CARE HOMES FOR OLDER PEOPLE
Springfield House 95/97 Portsmouth Road Woolston Southampton Hampshire SO19 9AF Lead Inspector
Lorraine Parton Unannounced Inspection 10th October 2005 09:00 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 House DS0000012321.V259040.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 House DS0000012321.V259040.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Springfield House Address 95/97 Portsmouth Road Woolston Southampton Hampshire SO19 9AF 023 8044 2873 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) Mr Richard Kitchen Mrs Elizabeth Kitchen Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th April 2005 Brief Description of the Service: Springfield House is a care home situated in Woolston, Southampton. The home is registered for twenty-three service users within the category of older persons. The home is owned by Mr and Mrs Kitchen and Mr Kitchen has submitted an application to become registered manager of the service. The home has a range of double and single bedrooms over two floors. The home has a large lounge, which is divided into three smaller seating areas allowing service users to select a quiet area if they wish. To the front of the property is a small garden and parking for service users visitors and to the rear is a larger well maintained garden that is accessible to service users. The home is situated close to local facilities and a short journey away from Woolston and the main city of Southampton. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The second inspection of the inspection year took place over 5.25 hours and the purpose was to ensure compliance with previous legal requirements brought to the homes attention at the first inspection in April 05 and to complete the inspection process for the year. The inspector audited 8 standards and reassessed 5 standards, in which the inspector had raised requirements at the last inspection. All key standards have now been assessed throughout the year. The inspection involved a walk around the home and an audit of some of the homes documentation. The inspector was assisted by the providers and one of the homes staff. All service user areas contained personal belongings, including the lounge. Service users advised that its their home and the staff encourage them to have their personal belongings around them. Much of the inspection was spent talking to the service users who clearly displayed their involvement in the home. Service users spoken to advised the inspector that they enjoy living at the home. What the service does well:
The home provides a homely and welcoming environment that enables service users to access all areas of the home and garden. All service user rooms are personalised and service users are encouraged to have their own personal possessions in their rooms. Service users spoken to advised the inspector that the homes staff provide an excellent service and comments received included “nothing is too much trouble” and “ the staff are very caring and respectful”. The inspector witnessed staff interactions with service users and noted the obvious good relationships that were in place. Service users stated that the care that they received is excellent, which is supported by extensive care plans and clear records that are being maintained on a daily basis. All service users spoken to advised the inspector that the home provides an good choice of meals and that the quality of the meals are good. Service users stated that the home offers a variety of choices and that they are asked what meals they would like. The home offered a range of choices on the day of the inspection.
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 6 Service user activities and leisure times provided by the home were found to be excellent. The home aims to promote individual choices and the promotion of independence. Service users are able to participate in the home. The home provides a range of equipment and games for the use of service users. Staff spoken to displayed a commitment to providing a high standard of care and support to the service users living at the home. All staff displayed an understanding of service user needs. The home is committed to ensuring its staff team will be trained in areas relevant to service user needs and the service the home provides. What has improved since the last inspection? What they could do better:
The home had started to assess and document the homes risk assessments, however, these had not been developed to include if necessary the controls required for any identified risks. These require further development. The home offers a range of activities for service user’s, however, one service user prefers not to be involved. The home has involved the mental health team, who visit the home on a regular basis. The home gave a range of examples in which they had attempted to involve the service user. These had not been documented and a plan of care had not been completed for this area of concern. Following discussion the home agreed to continue to look at ways in which the service user could be more involved and document the service users wishes in the care plan.
