Inspection on 24/09/09 for Springfield Manor Nursing Home

This inspection was carried out on 24th September 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Springfield Manor Nursing Home 18/09/07

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Springfield Manor Nursing Home Hogs Back Puttenham Guildford Surrey GU3 1AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 2 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 26 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Springfield Manor Nursing Home Hogs Back Puttenham Guildford Surrey GU3 1AQ 01483810177 01483810611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springfield Manor UK Limited Name of registered manager (if applicable) Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Springfield Manor Nursing Home is registered to provide nursing care for up to thirty older people. It is located on the Hogs Back in extensive grounds, overlooking the Surrey countryside. The home provides ample communal space, including an attractive conservatory. Residents accommodation is provided in single and shared rooms some of which have en-suite facilities. There is a shaft lift to access the first Care Homes for Older People Page 4 of 26 Over 65 30 0 Brief description of the care home floor and a ramp to access the patio garden at the rear of the home. parking provided as the home is not accessible by public transport. There is ample Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection of the care home was an unannounced Key Inspection. Mrs Lesley Garrett, Regulation Inspector, carried out the inspection. The manager represented the service and we were also assisted by the provider. We arrived at the service at 10:00 and were in the home for five hours. It was a thorough look at how well the home is performing. It took into account information provided by the home and any information that CQC has received about the service. The manager for the service supplied CQC with an AQAA (Annual Quality Assurance Assessment) and this document was used to assist with the inspection. We also received some completed surveys from people who use the service, staff members and social and health care professionals. The inspector also spent time talking with some of the people using the service. We looked at how well the service was meeting the key national minimum standards Care Homes for Older People Page 6 of 26 and complying with the regulations and have in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes care plans, daily records and risk assessments, staff files, training records and the homes safeguarding and complaints policies and procedures. From the evidence seen by us, and comments received, we consider that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. Care Homes for Older People Page 8 of 26 The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person to ensure that the home can meet their needs. Evidence: We looked at the service user guide and statement of purpose. They contained all the information required for people to make a decision about living at the home. Both of these documents were reviewed and updated in July 2009. The manager told us that all people that are admitted to the home have a preadmission assessment which she carries out. The manager said that she will often take a carer with her. This ensures that together they assess the care needs of the individual to ensure the home can meet their needs. We were also told that the person wishing to use the service has then had the benefit of meeting two members of staff from the home prior to their admission. The assessment looks at their activities of daily living and the assessment is placed in their individual folder. Documentation Care Homes for Older People Page 11 of 26 Evidence: sampled during the inspection showed us that these assessments had taken place and that care plans are then generated from this document. The home does not offer intermediate care. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care needs the of people using the service is based on their individual needs but the care plans supporting this need to be improved and expanded to ensure that this is documented clearly and agreed. Evidence: Two care plans were sampled and these contained brief details about each person using the service. A discussion took place with the manager and provider as there was too little information available for each person using the service. The care plans need to be expanded and written in a person centred style. All care plans and risk assessments must then be reviewed and agreed monthly. In each bedroom there is a short version of the care plan. The manger said this was to help the carers deliver the care for the day without having to read the full care plan folder every day. There was no evidence of nutritional risk assessments having taken place. The manager and provider then showed us the documentation that was about to be introduced into the home to assess the nutritional status of all people using the service. Evidence was seen that weights are taken every month and any person using the service that has a weight loss is referred to the GP for a review. The manager said that the home is also Care Homes for Older People Page 13 of 26 Evidence: supported by a dietitian and a speech and language therapist. Aids and equipment are provided to encourage maximum independence for people using the service and these are reviewed and replaced to accommodate peoples changing needs. The manager told us that the GP visits every week to see those people using the service who need a visit or who have requested one. The manager told us that the GP was a good support to the home and that they would visit then home more often if someone was unwell.The home also has the support of a physiotherapist who will visit all new admissions to assess their mobility and their manual handling needs. The physiotherapist will also visit other people using the service on a one to one basis as required by the people using the service. We were also told that the chiropodist visits every six weeks and the diabetic foot nurse also visits. The people who use the service also have access to the dentist and optician. The GP will also make referrals to the dietitian and speech and language therapist when required. There are medication policies and procedures in place. The manager told us that all medications are delivered every month and are in blister packs. The manager told us that an audit takes place of the medicines every six months by the supplying pharmacy. The manager also regularly reviews the medication administration records to ensure the accuracy of the recording and good practise by the nurses During a tour of the building it was observed that staff were speaking appropriately to the people using the service by their preferred name which had been documented in their care plan. All people were dressed in clothes appropriate for the weather with hair well groomed and nails clean. Staff were knocking on peoples bedroom doors prior to entering and responding to the call bells within a reasonable time. