENCE: It was pleasing to note that there had been no staff turnover since the last inspection. The fact that the staff team remains the same is of great benefit to residents and means that they receive their care from people who they know very well. Such a low staff turnover is also a sign of a well managed and contented staff team. As stated throughout this report, evidence was found that carers have a very good understanding of their roles. Many examples were found of carers not only identifying very quickly when a resident may need extra support, but also acting quickly to make sure that support is in place. Records held and discussions with carers confirmed that they are provided with training in a number of areas to help them care for people well. Such training includes pressure care and the safe handling of medicines. Out of 13 carers, 4 hold National Vocational Qualifications in care at level two or above. The home are working towards meeting the National Minimum Standard to have 50 of carers trained. The inspector was able to confirm that all staff who commence worked at the home are provided with training at the start of their employment. This training
Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 20 covers general principles of care and also looks at the home’s individual policies and procedures in all areas (induction). Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of the above standards were assessed during this inspection. EVIDENCE: Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 22 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 X 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X X X X X Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 23 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 OP28 Regulation 18 Requirement Timescale for action 50 of carers must hold National Vocational Qualifications 30/06/05 in care at level 2 or above. 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 OP19 Good Practice Recommendations The floorboards on the first floor, particularly outside room 2, should be checked by a suitably qualified person to ensure their safety. Springfield DS0000062334.V260489.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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