CARE HOMES FOR OLDER PEOPLE
Springfield House 95/97 Portsmouth Road Woolston Southampton Hampshire SO19 9AF Lead Inspector
Christine Walsh Key Unannounced Inspection 15th November 2006 09:30 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.V313630.R01.S.doc Version 5.2 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.V313630.R01.S.doc Version 5.2 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 Mr Richard Edward 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.V313630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One person may be accommodated in the category (A), whose date of birth is 2/2/50, until 31/3/06. 10th October 2005 Date of last inspection Brief Description of the Service: Springfield House is situated in Woolston, Southampton. The home is owned by Mr and Mrs Kitchen who own other residential services in Southampton and Dorset. The home is registered to provide care and support to twenty-three residents who are elderly and who have dementia. 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 residents’ visitors and to the rear is a larger well-maintained accessible garden. The home is situated close to local facilities and a short journey away from Woolston and the city of Southampton. The weekly fees range from £385 - £425. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection to Springfield House was unannounced and carried out by one inspector over two days. All key standards were reviewed with the assistance of the deputy manager, the registered providers, residents, their relatives and staff. In addition the inspector received a good response in the return of residents “Have Your Say” comment cards, relative and GP comment cards. The visit also included viewing records and touring the premises. The two of the four requirements made following the previous visit in November 2005 were viewed and have been met, one has been partially met and the other remains unmet. This requirement will be repeated. An immediate requirement was issued in respect of staff recruitment. The inspector would like to thank the providers, deputy manager, residents and staff for their hospitality and support whilst undertaking the inspection. The condition of registration currently in place is no longer relevant and will be removed from the certificate. What the service does well:
The home does well to provide a warm, welcoming and friendly environment for the residents to live and where the inspector found residents and relatives are very complimentary of the managers, staff and their environment: “I am very happy here, the home is very nice.” “My mum is very happy at Springfield House. The staff are very nice and it is lovely and clean and fresh looking.” The home does well to ensure that it can fully meet the needs of prospective residents by undertaking a thorough assessment process prior to them moving in and the managers will seek additional support and advice from other professionals if required. The information obtained is transferred into a personal plan of care, which provides information to staff in order that they can carry out the residents care in the way the resident wishes. (However further work is required in this area and is addressed in section “What the home could do better”). The home does well to ensure residents have their health and welfare needs fully met. The inspector observed a visiting GP made very welcome, and he had been made aware of concerns regarding individual residents prior to his visit. The registered manager informed the inspector that a local doctor has
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 6 placed a relative in the home. The home assists residents with their medication and is supported by a local pharmacy where medications can be obtained at short notice. The home does well to respect the resident’s individual needs, rights, choices and privacy and dignity. Residents are supported to spend their day as they wish and there are no restrictions on when residents wish to get up, go to bed, where and when to eat their meals and entertain their visitors. The home encourages visitor and positively encourages relationships to continue in and outside of the home. Visiting friends’ and relatives with whom the inspector met commented on how kind the managers and staff are and how they are always made to feel welcome and offered refreshments as soon as they arrive: “The home always makes me welcome and I have stayed for lunch.” “I have a good relationship with the staff.” The home does well to provide a variety of stimulating activities from bringing in outside entertainers to spending individual quality time with the residents. This was discussed with the managers as some residents commented that further activities would be desired, within a short period of time the managers were considering alternative interesting activities that will also consider the needs of those residents who have difficulty engaging. The home does well to provide wholesome and nourishing meals that are very much appreciated by the residents and relatives. The home provides for special diets and alternative choices. Residents requiring additional support are extra supplements are closely monitored by the staff and assistance sought from health care professionals if required. Some of the comments received from residents and relatives: “Staff are willing to offer an alternative if needed”. “The meals at Springfield are first class and varied in menu”. “The meals are beautiful, always a nice variety”. The home does well to provide an open and inclusive environment where the residents and their relatives feel confident that the managers and staff will listen to any concerns or complaints they may have. Of all the residents and relatives the inspector met not one of them said they have ever felt they had to make a complaint and were very happy with the home, staff and facilities. The home does well to provide a clean, well-maintained and homely environment, and where care is taken to ensure residents are made Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 7 comfortable. Residents are encouraged to bring in small pieces of furniture and personal items to individualise their bedrooms. The home does well to provide sufficient numbers of skilled staff that appear to be aware of their roles and responsibilities and go about their duties confidently. The inspector observed that the staff appear happy in their work and there is a sense of fun and camaraderie between one another and residents. A member of staff commented: “The atmosphere here is lovely!” Another member of staff commented that the home does really well to provide good staffing levels and staffing training and development. Springfield House assist residents to manage their personal monies on a day to day basis, the home has good systems for auditing expenditure and will provide relatives with advice on payments etc, however the managers will not act as an appointee, preferring for relatives, guardians or social services to act on behalf of the resident. The home as far as feasibly possible provides a safe environment for residents and staff. The home is well maintained and any works or repairs required are quickly dealt with. The managers ensure service facilities and serviceable equipment has regular checks as required, including fire fighting equipment. What has improved since the last inspection?
