Inspection on 21/09/07 for Springfield House

This inspection was carried out on 21st September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Springfield House 3-5 Ranelagh Road Malvern Worcestershire WR14 1BQ Lead Inspector Wendy Barrett Key Unannounced Inspection 21st September 2007 11:00 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 DS0000069711.V343341.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 DS0000069711.V343341.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield House Address 3-5 Ranelagh Road Malvern Worcestershire WR14 1BQ 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) 01684 574 248 01684 899 372 Young@Heart Care Homes Ltd vacant post Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17), of places Physical disability over 65 years of age (17) Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide personal care and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 17 Physical Disability over 65 years of age (PD)(E) 17 Dememtia over 65 years of age (DE)(E) 17 The maximum number of service users to be accommodated is 17. 2. Date of last inspection Brief Description of the Service: Springfield House is formed of two large semi detached houses that are internally linked to form one care home. It is situated in a quiet cul-de-sac on the outskirts of Malvern Link. There are eleven single rooms, two of which have en-suite facilities, and there are three double bedrooms none of which have en-suite facilities. A stairmatic is available to assist people with impaired mobility negotiate steps and stairs. The home is registered to provide care for a maximum of seventeen older people who have needs related to age, physical disabilities and/or dementia type illnesses. In May 2007 a new provider took over the home. The previous Care manager has also resigned from her management post and a care manager designate has recently been appointed. It is intended that she will submit an application for registration with the Commission in the near future. The new Provider has produced revised information literature describing the service provided at the home. This will be presented as an information pack in the main entrance to the home once decorating work has been completed. There is a copy of a Service User guide in each bedroom and spare copies are available on request. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the service since the registration of the new Provider and resignation of the previously registered Care manager. A random inspection was undertaken one week after the new Provider took over the home. This related to the previous management and has not, therefore, been taken into account as part of this inspection. This report has been written with reference to information gathered from a quality assurance assessment report submitted by the Provider at the request of the Commission, survey form responses from a sample of residents and relatives, and an unannounced inspection visit to the service over 2 days. What the service does well: What has improved since the last inspection? The new Provider has already completed some refurbishment work and has plans to continue upgrading the residents’ accommodation. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 6 Staff training opportunities and supervision and support has been strengthened. There has been work done to improve the way medication is managed. The way that staff record the care they give each residents is being revised so that it is more comprehensive. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents have been admitted to the home without a comprehensive preadmission assessment by a qualified person with the result that staff are having to care for people without the information they need to work safely and effectively. EVIDENCE: A random sample of care records indicated that residents had been admitted to the home without careful planning and pre-admission assessment work. It is essential that admissions be only agreed once the home is satisfied it can meet the potential resident’s care needs. Potential residents also need an opportunity to find out about the home and visit it so that they know what to expect. Well planned admissions are most likely to lead to a positive experience for everyone involved. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 9 An immediate requirement was made at the inspection visit in relation to admission procedures. The Provider immediately confirmed her acceptance of this and an intention to comply in future. This will involve resisting pressure from placing authorities or relatives while pre-admission assessment work is completed. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each resident has a written plan of care and the way that the care is organised and recorded has improved. There is still more work needed to develop careplanning practices that are robust enough to address the special needs of people who have needs arising from dementia. The way that medication is managed has also improved but there should be more robust internal auditing so that errors and omissions can be identified and dealt with promptly. EVIDENCE: The new Care Manager has been busy revising written records of each resident’s care. Examples of her work confirmed that the records were becoming more robust and better organised. The plans will need more development to achieve a satisfactory standard e.g. there is little current use of recognised assessment tools, consent forms, behaviour management Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 11 plans. This will ultimately require active involvement of other senior care staff in support of the Care Manager. Relatives are being invited to complete a pre-admission form about the potential resident. This is good practice but it is also important to keep consulting and informing relatives as part of the ongoing care planningparticularly for those residents who are unable to make informed choices for themselves. Residents look comfortable with the staff who care for them. There was plenty of relaxed conversation and laughter between staff and residents during the inspection visit. A resident commented ‘the (staff) look after my legs. If you’re not satisfied here, you are not satisfied anywhere’. There were examples of better management of residents’ medication. A new storage trolley has been purchased, records showed that staff are trying to ensure that medication is only used in the best interests of the resident e.g. use of tranquillising medication had been reduced with permission from the G.P. The Care Manager has introduced a new system of monitoring the use of topical applications. A number of shortfalls were identified e.g. random check of stock showed small discrepancies with recorded stock balances, stock rotation needs to be improved so that older stock is used first, double checking of hand written entries not always confirmed with staff signatures on administration records. These sort of things should be picked up through a regular audit exercise at the home. The problems can then receive prompt attention. A medication policy and associated procedures were available in the office. It was unclear how often staff refer to this guidance and it would be sensible to check the procedure against up to date pharmaceutical guidance, make sure all staff who handle medication have read it, prepare a simplified version for staff to use on a day to day basis, and keep a copy of this where staff actually work with medication. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff spend social time with residents but they need more information to help them get to know each individual well. There is a commitment to encourage and support relatives in helping staff plan the care in a way that reflects the individual resident. The meals are wholesome and appealing and they are carefully planned to reflect the needs and preferences of the residents. EVIDENCE: Residents are offered opportunities to take part in regular leisure activities at the home and there are records that list recent opportunities that include sing a longs and snakes and ladders. Holy Communion is also regularly held. An Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 13 external facilitator comes in each week to do exercises and a ’Music for Health’ therapist visits once a month. The residents obviously these diversions – ‘we do dancing and sing a longs. I like games, we are fortunate to be here’. Floor games and Holy Communion took place during the inspection visit. Many of the residents’ records contain little information about their social history and, because most have a limited ability to tell the staff about their previous lives, there is little known about their backgrounds. If staff knew more about each resident’s history it would be easier for them to plan the care to suit the individual. The previous Provider and Care Manager described some difficulty encouraging relatives to contribute to care planning for their resident. The current management staff recognise the importance of family support – particularly for residents who have dementia and who rely on others to make decisions about their lives. There are plans to advertise hallowe’en, bonfire night and Christmas parties as an initial method of getting to know relatives and friends a little better. There is considerable satisfaction with the meals –‘tasty and lots of it’. A record of comments is kept in the kitchen and included many complimentary remarks as well as some suggestions for improvement –‘custard could have been sweeter’. This is a really good way for the cook to know what the residents need and what they enjoy. Some very appetising food was being prepared in the kitchen during the inspection visit e.g. fresh broccoli, cabbage and swede being cooked in an electric steamer, home made vegetable soup being cooked on the stove. The cook recognised the importance of serving meals as attractively as possible i.e. good quality crockery, careful presentation of liquidised foods. The kitchen was very clean and tidy and it was clear that the cook has a good understanding of the way to manage the catering service in the best interests of the residents. She has a current food hygiene certificate. It may be helpful to obtain a copy of the CSCI publication ‘Highlight of the Day’ for additional ideas and guidance. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is written guidance at the home about making complaints and dealing with abuse but the procedures need to be more thoroughly understood and used to be sure residents interests are well protected. EVIDENCE: The Commission hasn’t received any complaints or allegations about the service since the new Provider was registered. A complaints and protection policy has been implemented at the home and details are included in the information literature available at the home. Prior to the inspection visit the Commission requested information about complaints made at the home. This was not received. Records of all complaints and action taken in response to them should be available at the home in the future. Residents who are able to raise concerns know who to talk to if they are unhappy. Their awareness of more formal procedures for making complaints was less clear. Many residents at Springfield House rely on others to protect them and to represent their interests so it is particularly important for all staff Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 15 to know how to deal with concerns shared with them, and how to identify and report abusive behaviours. A policy for safeguarding adults has been implemented but only two staff have received training in abuse awareness, and the Care Manager designate didn’t have details of the local multi-agency protocols for adult protection. There will, therefore, have to be more attention to strengthening staff awareness of adult protection issues. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The design of the building is not best suited to elderly residents because there are internal steps and narrow corridors although there is an easily accessed rear garden that is attractively presented and well cared for. The quality of the overall accommodation is improving through an ongoing programme of refurbishment, and residents are kept safe through regular maintenance checks and attention to hygiene measures. EVIDENCE: The home was clean and warm when the inspection visit took place and the Provider’s husband was doing some internal decorating. New carpets have recently been purchased and there are plans to upgrade the entrance hall and corridors in the near future. A conservatory lounge now offers an alternative Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 17 area for residents to sit and relax and it provides easy access to an attractive rear garden. Some aspects of the accommodation and facilities are still in need of refurbishment. The Provider has plans to deal with this but obviously can’t do everything immediately. There are plans to fit 2 chair lifts next year and general maintenance of essential services has been dealt with during this year. Staff are asked to check for any potential hazards and report any found at the end of their working day e.g. faulty window restrictors. Staff have written guidance to deal with spillages and infection control measures. Hand washing equipment and protective clothing are supplied around the home. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff to meet the residents’ needs and staff are supported in obtaining relevant care qualifications and health and safety awareness. New staff are generally well selected although there should sometimes be a little more evidence of the way decisions have been made that individuals will be safe to work alongside the residents. EVIDENCE: The staffing levels are generally satisfactory although teatime cover needs to be increased but advertising hasn’t been successful yet. Agency staff are being employed to cover any shortfalls. A good number of care staff have obtained a national vocational qualification in care and two more were working towards this at the time of this inspection. Health and safety training is being arranged to make sure the staff have the knowledge they need to work safely e.g. 12 staff had received fire safety instruction from a fire safety consultant in September ’07. Manual handling training was taking place during the inspection visit. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 19 Induction training has been expanded following the advice of a consultant and records confirmed that eight existing staff had recently repeated their original induction training so they covered all the new areas. A sample recruitment record contained most of the required information. There were a few examples of a need for more careful attention e.g. a staff member started work before the register for Protection of Vulnerable Adults had been checked. This decision should be explained in the personnel record, with reasons why it was considered safe to start the new employee before this essential check, or a full criminal records bureau check, had been completed. It is also essential to make sure a full employment history has been provided in the application form. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,36, 37 and 38Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Commission has recently assessed the Provider to be fit to run a care home and there has been an open and co-operative attitude with the Commission since registration was approved. The new Care Manager hasn’t yet been registered. Management decisions are being made in the best interest of residents. Some work has already been done to introduce quality control systems but there will need to be further development of this once the new management team have had longer to fully address it. EVIDENCE: Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 21 The Provider has been open and co-operative with the Commission since taking over the service. Regular reports of monitoring visits have been sent in and notifiable events at the home are being reported, as required. The new Care Manager designate already has considerable experience at the home and is willing to undertake further training to update her knowledge e.g. she has arranged to attend sessions on risk management and quality assurance assessment. She hasn’t yet applied for registration with the Commission. It would be advisable for her to access guidance regarding the management of care services for people with dementia and to keep herself updated through regular reference to professional literature, contact with organisations such as Alzheimers Society etc. There will need to be more work done by the Care Manager and the Provider to introduce a system of quality assurance and this work is already being given attention. The quality of the residents’ accommodation is improving, staff training opportunities are improving, and care planning procedures are being reviewed. The recent introduction of regular one to one supervision meetings will strengthen monitoring of individual staff performance. Some aspects of the service need to be regularly audited so that any work required is quickly picked up and dealt with e.g. accident records should more clearly show how the management have responded to events and accidents to reduce the risk of them being repeated. Medication stock and records need to be regularly audited for errors, omissions and discrepancies, care plans regularly evaluated and updated in response to any changing conditions described in day and night reports. Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 x x 3 2 2 Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/a 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 OP3 OP4 OP5 Regulation 14(1)a-d Requirement A suitably qualified or trained person must agree admissions to the home on the basis of a comprehensive pre-admission assessment of the needs of the potential resident. This should include consultation with any involved professionals e.g. confirmation of medical history and current medication regime by a G.P. The assessment information should be sufficiently detailed to enable an initial care plan to be produced that covers potential areas of risk. You must confirm in writing to the resident (or their representative) that having regard to the assessment the care home is suitable for the purpose of meeting the resident’s needs in respect of health and welfare. Immediate requirement. Timescale for action 21/09/07 Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP9 OP9 Good Practice Recommendations The review of care planning procedures should include more attention to risk management, consultation and specialist needs of residents with dementia. Medication policy and procedures should be revised with staff who handle medication to be sure they understand how they should be undertaking this work. Regular audits of medication management would help identify shortfalls e.g. stock rotation, double checking of handwritten entries, discrepancies in stock balances when checked against administration records. There should be more staff training and guidance on abuse awareness and local adult protection protocols. When new staff start their duties before all the required checks have been made there should be a record that explains how a decision was made that they were safe to work with vulnerable adults. A system of quality assurance will need to be fully implemented. This should include regular internal audits that will help to monitor the effectiveness of the service. 4. 5. OP18 OP29 6. OP33 Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worcester Local Office John Comyn Drive, Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield House DS0000069711.V343341.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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