Inspection on 05/11/08 for Springfield Garth - North Yorkshire County Council

This inspection was carried out on 5th November 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springfield Garth - North... 30/11/06

Springfield Garth - North... 30/01/06

Springfield Garth - North... 05/10/05

Springfield Garth - North... 04/11/04

Springfield Garth - North... 17/06/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Springfield Garth - North Yorkshire County Council Springfield Garth York Road Boroughbridge York North Yorkshire YO51 9EW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Jo Bell     Date: 0 5 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Springfield Garth - North Yorkshire County Council York Road Springfield Garth Boroughbridge York North Yorkshire YO51 9EW 01423322189 01423323309 springfield.garth@northyorks.gov.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Yvonne Elizabeth Cook Type of registration: Number of places registered: North Yorkshire County Council care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 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. 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. Service users are given an information pack either at the initial visit or on admission. Care Homes for Older People Page 4 of 25 Over 65 30 0 Brief description of the care home The Commission for Social Care inspection reports are displayed in the home for anyone to read. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We have reviewed our practice when making requirements,to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations,but only when it is considered that people who use services are not being put at significant risk of harm. In future,if a requirement is repeated,it is likely that enforcement action will be taken. We went to the home without telling them that we were going to visit. This report follows the visit that took place on Wednesday 5th November October 2008. The visit lasted from 09:30 until 16:30. The purpose of the visit was to make sure that the home was operating and being Care Homes for Older People Page 6 of 25 managed in the best interests of people living there. Information has been used from different sources for this report. These sources include- Reviewing information that has been received about the home since the last inspection. The annual quality assurance assessment. This is information which details what has happened during the past 12 months. Notifications (Regulation 37) relating to incidents in the home affecting people using the service. Details of complaints and allegations raised by people connected to the service. Progress of the previous requirements and recommendations made at the last site visit. At the site visit one inspector spent 7.0 hours at the home. During this time observations of care practices took place. People using the service were spoken with along with some relatives. Discussions with the manager and team manager regarding meeting needs, mealtimes, protecting people and the environment took place. The lunchtime meal was observed and time was spent inspecting care plans, looking at individual rooms and reviewing a selection of health and safety information. Staffing and management issues were discussed and feedback was given to the manager at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People generally have their needs assessed effectively, though more consideration should be given to the registration category of the home. This will mean people are placed correctly. Evidence: The three pre-admission assessments looked at confirmed that a senior person completes an assessment before an individual moves to the home. This is to check what type of care and support the person needs and whether the staff have the skills and knowledge to provide that care if the individual chooses to move there. The process also reassures the individual and their family that they will receive the right support. Assessments are completed if the person has a care manager or is privately funded. These detail health, personal, nursing, social and mental health needs. All the surveys Care Homes for Older People Page 10 of 25 Evidence: completed by people living there report that people are given enough information about the service and what it provides. This means they can make an informed choice about whether to move there or not. It was evident that emergency admissions take place in the home and detailed assessments are not always received prior to the person coming into the home. On one occasion a person with a diagnosis with dementia was admitted to the home, their behaviour became challenging and staff could not meet their needs. The Annual Quality Assurance Assessment states there are eleven people with dementia needs. The manager must only admit people within the homes registration category for older people. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their health and personal care needs generally met, and this is carried out in a dignified manner. Evidence: Three care plans were looked at during this visit. These describe the care and support people need to stay in charge of their own lives as much as possible. The plans looked at contained a lot of information, so that an unfamiliar carer could look at them and would be able to work out how much support they needed. There were written assessments as to whether people were at risk of developing pressure sores, of losing weight because of poor appetite or a health problem or needing help with moving and handling. Those identified as at risk had a care plan in place describing how that risk was to be managed. It was evident that some records were not fully completed. For example health info, sleep patterns and night checks. Whilst nutritional assessments were in place these had not be reviewed in line with the timescale. The one to one records had many Care Homes for Older People Page 12 of 25 Evidence: omissions. This related to how often hair, nails and