Since the previous visit to Springfield House the managers have fully met two of the requirements and partially met one. One remains unmet and will be addressed in “What the home could do better” The owners Mr and Mrs Kitchen speak highly of their deputy manager who has taken considerable steps to improve the information and documentation held on the residents. Easy to read information for staff is easily accessible in order to provide a continuity of care, however as discussed with the deputy and the registered manager Mr Kitchen a further improvements can be made and these will b e addressed in “What the home could do better”. The requirement to involve residents more in the home and document in their personal plans has been partially met. There is evidence that residents are encouraged to participate in daily activities such as laying tables, folding napkins, feeding pets and assisting with the laundry, however this information has not been recorded in the resident’s plan of care. The managers have done well to complete comprehensive environmental risk assessments on residents and staff. A member of staff commented:
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 8 “The health and safety to all is always a top priority”. The home is very supportive and encourages istaff to undertaken and complete a National Vocational Qualification, by the end of 2006 the home will have over 50 of its staff either qualified or undertaking an NVQ. The home has a continuous training programme and ensures their staff receives mandatory training such as moving and handling and fire training. The staff that completed comment cards answered “yes” to “does the home provide funding and time for you to receive relevant training?” What they could do better:
The information obtained from comment cards, discussion with residents, relatives, staff and managers, visiting the home and through observation that there is evidence that the outcomes for the residents living at Springfield are good. However through viewing documents and meeting with the managers the inspector identified small but a significant number of areas of concern that could potential have affect the wellbeing of the residents. Residents’ personal plans need further work on them. This is to ensure the residents receive a full continuity of care in the way in which they wish, such as detailing “how” the residents wish to be supported and to ensure care plans are regularly reviewed and reflect the changing needs of the residents. The home has good systems in place for supporting residents with their medication, however they must ensure that they keep a record of changes to their medications such as requesting the prescribing medical professional to confirm alterations in writing. The home is very clean and tidy and well complimented by residents and relatives, however residents and staff are not fully protected from the potential risk of cross infection. Staff are due to undertake infection control training soon, however the home must ensure there are adequate hand washing facilities and ensure staff have adequate stock of disposable gloves and aprons at all times. The home has a good training plan in place and care staff receive training applicable to the roles and responsibilities they undertake, however domestic staff currently do not receive training applicable to the work they undertake such as moving and handling, health and safety and infection control. Springfield House has good systems and policies and procedures in place for recruiting staff, however the failure to appropriately follow these procedures and adhere to required legislation the managers have potentially placed residents at risk. An immediate requirement was issued in respect to the failure to take up appropriate checks such as Protection of Vulnerable Adults (POVAfirst), Criminal Record Bureau (CRB) and valid references.
