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Inspection on 27/02/06 for Springfield Care Home

Also see our care home review for Springfield Care Home for more information

This inspection was carried out on 27th February 2006.

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

The manager and staff are very committed to providing good standards of care for the residents. Residents and relatives stated they feel that the staff are sensitive to their needs and choices. The food is well thought of and residents feel respected and enabled to socialise in a manner that is comfortable for them. Evidence from relatives indicated that the staff have provided excellent services for a relative with complex needs and were particularly complimentary over the additional emotional support provided by the staff team. They also felt that this was consistent throughout the home.

What has improved since the last inspection?

A number of requirements set at the previous inspection, have been addressed by the manager and proprietor. Care planning documentation has improved and includes evidence of the regular review of individual support needs.

What the care home could do better:

Evidence indicates that there are a high number of resident`s falls within the home. Whilst a majority of these resulted in the appropriate action being taken by staff in the home, two occasions indicate that appropriate action was not taken. This has resulted in two complaints received by the commission, being discussed with the manager. Prior to the inspection, regulation requirements were set in respect of these issues. It is acknowledged that the manager has requested intervention from the local Primary Care Trust Falls team for advice and possible training prior to reviewing the homes risk management in relation to falls. In addition evidence indicates that one resident has been admitted inappropriately to the home. The individual concerned has had a number of falls and requires constant supervision. This case is in the process of being reviewed. Between the hours of 2pm and 5pm there are insufficient numbers of staff on duty. This will need to be resolved. Evidence suggests that the staffing requirements generally meet the guidance levels, but due to the needs of individuals at the home this needs to be regularly reviewed in full consultation with all stakeholders.

