CARE HOMES FOR OLDER PEOPLE
Springfield Garth - North Yorkshire County Council Springfield Garth York Road Boroughbridge York North Yorkshire YO51 9EW Lead Inspector
Jean Dobbin Unannounced Inspection 30th January 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 Garth - North Yorkshire County Council DS0000034398.V275366.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 Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Springfield Garth - North Yorkshire County Council Springfield Garth York Road Boroughbridge York North Yorkshire YO51 9EW 01423 322189 01423 323309 Address 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) North Yorkshire County Council Mrs Yvonne Elizabeth Cook Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th October 2005 Brief Description of the Service: Springfield Garth is a purpose built home on two levels situated on the outskirts of Boroughbridge, where there are local amenities as well as transport links with Harrogate, Ripon and York. It is a care home owned and operated by North Yorkshire County Council. It was built over thirty years ago and provides personal and social care for 30 residents over the age of 65 who have no specialist needs. There is a vertical passenger lift in the home to aid access, as there are twenty-eight bedrooms located on both floors. There is one double room and the remainder are for single occupancy. The home also has 2 short stay places and day care for 6 further clients. There are gardens, with benches and a summerhouse, and car parking on site. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This summary relates to an unannounced visit on Monday 30th January 2006. The inspection lasted six hours including preparation time. The manager was present for the whole of the visit. Some residents’ files were looked at to see how residents’ individual needs were assessed, .as well as some policy documents and records from residents’ meetings. Details from the Accident book were also examined. A tour of the home included both private and communal areas and there was the opportunity to observe interactions between staff and residents, in both a caring role and during lunch. During the visit there were discussions with seven residents, three visitors, five members of staff and a visiting community nurse. Their comments are included in the report. What the service does well: What has improved since the last inspection?
The residents’ meetings generate small changes and the opportunity to discuss issues. There has been a visit to the home by a Community Nutritionist and a discussion on ‘Promoting Independence’, led by an outside person, for both staff and residents. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.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 Garth - North Yorkshire County Council DS0000034398.V275366.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 Garth - North Yorkshire County Council DS0000034398.V275366.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): 3 All residents have the opportunity to discuss their care needs, prior to moving to Springfield Garth, and are comfortable that those needs will be met. EVIDENCE: Four residents’ service plans were examined to determine whether an assessment had been carried out prior to moving to the home. All had an assessment in place. Some of the residents questioned could recall a meeting before they came to Springfield Garth. The manager is reluctant to accept ‘emergency’ admissions without assessment. She explained that if it’s not possible for a member of her team to carry out an assessment in hospital or private house, then she will invite the prospective resident and their family to the home for the day, so that the assessment process can still take place. Residents can be reassured that their care needs will be discussed, assessed and agreed before moving to the home. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 The health, personal and social care needs of residents are well addressed, however some of the documentation requires more detail. EVIDENCE: Four service files were examined during the inspection. All had individualised plans in place, but they were not presented in a consistent format and so it was quite difficult to find specific information. Some information was in good detail, for example how a resident wishes to have her privacy respected when bathing. Other files stated that a resident “needs assistance” with bathing, which is insufficient information for an unfamiliar or inexperienced carer. The care plans need to have enough detail so that residents can feel confident that staff know what help they need. Generally they were reviewed regularly There are good links with the health care team, whose community nurse visits regularly and the GP holds a weekly surgery within the home. Residents can request a private consultation with the doctor. The service files provide relevant information about their health needs. One file documented that the resident takes a “poor or inadequate diet” however there is no nutritional risk assessment to support an action plan. There were neither nutritional assessments in the files examined nor assessments of the risk of skin
Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 10 breakdown. Risk assessments would inform of potential problems, which could then be referred to the community nursing team for support. Residents would feel reassured that staff were alert to any changes in their health. Standard 9 was not fully inspected, however it was observed that at lunchtime prescribed tablets were left with residents to take with their lunch. At the end of the meal the carers were seen requesting that a resident takes her medicine before leaving the table. The resident had forgotten it was there. Staff must be alert to residents not taking their tablets and another resident picking them up. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Residents are confident that any complaint they may have will be acknowledged and treated seriously, however staff need some updating of their knowledge and responsibility to ensure residents are protected from any potential abuse. EVIDENCE: North Yorkshire Social Services have a comprehensive complaints policy, which is displayed in the home. All residents spoken with were very clear about whom they should inform if they had any concerns. They knew the manager’s name and one resident described her as “one of the best – she will sort it out”. Residents can be confident their complaints will be addressed appropriately. Those visitors spoken with were also aware of the policy and were sure a complaint would be taken seriously. There have been no complaints since the last inspection four months ago. There is information about Adult Protection issues also displayed in the home and there have been no recent allegations made. Only one of the five staff members spoken with, however, had any clear knowledge of possible abuse and their responsibility should an allegation take place. There needs to be further training to ensure staff have that knowledge, to enable residents to feel carers are alert to possible neglect. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The residents live in a well maintained home. EVIDENCE: Springfield Garth is a well maintained home with a planned programme of decoration and refurbishment. There are five lounge areas, including one for residents who smoke. There is adequate storage space for wheelchairs and moving and handling equipment. The outside gardens are tidy, but the previous recommendation suggesting repainting the front of the home has not been carried out because of the cold weather. It is hoped that this will be addressed when the weather improves. This reassures residents that the owners continue to invest in their home. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 14 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 Residents’ needs are met by adequate numbers of staff, however new initiatives cannot be developed without examining shift patterns. EVIDENCE: The staffing levels remain adequate to meet the residents’ care needs, and dependency levels are reviewed regularly. The management would like to introduce a more flexible breakfast-time, however as well as needing extra catering equipment the present staffing levels would make this difficult to achieve. There is still one outstanding vacancy, whose hours are covered by relief staff. 50 of care and management staff have achieved, or are working towards, an NVQ in Care qualification. Residents can be reassured that there are sufficient staff on duty to meet their current needs, many of whom have undertaken further training Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 15 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): 33,36 Residents’ views matter to the management team, who recognise that the staff too, need the opportunity to discuss what is important to them. EVIDENCE: The management team at Springfield Garth hold residents’ meetings every six weeks. The minutes show that a good proportion of the residents attend these, and a range of topics is covered. The cook also talks regularly to the residents to gain their views about the meals that they receive. The residents are given feedback from the meetings. There are also regular visits by the home’s line manager, where residents are encouraged to offer opinions about the service. Residents can be sure that their opinions matter. Permanent staff questioned said that they received regular supervision and were able to attend staff meetings, which were primarily information giving. They felt able to raise any issues with the management team, who are hoping to establish regular meetings for particular staff groups, where more specific
Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 16 discussion could take place. Relief staff have not yet received supervision, although those questioned were aware of the need, and they hoped that this would take place imminently. This is an outstanding recommendation from the previous report. Residents need to feel comfortable that staff have the opportunity to discuss and reflect on the service, which they provide. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X X STAFFING Standard No Score 27 3 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X X 3 X X Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 18 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. Standard Regulation Requirement Timescale for action 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 3 4 5 6 Refer to Standard OP7 OP8 OP9 OP18 OP19 OP36 Good Practice Recommendations More detailed service files, presented in a consistent format would provide more accessible and useful information for care staff Nutritional risk assessments would highlight potential problems, which can then be discussed with nursing team. Staff should be vigilant that residents take their medication and another resident doesn’t pick it up inadvertently. Further discussion with staff members, about adult protection issues, would remind them of their responsibilities. Outside paintwork at the front of the house needs renewing. Relief staff who work regularly at the home should receive supervision. Springfield Garth - North Yorkshire County Council DS0000034398.V275366.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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