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 9 The home provides an open and cohesive environment where residents, relatives and staff feel they can easily approach the managers if they have a concern, query or a view on how the home should be run. The managers have done well to quality monitor the views of the residents however as required following the previous inspection the managers must ensure they involve other stakeholders and finalise the process in the form of a report and feedback to key parties. The staff informed the inspector that they feel very well supported by the manager and feel the regular presence of the manager is a form of supervision, however the manager does not formally meet with individual staff on a one to one basis, a process that will identify the staff member’s strengths and areas of need. The managers consider the health and safety of its residents and staff as a top priority, however the registered manager is yet to obtain information on the new Fire and Rescue legislation implements on October 1st 2006. 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.V313630.R01.S.doc Version 5.2 Page 10 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.V313630.R01.S.doc Version 5.2 Page 11 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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure it can fully meet the needs of prospective residents by undertaking a comprehensive assessment. The home does not provide immediate care, however it has done well to support residents to improve their lifestyles in order that they can move on to other supported accommodation. EVIDENCE: The inspector viewed three residents’ personal files to establish the process of assessment and met with the deputy manager and Mrs Kitchen, one of the registered providers. The files viewed by the inspector provided evidence that the home undertakes a comprehensive assessment of prospective residents needs. All files seen contained information about the residents’ health and wellbeing, physical and
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 12 emotional needs such as medical history, mobility, the persons strengths and areas where the resident requires support. Both Mrs Kitchen and the deputy manager provided the inspector with good examples of how they have undertaken assessments following the receipt of a referral from social services or a relative wishing to find alternative accommodation for their loved one. Through discussion the owners demonstrated they take seriously their responsibilities in ensuring that the home can meet the prospective residents’ needs and there was written evidence to support the claim that they will not admit someone with specific complex needs without the full support of social services and health care professionals and in some circumstances the agreement of the Commission for Social Care Inspection. The inspector spoke with a social worker who confirmed that the home is very good at obtaining information about prospective residents, meeting with them and doing everything they can to make new them feel welcome and at ease. “They are efficient, kind, helpful and make sure everything is ready before the resident moves in”. The providers and the deputy manager are fully aware when they are no longer able to meet resident’s needs and will seek to find alternative accommodation for the resident with the advice and support of health care professionals and social services. Such a situation was observed on the day of the inspection. The home does not provide intermediate care, however Mrs Kitchen spoke fondly of some of the residents they have supported who after the right care have chosen to either return home or have moved to alternative supported accommodation. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to ensure residents health and personal needs are set out in an individual plan of care, however further improvement could be made to obtaining the residents social care needs and to develop the plans further to provide detail on how specific care needs are to be met. The home does very well to ensure the health care needs of the residents are fully met. The home does well to ensure residents receive their medication as prescribed, however the manager must be mindful to ensure correct procedures are followed at all times. The home does well to ensure residents rights, dignity and privacy are upheld. EVIDENCE: As part of the inspection process the inspector viewed four residents’ and found them to hold appropriate information and documentation including care
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 14 plans that have been developed from information obtained from the assessment process and met with residents, staff and visitors. There is evidence that the home has taken great steps to improve the quality of information held within the personal plans and the deputy manager was repeatedly praised by her employers for the hard work that she has undertaken to ensure staff have access to information on safely caring and supporting individual residents needs. There was evidence that those residents who could sign their own plans had been involved in doing so and relatives/representatives had signed on behalf of their relative. The residents and visitors with whom the inspector met said: “I am very well cared for here, we don’t want for anything” “The staff are very kind and caring” “They help me with things I cant do myself, they are very good” “We couldn’t have found a better home for mum, we think ourselves very lucky and have peace of mind that she is being well cared for” Following the last visit to the home the manager was required to research ways to involve a resident in the home and clearly document in the plan of care. Through discussion it was clear that the managers have made attempts to include the identified resident more into the home and discussed a list of activities the residents now involve themselves in. The managers appear to be very in tune with the residents needs and how best to support them, however this has not