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 7 The home is providing a small range of training courses, which includes fire, moving and handling and basic food hygiene. The home has booked two courses for staff on medication and dementia care in which all staff will attend. Not all areas of training to meet service user needs have been undertaken and currently only two staff have completed the NVQ2. The home is to ensure staff are trained in areas relevant to service user needs and the roles that they are undertaking, which must include NVQ 2 training, adult protection and diabetes. The home must also consider specific training needs based on service user and staff needs for example care of the dying and skin care. The home does seek the views of service users and has completed a range of questionnaires for service users and visitors to comment on the service being provided. The home needs to formalise the quality monitoring system of the home, which is also to take into consideration the views of other stakeholders of the service. 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 House DS0000012321.V259040.R01.S.doc Version 5.0 Page 8 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 House DS0000012321.V259040.R01.S.doc Version 5.0 Page 9 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, 6 New service users are only admitted following an in depth assessment of their needs. The home does not admit service users who require intermediate care. EVIDENCE: The home has had several new admissions and on audit of one new admission files these were found to contain an in depth assessment of needs undertaken by the homes senior carer. The carer had spoken to the service user either in their home or hospital and had also ensured that family or carers views had been documented as part of the assessment. The assessment included general information, mental state, sleep patterns, diet, mobility and health care needs. The home assesses service user wishes for care and these were found to be included in the care plans and routines of the home. The home does not provide facilities within the home to offer service users intermediate care. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 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 All service users have an extensive care plan. EVIDENCE: The inspector audited four service user plans, which were found to contain relevant care planning information, risk assessments, health care professional involvement where necessary, occupational therapist assessments, guidance for moving and handling for service users requiring this assistance and records of monthly and 6 monthly reviews. One new service users file displayed that an assessment of needs had been undertaken. One service user plan was audited for a service user who prefers to stay in their room. The plan was found to be extensive and displayed that the mental health team are involved, however, this did not include ways in which the home had encouraged socialisation. The home has agreed look at further ways to encourage socialisation and document the service users wishes. All service users care needs are incorporated into service user plans. Any issues relating to health were found to be well documented in daily records, which included referrals to general practitioners and district nurses. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 11 Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 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): 15 Service users confirmed that the home provides excellent food of their choice. EVIDENCE: Service users spoken to stated that the home provides good food and offers a choice of menu. Menus display a well balanced and nutritious variation, which, the staff stated are based on service users likes and dislikes. Individual choices and needs in food are catered for and this includes likes, dietary needs and special requests. At the time of the inspection the home offered two choices in the main meal, and service users confirmed that the home always offers alternatives. Several service users were seen to be eating alternative meals to the two main choices and these service users confirmed that the home always meets their specific choices. The inspector was afforded the opportunity to join the service users for a meal, which was found to be tasty and well presented. Meal times were noted to be relaxed and service users who were being supported were not rushed and their dignity was maintained. The home has recently employed a new cook who advised the inspector that they are currently reviewing with service users a new menu. The cook advised the inspector that they provide specialist meals to meet dietary requirements
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 13 for example diabetes and that all meals appear the same to ensure service users do not feel excluded. The home had a visit from Environmental Health on the 12/9/05 in which no requirements were made. The home is maintaining all relevant documentation to support food safety practices. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 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 Service users are aware of how to make a complaint and to whom. EVIDENCE: Previous inspections indicate these standards are fully met, except that the complaints procedure needed amending to take into account the contact details of the Commission for Social Care Inspection. The complaints procedure has been updated and meets current standards. Service users confirmed that they were aware of the complaints procedure and several service users advised the inspector that they would speak to the homes staff if they had a concern. Some service users stated they would discuss their concerns with their families or their representatives in the first instance, who would then speak to the owners of the home on their behalf. Neither the home or the Commission for Social Care Inspection have received any complaints since the last inspection. A record of a complaint would be maintained if necessary. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 15 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, 20, 24 , 25, 26 The home is clean, safe and well maintained and provides a homely environment for service users. Service users who wish have personalised their bedrooms with their own belongings. EVIDENCE: The inspector undertook a walk around the home and identified no issues in the rooms that were entered. The home was found to be homely, clean and suitable for service users. All areas of the home are accessible to service users and the rear garden was found to be well maintained. At the time of the inspection service users were seen to be moving around the home and garden as they chose. All rooms seen were found to include service users own possessions and some rooms contained service users own furniture. The inspector noted that these rooms were homely and reflected service users own choice.