baths took place. It was unclear from this if people had been offered these aspects of personal care. However some plans had been reviewed and evaluated. This was discussed with the manager and team leader. People spoken with confirmed that they received a good standard of care and observations throughout the day showed that people looked clean and well cared for. Healthcare professionals are invovled with the service and a GP and District Nurse during the visit stated how good the service was. The home deals with accidents and injuries effectively through auditing and effective reporting. The Annual Quality Assurance Assessment also confirmed there are strong links with the community chiropody, dental and optician service. The medication system was inspected. Staff receive training in how to administer medication and this covers side effects, storage and disposal of medicines. Three charts were inspected and generally these were completed correctly, however there were some blanks where codes had not been used and up to date stock balances were not in place. On one occasion paracetamol had been signed for in two different places and it was unclear how many the person had received. Some hand written records were not complete and staff confirmed that an audit of the system is not in place. This would help to reduce errors. It was also evident that the drugs trolley and medication in the cupboards and fridge are in two different rooms. The system would be more secure if it was kept together. Privacy and dignity in the home is maintained. Staff were observed knocking on doors prior to entering and people were observed interacting with staff who had pleasant attitudes and manner. People are able to bring personal possessions into the home and they were viewed in peoples bedrooms. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People participate in a range of activities and visitors are welcomed. Staff encourage autonomy and choice, and people enjoy dining in pleasant surrounding with appealing food Evidence: People are able to participate in a range of activities which are facilitated partly by the activities organiser, through volunteers and links with the local Lions group. There have been garden fetes, motivation classes, luncheon clubs, barbecues and dominoes evenings. The Annual Quality Assurance Assessment states We encourage social activities by offering; weekly games afternoon; monthly domino drive; shopping trips; annual holiday week; regular church services; evening entertainment; selection of Christmas celebrations and seasonal events including Easter, Mothering Sunday Valentines day, Halloween, Remembrance day. All events/activities are advertised well in advance via poster/flyers displayed in the home and community, on newsletters, in the local press and/or via personal invitations to family and friends. This was confirmed when speaking with individuals and viewing details of activities in the home. Care Homes for Older People Page 14 of 25 Evidence: Visitors are welcomed into the home and staff have an awareness of equality and diversity issues. Religious needs are catered for and this is recorded in individual care plans. The lunchtime meal was observed, people dine in a pleasant environment with tables laid with table cloths, napkins, and suitable cutlery and crockery available. Catering staff confirmed they have completed food hygiene training and they are aware of how to manage people with soft or pureed diets, or those on reducing or diabetic diets. Staff have recently completed nutrition training which helps them understand how to fortify food for those people who are underweight. Catering staff did comment that during the morning it is quite challenging at breakfast time to look after everyone, due to the few staff available. The food served was appealing (steak pie and vegetables or sausages), the vegetables are a mix of fresh and frozen and homemade desserts are available. People have access to a range of drinks and staff wear protective clothing when needed. One person said the food is lovely, another said I always look forward to my lunch. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have their concerns listened to and acted upon, with staff been alert to signs of abuse.This helps keep people safe. Evidence: The home have a complaints procedure in place which people and their visitors are aware of. This is discussed at the admission stage and a copy of this is displayed in the home. Staff spoken to were aware of the safeguarding procedures in place. During the past year five complaints have been received at the home, none of these were upheld. Some staff have completed abuse awareness training, and staff knew about the different types of abuse and the action to take if an abusive situation occurs. The home have a policy in place and staff are encouraged to use the Whistle Blowing policy. No safeguarding referrals have been made. The Annual Quality Assurance Assessment confirms that people have access to an advocacy service and all staff undertake protection of vulnerable adults checks prior to starting work in the home. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service experience good quality outcomes in this area. People live in a comfortable and clean environment. Evidence: People live in a clean and well maintained home. A rolling porgramme of refurbishment is in place. Three bedrooms inspected were clean and pleasant smelling. The Annual Quality Assurance Assessment confirms that several lounge chairs have been replaced. Along with light fittings and new blinds for windows in the dining room. Some bedrooms have been redecorated and a Plasma TV for the Lounge area has been obtained. This makes for easier viewing. Also outside there is an enclosed garden/patio area. People spoken with said they felt safe and comforatable in the home, there is a homely and welcoming feel to the home which was evident throughout. Staff are aware of infection control procedures and some training has taken place in this area. People were observed wearing clean and well ironed clothes, and domestic staff confirmed how they deal with soiled laundry to prevent cross-contamination. The home do need more domestic staff which the manager is aware of. Care Homes for Older People Page 17 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by staff who are competent, well trained and safely recruited. However more staff are needed to ensure all needs are being met. Evidence: People are cared for by professional and competent staff. However there are insufficient staff to ensure peoples needs are routinely met. At the site visit for up to twenty eight people there were three carers, one of which was from an agency and one was relief. A team manager is available though her remit is to complete the medication round, deal with care plans and health care issues. On an afternoon sometimes there are two carers, though agency staff were evident. Overnight there are generally two staff. This needs to be reviewed as the dependency levels recorded do not take into account the current needs of people. Staff may have to work in twos and there are eleven people with aspects of dementia who need extra supervision at times. The Annual Quality Assurance Assessment states there are no full time staff and eleven part time female staff. Ten out of eleven people have completed an NVQ Level 2 or above. The home confirmed that there are updated relevant training opportunities for staff including; liaising with Workforce Development Unit and offering training opportunities as and when they arise to all staff; installation of new Personal computer Care Homes for Older People Page 18 of 25 Evidence: solely for the purpose of e-learning providing care workers with their own individual log-in and training accounts; providing support and guidance as and when appropriate. However, information received shows that no staff have completed induction training. Though records in the home show some people have completed this. Staff are recruited safely and three staff files showed that police checks and protection of vulnerable adult checks take place prior to people starting work in the home. Some application forms are kept in a central location so were unable to be inspected. Generally two written references are obtained and gaps in employment are checked. The interview process was discussed along with equal opportunities. Care Homes for Older People Page 19 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people using the service. Evidence: The manager is registered with The Commission and has completed an NVQ Level 4 in Care and Management. She is an experienced manager with many years experience working with older people. The atmoshphere in the home is calm and relaxing and visitors feel they can approach the manager or team managers if they have any concerns. The home have a quality assurance system in place which includes client and visitor questionnaires and a range of audits which relate to health and safety, the environment and care practices. A senior manager also visits monthly and speaks to people using the service and identifies what improvements have been made. Records of these visits were available. The manager discussed having care plan and medicaiton audits implemented, this will ensure people receive the care and medication they Care Homes for Older People Page 20 of 25 Evidence: need. People can keep personal money in the home. This may be used for chiropody, hairdresing, clothes or toiletries.Well-maintained records are kept of all transactions and invoices are available which confirm the money coming in and going out. Three records were inspected to confirm this. Health and safety was discussed and a selection of policies were inspected. A fire risk assessment is in place and staff had a good understanding of the action needed in the event of a fire. The fire alarm and emergency lighting system is currently been replaced. Staff receive fire, moving and handling, infection control and food hygiene training. Specific training is also given relating to older peoples conditions. It was evident that the records on the computer did not match with the paper copies of records, this needs to be reviewed to ensure it is a true reflection of the training people have undertaken. Health and safety certificates were discussed in the Annual Quality Assurance Assessment and these are generally up to date. Care Homes for Older People Page 21 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 22 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 Staff undertaking initial assessments must obtain enough information on the indiviudal before they enter the home. This will ensure people are placed correctly within the homes registration categories. 07/12/2008 2 7 15 All information relating to the care plan must be fully completed in a timely manner. This will ensure staff are up to date with current needs of individuals. 04/12/2008 3 27 18 A review of the staffing 04/12/2008 levels must take place to ensure people can have their needs met on a daily basis. This will keep people safe and well cared for. Care Homes for Older People Page 23 of 25 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Consideration should be given to storing all the medication in one area, this would be easier for staff and keep the medication more secure. An audit of the medication system should take place, this would identify any errors or areas for improvment. 2 3 15 30 A review of the staffing levels at breakfast time should take place. This will ensure peoples dietary needs are met. Staff should complete all aspects of the induction programme to ensure they are up to date with current practices. Auditing of all care systems should be implemented. Records relating to training of staff should be kept up to date. 4 5 33 37 Care Homes for Older People Page 24 of 25 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 25 of 25 - 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!