been in corporate into the plan as required. The inspector has taken the decision not to repeat the requirement as it has been partially met, however the registered manager must ensure care plans reflect the needs of the residents as described below. Residents were observed to be well dressed and groomed. The staff with whom the inspector met confirmed that the home uses a keyworker system and they appeared familiar with what this role involved and their roles and responsibilities in providing good supportive care that includes encouraging residents to do as much for themselves as possible. In discussion with the deputy manager and the owners it was agreed further development of the plans are required to ensure that information in them details how the residents needs must be met and to ensure changing needs are reflected in the plans. As part of the tracking process the inspector established that a resident who has become very frail and bedridden was being very well cared for, made
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 15 comfortable with appropriate pressure relieving equipment, clean bed clothes and bed linen, and further evidence of good care being carried out through the record of fluid in and out take and turning charts. However, sadly the plan of care did not reflect the changing needs. The homes has the tools to monitor monthly the changing needs of the residents, however there was evidence in the records viewed by the inspector that this had only been used once shortly after admission and had not been used since. Further observation of the plans also failed to provide the inspector with a view and insight into the person, their history, hobbies and interests, occupation etc…a long discussion took place regarding the purpose of the home and how it can further improve its care and support of residents with dementia, such as person centred planning and dementia care mapping. In view of the findings from the care plans the registered manager is required and advised to: 1. Ensure care plans reflect the changing needs of residents at all times. 2. Regularly review and amend care plans as required. 3. Ensure care plans provide specific detail on how the resident wishes to be supported. 4. Consider developing life histories/dementia care mapping to ensure a person centred approach is adopted at all times. Through viewing records and speaking with the managers the inspector established that the health, welfare and emotional needs of the residents are appropriately supported and tended too. The inspector observed a positive and professional relationship with a visiting GP, who was made very welcome and appeared to have already been, informed of his patient’s needs. The social worker with whom the inspector met was complimentary of the owners and deputy managers caring approach and commented that: “They will go out of their way to ensure the residents receive the right medical and psychological support they need”. There was evidence of some residents receiving regular visits from district nurses to carry out medical procedures such as dressings etc.. A relative with whom the inspector met said: “ They always keep us informed of how mum is and if she isn’t very well they will call us straight away” The home uses a monitored dossett system provided by a local pharmacist. The deputy manager conformed that they had a good working relationship and medications can be obtained at short notice. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 16 The inspector viewed three residents’ medication administration records and stock and found these to correspond, however the inspector did observe that a medication had been reduced without any written evidence of who had made the changes and why, the deputy manager confirmed that it had been done by a prescribing community nurse. The registered manager is advised to ensure that changes are not made to resident’s medication administration record (MAR) unless evidence of authorisation is obtained. The inspector arrived at the home at the time morning medications were being administered, this practice was observed from a distance, the inspector observed a courteous and informative approach and the resident was provided with a drink, however the member of staff administering the medication left the keys in the medication trolley and did not sign the record until all the medications had been administered. Good practice would have been to have taken the MAR with them and signed immediately after. The deputy later spoke with the member of staff who confirmed that she had been slightly put off by the arrival of the inspector and that this was not her usual practice. In view of the concerns being immediately addressed and the staff soon to be trained in medication administration no requirement has been made, however the registered manager must ensure staff are following correct practices at all times. The deputy manager provided evidence that staff are to receive a comprehensive medication training package. The training is to be undertaken through distance learning but is assessed by an outside assessor. Staff confirmed they were shortly to receive the training and were looking forward to doing it. Through observation and discussion with the residents, managers and staff the inspector established that residents are treated with respect and their privacy and dignity upheld. The residents with whom the inspector met said they were able to spend their day as they wished, staff were aware of the principles and values for caring for the residents and spoke about how they ensured residents were encouraged to maintain their independence and the importance of dignity and respect. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to provide basic activities for the residents, however further improvement in this area must be considered. The home does well to make all visitors to the home very welcome. The home supports residents to exercise choice and control over their lives, however this can be further improved by adopting a person centred approach. The home does very well to provide the residents with a wholesome appealing balanced diet in pleasing surroundings. EVIDENCE: The home does well to provide a range of activities for the residents, including bingo, armchair exercises, arts and crafts activities, newspapers, inviting outside entertainers into the home and themed parties such as Christmas. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 18 Through observation and discussion with the residents, relatives, staff and managers and receipt of comment cards there was mixed views about the amount and standard of activity. The inspector observed some residents taking an active role in home such as feeding the house cat and laying tables for mealtimes and was informed of another resident who liked to assist with folding the laundry. The inspector was informed that this is of the residents choosing. These are positive and valuing activities for those residents. However the inspector received some comments that form the opinion that not all residents are contented with the activity provided: “ It would be nice to have more activities and perhaps more sing-alongs as we all enjoy this when it happens” “The home could do with more entertainment and activities to keep the residents stimulated”. “The home could provide more entertainment and outings” The managers were made aware of the comments received and a long discussion took place on how the home could improve its activity and involve residents more in the day to day running of the home using a person centred approach. The managers came up with some superb ideas and confirmed that through dementia care mapping, obtaining a history and recording hobbies, interests they will encourage residents to become involved in more personalised activities. The inspector met with a number of residents and their relatives on the day of the inspection and received a number of positive comments from relatives re the standard of care and the friendliness of the home. “The home always makes me welcome and I have stayed for lunch” “The staff are always friendly and always find time to have a quick chat despite being very busy” The inspector observed a stream of relatives visiting the home and was informed that they visited regularly; all were greeted warmly and made to feel welcome with the offer of refreshments. The managers’ spoke of the importance of maintaining relationships and what steps they have taken to reunite some of the residents with distant family members. They also spoke of the importance of making all visitors feel welcome and how for some families they have invited them for Christmas lunch.
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 19 Through observation, discussion with residents and relatives and the receipt of comment cards the inspector established that the standard and quality of food provided in the home is very good. The residents spoke highly of the food and said they looked forward to mealtimes. “The meals at Springfield are first class and varied in menu” “We have an excellent chef and all our meals are freshly cooked with a good selection of meat and veg, the homemade cakes are very good as well” “The meals are beautiful, always a nice variety and sensible size portions” “They will prepare something different if they feel the person will enjoy it more, or if their appetite is not so good, and above all the cook and her kitchen is always spotless, which to me is more important than anything”. Frail residents needing assistance or special diets are provided for. Food and fluid records are kept for those residents who are not well. The dining room is atheistically pleasing and tables are laid with linen cloths and napkins, those receiving their meals where they wish are provided with a dressed tray. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to provide an open and inclusive environment where residents and relatives feel confident that their concerns and complaints will be listened to and acted upon. As far as feasibly possible the home does its best to protect the residents. EVIDENCE: Through discussion with residents, relatives, staff and the receipt of comment cards the inspector established that the home provides sufficient information to inform and enable residents to make complaints. All the residents and relatives with whom the inspector met said they were very happy with the home, the manager and the staff and had not had reasons to complain. The staff with whom the inspector met were aware of their responsibilities to try and resolve complaints and queries as soon as possible to avoid escalation and informed the inspector that they would take written details of the complaint and ensure the manager was made aware. The home has done well to ensure their staff are fully aware of what constitutes abuse and how to report it should they witness such an event. The staff have recently received training from a recognised training company and confidently informed the inspector what they would do. The home has on site
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 21 appropriate policies and procedures and a flow chart guide fro staff provided by the local authority. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 22 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home does well to provide a warm welcoming and well-maintained environment for the residents to live. The home does well to provide a clean and pleasant environment for the residents to live, however further improvements are required to ensure residents are protected from the potential risk of cross infection. EVIDENCE: Springfield House is a two-storey building with ground and first floor accommodation, residents residing on the first floor can access their rooms with support if required by a fully serviced lift or stairs if they are able. The home has a large communal room that has been cleverly divided into three separate communal areas each with its own TV and a dining room. Bedrooms and communal areas have been decorated to a high standard and furnished with quality furniture and soft furnishings.