CARE HOMES FOR OLDER PEOPLE Springfield Care Home Lawton Drive Bulwell Nottingham NG6 8BL Lead Inspector Andrew Sales Unannounced Inspection 27 February 2006 10:00 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 Care Home DS0000002305.V279771.R01.S.doc Version 5.1 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 Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Springfield Care Home Address Lawton Drive Bulwell Nottingham NG6 8BL 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 927 9111 0115 979 4759 Annesley (Oldercare) Limited Mrs Eileen Hester Care Home 40 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (40) of places Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. To accommodate one named out of category service user for respite care To include up to 7 elderly relatives with Dementia. The registration reverts to 40 places for Older People when the placement of the one named individual ceases. 24th May 2005 Date of last inspection Brief Description of the Service: Springfield is a care home providing personal care and accommodation for 40 older people. The home has seven registered places for people with a diagnosis of dementia. The home is owned by Annesley (Oldercare) Limited. The home is located on the outskirts of Bulwell town centre which is approximately 7 miles to the north of Nottingham city centre. The home was purpose built and was opened in November 1989. It consists of a three-storey building with the lower ground floor being used to accommodate the dining room and conservatory, kitchen and laundry. All but four of the homes bedrooms are single. All bedrooms have en-suite facilities that consist of a toilet and wash hand basin. There is a passenger lift. The gardens are mainly laid to one side and the rear. They are easily accessible from the conservatory and consist of lawned areas. There is a car park to the front of the building. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was an unannounced visit conducted by Andrew Sales, Regulation inspector on Monday 27 February 2006. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for Relatives and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provisions that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three residents and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. One of those identified was in hospital, a number of other residents aslo spoke with the inspector. The residents and relatives spoken with, made positive comments about the services provided. They felt comfortable in the home, were pleased with attitude and skills of the staff and were happy with their private accommodation and with the food provided. What the service does well: What has improved since the last inspection? A number of requirements set at the previous inspection, have been addressed by the manager and proprietor. Care planning documentation has improved and includes evidence of the regular review of individual support needs. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 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 the following standard(s): 1,3,4,6. The home provides adequate information for residents prior to and during admission. Resident’s receive an assessment prior to admission. Assessment plans are well documented. The home has admitted a resident that it may not be able to support. The staff team are familiar with the individual needs of the resident’s. The manager supports staff to access training in the needs of older people. Intermediate Care is not provided at the home. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 9 EVIDENCE: A revised statement of purpose and residents guide was observed. The Inspector also viewed three resident’s files as part of the case tracking process. Evidence was found in all files of a comprehensive assessment to ensure the home is able to meet the needs of prospective residents. All areas of needs assessment required in standard three were present. An additional care plan was observed, as a result of studying accident records. This resident was admitted on the basis of a Local Authority Extended Community Care Assessment. The homes assessment, details the individual’s needs, problems and challenges, but did not contain any information as to how to support this person, or manage the risks that he encounters and presents. From the information available, it is the inspector’s opinion that this resident has been referred and admitted out of category. The home obtains specialist advise from resident nurses and other health care professionals including tissue viability, infection control, general practitioners and continence advisors. This was supported by documentation in care plans. Residents also spoke of visiting healthcare professionals and domiciliary community services, such as Dentist services. All residents spoken with felt the that staff were competent and professional. Staff discussed training events previously attended and courses they were due to attend. These were; mandatory health and safety training, dementia awareness, pressure area/skin care, NVQ level 2 and Adult Protection. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 10 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 receive a comprehensive assessment. Assessments are updated following a review. The home is able to meet the healthcare needs of it’s residents. Medication issues are managed appropriately. Residents are treated appropriately. EVIDENCE: Assessment plans are well set out and detail each area of need and an action plan is drawn up to meet this need. Risk assessments are also observed to be well documented. Attention is placed on the need to prevent pressure sores, and promote safe working practices. Daily records are well maintained by care staff and professional input from district nurses and GP’s is well documented. Evidence gained from speaking to residents and staff suggested the care planning process was accurate and outcomes satisfactory. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 11 An additional care plan observed for a new resident identified a high level of care needs, but did not specify action plans for care staff or the management of identified risk. It became evident that this persons health and confusion had deteriorated on admission, due to a number of reasons. However the individuals case was not fully assessed or reviewed during this period. The individual had also sustained a number of falls, where appropriate action was taken by staff at the time, but the home failed to review the individual support plan or notify relatives. Resident’s plans contain details of each individual’s health care needs, including tissue viability and continence risk assessments. There is evidence that people have been appropriately referred to health care professionals. Care plans contain records of visits by district nurses, General Practitioners and other professionals. Healthcare professionals were observed visiting on the day. The inspector was informed that residents can register with a GP of their choice. Staff training records evidenced that medication training was provided for staff responsible for the administration of medication. The homes medication administration systems have been well maintained. There is a policy and procedures for receiving, recording, storing, handling, administering and disposing of medicines. The home is registered with a local pharmacist and support and advice is obtained as and when needed. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Residents feel comfortable with the routines and their ability to exercise choice within the home. Family members are actively involved with the home. Meals are well organised and enjoyed by the relatives. EVIDENCE: Residents and relatives spoken with, commented that were made welcome at any time when visiting the home. The relatives spoken with confirmed that they have visitors at any time. The accommodation allows for relatives to visit in private rooms where required or there is a quiet lounge if desired. The home arranges for local entertainers to visit the home and some relatives spoken with confirmed that they looked forward to such events. Residents and relatives were positive about the conduct of the staff and their sensitivity over handling different and complex issues. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 13 Staff were observed during the visit interacting positively with individuals. Three residents spoken with, reported that staff provide a good standard of care and areas of concern would be discussed with the registered manager. All residents who spoke with the Inspector commented very positively on the conduct and attitude of the staff. Two relatives were particularly complimentary about the practical and emotional support that is provided for their relative, who is over a hundred years old with complex needs. They felt this approach and standard is consistent throughout the home. Residents were observed briefly, eating lunch during the visit. The food provided looked nourishing and appetising. Residents and relatives spoken with commented positively on the standards and quality of food. Staff spoken with were well aware of individual preferences. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 14 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. The home operates suitable complaints and adult protection procedures. EVIDENCE: The home has a complaints procedure, that meets the NMS, which is appropriately displayed, throughout the home. Residents and relatives spoken with, stated they would raise concerns with the registered manager and the proprietors. Complaints records were not observed on this occasion. Two complaints were discussed with the homes manager and proprietor. These related to issues around accidents to residents through falls. The commission has previously identified action to be taken by the home in respect of managing falls, i.e.; taking appropriate action and notifying residents relatives of such incidents. The manager discussed further action to be taken in relation to addressing the issue. The home has an appropriate Whistle Blowing Policy and a policy detailing Adult Protection Procedures. The homes policies and procedures for responding to suspicion or evidence of abuse, or neglect, are all satisfactory. The home has comprehensive policies regarding residents money and financial affairs. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 15 Two staff members were spoken with, neither had attended training in adult protection but demonstrated a positive awareness of exposing abuse and bad practice. The manager discussed imminent training dates for Adult Protection training for staff. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 16 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): 19,25,26. The home has been maintained to a satisfactory standard. Residents feel the home provides a safe and comfortable environment. Systems are in place for the control of infection. EVIDENCE: No issues have been raised during the homes annual fire inspection. The accommodation is flexible enough to provide for a range of different needs. There is a conservatory that is the homes designated smoking area. There is a smoke free sitting room. There are accessible toilet facilities close to the lounge and dining room. In addition all rooms have en-suite facilities that include a toilet and wash hand basin. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 17 Satisfactory maintenance records were observed for water systems, lighting, electrical and gas central heating. Records were observed for the testing of water temperatures at outlets throughout the home. Should levels exceed the 43c, a risk assessment is required to be conducted for residents in the home, prior to consultation with the local Environmental Health Authority. A team of domestic staff maintain the home to a good standard. Residents feel the home is generally clean and hygienic. The home has polices and systems in place for the control of infection. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Satisfactory numbers of staff were on duty at the time of the inspection. At some points during the day there are not sufficient numbers of staff on duty. Residents are protected by suitable recruitment methods and training plans used by the home. The home is progressing the NVQ training program for staff. EVIDENCE: There were appropriate staff numbers on duty at the time of the inspection. Though evidence indicates that only four staff are present between the hours of 2pm and 5pm. This is below the basic minimum requirement and needs to be addressed. Evidence also indicates that where minimum staffing levels are maintained, due to the increasing and ever changing needs of residents, this need to be reviewed regularly in consultation with all stakeholders. Staff confirmed that Criminal Records Bureau (CRB) enhanced disclosures and POVA first checks, along with other pre-employment checks are being sought prior to a person commencing employment. This was evidenced on three staff files. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 19 One staff member discussed her induction and training at the home. This met with the requirements and was confirmed by records seen. Training records and plans were observed. The manager is a qualified NVQ assessor for level 2 and 3. staff interviewed had completed Level two training. Distance learning is provided by the Beeston training centre. All new staff also attend the T.O.P.P.S induction to social care at the Beeston training centre.. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,38. The home is generally well managed with residents interests put first. Health and safety management is well documented. Staff are well supported but formal supervision is not conducted. EVIDENCE: Residents and relatives said they felt the home was well run and the management team were always on hand for support and advise. Staff spoken with confirmed that they felt supported by the managers and that they are approachable to discuss any issues. They confirmed that there is an open management approach and a positive culture within the home. The staff stated that they had not received monthly supervision but did attend regular team meetings. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 21 The manager stated that the staff have received training updates in the last year on moving and handling, first aid, basic food hygiene, administration of medication and health and safety issues including hygiene control. Certificates and individual training profiles supported this. The care staff spoken with also confirmed this. Residents finances are managed separately. Records of these were not inspected on this occasion. It was observed that equipment is serviced and maintained on an annual basis by agreed contracts. There is a written health and safety policy to guide staff. The inspector was told the manager is responsible for the risk assessment of activities of residents. In addition to individual risk assessments for residents, there are risk assessments relating to environmental areas of the home. Records of fire system tests, water temperatures and other health and safety records were observed and were found to be carried out at the required intervals. Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 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 3 X 2 3 X x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 X X X X X 3 3 STAFFING Standard No Score 27 2 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x X 3 2 X 3 Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 23 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. 2. 3. 4 5 6. Standard 3,7 7 7 12 27 27 Regulation 14.1.a 15.2.b 14.2.a.b 15.2.c. 13.4.a.c.5 18.1.a. 18.1.a Requirement Ensure residents are fully assessed prior to admission. Ensure residents are regularly reviewed following admission Ensure residents relatives are informed of significant incidents where appropriate. Ensure the incidence of falls is reviewed and managed appropriately. Ensure staffing levels reflect the number and needs of residents at all times. Ensure staffing levels are revieweved frequently and all stakeholders are consulted in this process. Ensure all staff receive regular formal supervision. Timescale for action 30/03/06 30/03/06 30/03/06 13/03/06 13/03/06 13/03/06 7. 36 18.2 30/03/06 Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 24 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 Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield Care Home DS0000002305.V279771.R01.S.doc Version 5.1 Page 26 - 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!