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 16 The home has a maintenance programme and repairs are carried out as and when necessary. This provides a safe environment. The home has under taken risk assessments, however, the home needed to develop them to include the controls required for any identified risks. The home has fitted radiator covers to all radiators, thermostatic valves to hot water outlets and restrictors to windows on the first floor. All chemicals were found to be kept securely. The home has a range of policies and procedures for ensuring the safety of service users and this includes a suitable infection control policy. The home has a separate sluice area. All certificates and insurances were found to be in place and up to date. The home has had a recent visit from environmental health where no issues were identified. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 17 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 The home had adequate staff on duty, who were found to be competent to do their jobs. Service users are safe. The home has suitable recruitment procedures in place for the employment of new staff. Staff are receiving some training, however, this needs developing to ensure training is relevant to the service it provides. EVIDENCE: Five staff, a cook, a cleaner and the proprietors were on duty at the time of the inspection. Staff confirmed that the home is always covered by adequate staffing levels. The inspector had access to the homes rota, which also confirmed the above. Only two of the eighteen staff working at the home had completed the NVQ and one staff is currently on the course. This was discussed with the proprietor, who advised the inspector that they are looking at suitable courses for staff to attend. The home has made staff training a priority and has booked courses in dementia care and medication for the near future. Staff advised the inspector that they had recently done training in moving and handling, fire and basic food hygiene. A requirement for staff training has been
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 18 made, which must include adult protection, diabetes, care of the dying, skin care, and NVQ 2 training. Service users confirmed that they felt safe in the home and that the homes staff are always supportive and professional in their approach. The home has policies and procedures in place to protect vulnerable adults. On speaking and questioning staff they displayed their awareness and understanding of the homes policies on reporting any issues that may be abuse and how to maintain privacy and the dignity of the service users living at the home. Staff displayed an excellent awareness of service user needs. Two staff files were audited by the inspector and found to contain all the relevant information. This included references and CRB and/or POVA checks for new staff. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 19 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, 33, 35, 36, 38 Service users live in a well managed home, that is run for their benefit. Service users are consulted about the running of the home, however, this needs formalising. Service users money is safeguarded by adequate financial records. Staff are supervised and appraised within their jobs. Service users and staff are protected by policies and procedures, however, these need further development. EVIDENCE: Service users and visitors to the home all spoke positively about the home and the care they received. Service users confirmed that the providers and the
Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 20 homes staff are available in the home almost every day and that the homes staff seek their views about the service it provides. The home occasionally holds service user meetings and on a daily basis service users are spoken with to see if there are any issues. The meetings held had been documented. Service users confirmed that staff act on their wishes and this was evidenced through menus, activities and how care is provided in the home. The home has started to complete questionnaires and these are available for service users and visitors to the home. The ones completed contained positive comments both about the homes staff and the service they receive. Service users spoken to confirmed that their views are listened to and that the home acts on their concerns. Following discussions with the proprietors and homes staff, the home does not seek the views of all stakeholders of the business. The home is required to formalise their monitoring of the quality of the service it provides. The home since the last inspection has reviewed the procedures for safeguarding service users money that the home hold for them. All records were found to be correct and clear as to the transactions being carried out on behalf of service users. The home does not manage any service users money and only keeps safe service user money in the homes safe. The home had started to implement staff supervisions, which was found to be in the early stages. All staff had received supervision and some staff appraisals had been completed. The home has undertaken a range of risk assessments, however, these need further developing to include any controls that may be necessary for any identified risks. The home has implemented some controls for identified risks including radiators, hot water, chemicals, falls, moving and handling. The home is to review its risk assessments and implement risk assessments for any further identifiable risks. Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 21 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 N/a N/a 3 N/a N/a N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 N/a 9 N/a 10 N/a 11 N/a DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 N/a 13 N/a 14 N/a 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/a 18 N/a 3 3 N/a N/a N/a 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 N/a 2 N/a 3 3 N/a 2 Springfield House DS0000012321.V259040.R01.S.doc Version 5.0 Page 22 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 Standard OP38 OP7OP12 Regulation 13 16, 15 Requirement Develop risk assessments and inform staff. Research ways to involve a service user more in the home. Clearly document and incorporate this into the service user plan. Develop staff training to include NVQ 2 and specific training to meet service users and staff needs. Develop the quality monitory systems in the home to take into account all stakeholders views. Timescale for action 31/12/05 31/12/05 3 YA27 18 31/12/05 4 YA33 24 31/12/05 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 House DS0000012321.V259040.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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