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 23 All the residents and relatives with whom the inspector met were very complimentary of the homes environment and facilities. The home has been maintained to a high standard and recent redecoration of the hall stairs and landing, some bedrooms and the fitting of new carpets has gone further to improving the environment. The residents with whom the inspector met said they were very happy with their bedrooms and were able to bring in some furniture of their own. Bedrooms are personalised and reflect the personality and history of the resident. Matching bed linen and curtains demonstrates the importance the managers and staff place on ensuring the residents have a nice place to live. At the time of the inspection the home was taking delivery of two new tumble dryers and the manager spoke of his plans to make further improvements to the laundry facilities and staff room. The home has a dedicated cleaner who works twenty hours a week, the home was observed to be very clean and tidy and staff were observed taking specific care of laundering, ironing and putting residents clothes away. The inspector met with the cleaner to establish what training and cleaning equipment she has been provided with. The cleaner has a well-stocked secure COSHH cupboard and informed the inspector that she has not received any training specific to her role. The manager must ensure ancillary staff receive training to their role such as infection control, moving and handling, health and safety. The cleaner informed the inspector that she is assisted by the managers to maintain a good stock to prevent running out of essential items. However this could not said for disposable gloves as the inspector was made aware that the home regularly runs out of them and on the day of the inspection a member of staff had to go and buy some from a local store. The manager must ensure staff do not run out of such stock to prevent the risk of cross infection and potential risk to themselves. The staff were observed to wear different coloured aprons for assisting with meal times and when assisting with personal care. The staff are currently in the process of undertaking distance learning in the control of infection, this form of training is accredited and supervised by an outside assessor. The manager is advised to ensure staff are made aware of the procedures for dealing with and managing media hyped super bugs. The manager must also ensure that residents and staff have access at all times to hand washing facilities when using the bathroom, such as liquid soap and paper towel dispensers. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does well to provide sufficient numbers of skilled staff to meet the needs of the residents. However the home has failed to fully protect the residents by not adopting a robust recruitment procedure. EVIDENCE: Through viewing the staff duty rota, observation, speaking with residents and viewing comments cards received from residents and relatives the inspector was able to establish that the home provides sufficient numbers of staff. The duty rota reflects that the home is staffed appropriate to the times of the day and employs more staff in the morning and evening. In addition to care staff the home has a dedicated cook and cleaner. The inspector observed positive interactions between staff and residents, requests met efficiently and staff sitting and spending time chatting with them. Call bells are promptly answered. Comments recieved from residents and relatives confirm that the home provides sufficient numbers of staff:
Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 25 “They always make time to listen despite always being very busy”. All ten comments cards received indicated that staff were always available when needed. The managers positively support and encourage their staff to undertake a National Vocational Qualification (NVQ) and they currently have a total of 60 of their staffed trained this exceeds the National Minimum standard. The staff with which the inspector met said they were happy with the opportunities and support they are provided to achieve this award. Through discussion with staff the inspector established that the home sends out applications, interviews staff, requests references and information to obtain and take up required checks. However through viewing staff personal files there was evidence to suggest that the home fails to follow correct procedures when taking up required checks such as Protection of Vulnerable Adults (POVAfirst), Criminal Record Bureau (CRB’S) and appropriate references. There was evidence of one employee not having a CRB or POVA check undertaken on them and sent for until the day after they commenced in the home. An immediate requirement was issued in respect of this as a failure to obtain these checks places residents at potential risk of harm. The deputy manager who is applying to register was not fully aware of the process, however it is the responsibility of the registered manager to ensure procedures are being followed correctly. Through speaking with staff the managers and the viewing staff records the home is able to demonstrate that they ensure staff are skilled to meet the needs of the residents. The home uses a number of resources available to ensure staff receives training including distance learning, formal training and seeking advice from professionals. The staff informed the inspector they are happy with the level pf training they receive and are confident that if they identify a training need the managers will support their request. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 26 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home dose well to have a sound and cohesive management team, however the registered manager must ensure that at all times policies and procedures are correctly followed. The home does well to consider the views of the residents, staff and relatives, however the home must ensure that this process is extended to other stakeholders and formalised as required following the previous inspection. The home has appropriate systems in place to assist to support the residents to safely look after their personal monies. As far as feasibly possible the home provides a safe environment for the residents and staff. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 27 EVIDENCE: The current registered manager is in the process of supporting his deputy to make application to register. The deputy manager was highly praised by the owners and informed the inspector how much they value her and the hard work she has done over the last year. Although slightly daunted by the process the deputy manager said she was happy to register and is to commence her NVQ4 in the New Year. The deputy manager is advised to ensure she familiarises herself with important legislation that effects the running of the home. However the registered manager Mr kitchen must ensure that he is fully supporting his deputy in order to avoid inappropriate practices such as recruitment occurring. Through observation the inspector found the managers to be efficient, professional and very caring towards the residents, their relatives and staff. The residents, relatives and staff with whom the inspector met spoke highly of Mr and Mrs Kitchen and the deputy manager. “They are very kind, nothing’s too much trouble” Through observation and discussion the inspector was able to draw the conclusion that the residents, their needs and how they are feeling is of a high priority to the managers. The inspector observed one of the managers taking time to speak with each resident in turn to ask how they were and if everything thing is okay with them and then feeding back to staff if there was a concern. This is a very good way to quality monitor the individual views and feelings of the residents on a daily basis. At the last inspection of the home the manager was required to formalise the quality audit they had undertaken with residents and extend this to visiting professionals. The inspector viewed the quality audit tools used to seek the views of the residents and observed the questions asked of them covered their overall care, including personal care, mealtimes and views of staff’s performance. However the audit is yet to be extended to visiting professionals and other stakeholders and the information collated and formalised in the form of a report and fed back to the residents and their families. Therefore the requirement will be repeated. The deputy manager informed the inspector that the residents’ relatives, social services or a designated appointee manage all residents’ monies. However the home does hold resident monies on their behalf. The inspector viewed the storage and balances of three residents monies and found these to be securely Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 28 held and well audited with a record of incoming monies, expenditure and balance, receipts back up expenditure. The inspector met with several of the staff that informed the inspector that they feel very well supported and find the owners and managers very approachable. However supervision is not undertaken six times a year as required. The home does well to provide as far as feasibly possible a safe environment for the residents and staff. The home is well maintained, hygienically clean and environmental and fire safety standards are appropriately followed. The inspector viewed records of daily fridge and freezer temperatures being taken and food stored correctly. The home could evidence that all serviceable appliance have been checked as per the stated guidelines and that appropriate tests and checks have been undertaken on all fire appliances. There was evidence to demonstrate the home takes seriously the risk of fire or other emergencies as an emergency procedure is in place. Staff receive regular fire training and drills and fire safety equipment is regularly checked. The registered manager was not familiar with the new legislation that came into effect on the 1st October in respect of the new fire safety regulations and the need for the home to undertake their own fire risk assessments. A requirement has been issued in respect of this. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 29 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 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 3 3 2 X 2 Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(4) Requirement The registered manager must ensure the prescribing medical professional confirms alterations made to resident’s medications. The registered manager must ensure care plans are regularly reviewed and the changing needs of the residents are reflected in the plan of care. The registered manager must ensure the care plans provide specific detail of “how” the resident wishes to be supported. The registered manager must ensure the cleaner receives training specific to her role such as infection control, health and safety and moving and handling. The registered manager must ensure there are appropriate and adequate hand washing facilities available at all times for residents and staff. The registered manager must
DS0000012321.V313630.R01.S.doc Version 5.2 Timescale for action 31/12/06 2 OP7 15 31/12/06 3 OP7 15 28/02/07 4 OP26 OP30 18 31/03/07 5 OP26 16, 24 31/12/06 6 OP26 16, 24 31/12/06
Page 31 Springfield House ensure there are adequate stocks of disposable gloves at all times. 7 OP33 24 The quality monitoring systems must be further developed to take into account all stakeholders views. The registered manager must ensure all staff receive a minimum of six formal supervision sessions a year. The registered manager must ensure the home complies with the new Fire Safety Regulations and undertake a thorough fire risk assessment of the home. 28/02/07 8 OP36 18 31/12/06 9 OP38 24 31/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered manager is advised to consider developing life histories/dementia care mapping. Springfield House DS0000012321.V313630.R01.S.doc Version 5.2 Page 32 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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