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are able to take part in some social, religious and recreational activities and are able to exercise choice in their daily lives. The quality of the meals is good which means nutritional needs should be met. Evidence: The manager told us that the home does not currently employ a dedicated activity organiser. We were told that an activity takes place every day but this is organised by the staff on duty. An activity programme was on display and most activities are scheduled to take place in the afternoon. The programme indicated that large group activities and one to one sessions are available. Outside entertainment is also arranged by the provider and is often a musician or singer. On the day of the inspection no activity was observed. People using the service were either seated in the small lounge reading newspapers or in the larger lounge watching the television. It was observed that the care plans do not identify the preferences of the people who use the service with regard to activities and does not detail past hobbies and interests. The AQAA identified this when we asked what do you think you could do better. It was stated that the pre-admission assessment would be further developed to include the future expectations, current activities and future aspirations of the people who use the Care Homes for Older People Page 15 of 26 Evidence: service. We received some completed surveys from people who use the service. We asked the question does the home arrange activities that you can take part in? Only one respondent stated always the others replied usually. The manager told us that visitors are welcome in the home at any time and the home promotes open visiting. On the day of inspection it was observed that people using the service had visitors during the day in individual bedrooms and in the communal areas. The provider told us that visitors who previously had relatives at the home remain in contact and maintain contact with the home. The manager told us that people who use the service have access to a church service which takes place at the home every month. The vicar also visits at least twice a month to visit people on a one to one basis if requested. The management of the home have details and information for other denominations with contact details if this is required. The manager told us that on a recent environmental health officer visit the home was awarded four stars. Consultation regarding menus takes place with the people using the service. A meeting is then held between the manager, provider and chef and the menus for that season are devised. The manager said that different dietary needs can be catered for and if people using the service require pureed or soft diets the dietitian or speech and language therapists are consulted. The manager told us that relatives are welcome to stay for meals and currently two relatives take this opportunity to have a meal with their husband or wife. A choice of meal is offered every day and the AQAA told us that these meals are tailored to suit individual likes and dislikes. People spoken to on the day of the inspection were complimentary about the food at the home. The home has a nutritional and catering policy. This policy details different faiths and their likes and preferences so that any religion could be accommodated at the home as staff have access to this detailed information. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service can be confident that their complaints are listened to and that they should be protected from abuse as the staff team have received training in safeguarding adults. Evidence: The manager said that during the last year they had received five complaints. These had all been investigated and resolved. The complaints policy is available in the service user guide and is clear and easy to understand. The deputy said that all complaints received by the home are documented and placed in a complaints folder. Prior to this inspection CQC received an anonymous email raising some concerns. We referred these concerns to the local authoritys safeguarding adults team. The planning meeting was due to take place the day after the inspectionand the manager and provider were due to attend. There have been no other safeguarding alerts during the year. Documentation seen on the day of inspection confirmed that staff had received training in safeguarding adults procedures and refresher training takes part every year. The home has an internal policy on safeguarding adults and this is in line with the local authoritys and the home also has a copy of that procedure. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home enables people who use the service to live in a safe and comfortable home where a a maintenance and refurbishment programme is in place to further improve the environment. Evidence: A tour of the home took place and people who use the service were seen to be able to access all parts of the home and grounds. The home on the day of inspection was seen to be clean and tidy and free from offensive odours. Most of the bedrooms are single and these were observed and had been personalised. The provider told us that since she had bought the home in 2007 she had spent a lot of money on the outside of the building including a new roof. The wood panelling inside the home had also been varnished. We observed during the tour of the building that the corridors had also been painted. Work still needs to take place with regard to decorating as some of the bedrooms still have peeling wallpaper and scuffed paint work. The bathrooms are dull and in need of refurbishment. The provider is aware of the internal decorating and refurbishment requirements and showed us the plans in place for a structured refurbishment programme. The provider has replaced most of the divan beds and people using the service have Care Homes for Older People Page 18 of 26 Evidence: the benefit of adjustable beds. Hoists have also been purchased to aid manual handling. The provider employs a full time maintenance supervisor who follows a routine maintenance programme. The home also has the support of a housekeeping team who cover the home seven days a week to maintain the cleanliness of the environment. One completed survey received by us from a relative said the bedroom is a little dark and dreary and would benefit from redecoration. The provider is aware of the shortfalls within the home but as stated previously has a programme of refurbishment in place. Since the provider bought the home in 2007 the outside of the home has improved. The entrance door has been painted and the surrounding brick work cleaned. There are hanging baskets to the front of the home and the paving slabs on the patio have been re-laid. The manager said that the people who use the service have enjoyed sitting outside during the good weather and admiring the views of the Surrey Hills. The home also employs a person to cover the laundry. The laundry is small but very tidy and clean on the day of the inspection. Gloves, aprons, hand towels and liquid soap are all available and staff have received infection control training. Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff numbers at the home on the day of inspection were sufficient to meet the assessed needs of the people using the service. NVQ training for the care staff continues to ensure a good skill mix of staff on duty. Evidence: The home benefits from an experienced staff team and when sampling the staff rota it was observed that staffing levels are consistent. The AQAA told us that the home benefits from a loyal staff team who have worked for the home many years. The manager told us that she does the rotas for the staff and that they always try to ensure that there is a a good skill mix. We was also told that the home does not have to use agency staff very often as empty shifts are often covered by the current staff team. One person using the service told us the staff are very kind to me another said the staff are good they do what they can. They always answer my bell when I need them. The manager said that well over 75 of the care staff have NVQ certificate at level two and that the training at the home is on going. Some members of staff have achieved the level three qualification. Two staff employment folders were sampled and were found to have the necessary paper work to enable the home to employ those people safely. This ensures that the Care Homes for Older People Page 20 of 26 Evidence: people who use the service are protected by the homes recruitment procedures. All staff that returned our surveys told us that the management had carried out the necessary checks prior to them being employed. The staff also confirmed that they had all received an induction. The provider told us that she now has a trainer for the company. She will provide some of the mandatory training for the three homes and this will include safeguarding adults, infection control and first aid. The home has a training matrix in place and all training that is required is documented for each member of staff and when their update is due. The provider said that the mandatory training will take place at the home and the staff will be informed of the dates that they must attend. Staff told us standards of care have improved due to the intensive training staff receive and another said the home provides good training and up to date information is provided on a regular basis. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home ensures the staff team is adequately supported and there are clear lines of managerial accountability. Quality assurance systems are in place which improve the quality of care offered to the people who use the service. Evidence: The registered manager for the home left in July 2009 and the registered provider appointed the current manager who has worked at the home since 2007. The provider told us that they are currently putting together her application form to become the registered manager. The manager told us that there had been a smooth transition for her as she had worked closely with the previous registered manager. The manager told us that she has also planned to do her managers award certificate. The manager is supported by a clinical nurse manager who is in charge when she is away. During this inspection a discussion took place about the improvements needed regarding the care plan documentation and the manager and provider confirmed that these shortfalls would be addressed. Care Homes for Older People Page 22 of 26 Evidence: During the inspection we observed that people using the service were offered tea and coffee during the morning from a trolley that visited all rooms and the lounges. One person that we were speaking to in the bedroom was given a drink in a plastic beaker. The manager said that she thought all people were given a preference between a plastic beaker or a cup and saucer but most people preferred a larger mug. She said she would review this practise to seek the views of people using the service to ensure they prefer plastic drink containers and change the practise if necessary. The manager and provider told us that questionnaires are sent to the people who use the service and their relatives/representatives to seek their views on the quality of the service and care provided. An action plan is then written so that any shortfalls identified can be addressed. Internal quality audits also take place and these include the medication systems and daily contact sheets for the nurses to feed back on any issues arising from that shift. The manager told us that she reads each of the contact sheets so that she can action any problems that have been identified and these are also discussed with the provider. The provider also told us that she carries out Regulation 26 visits to the home every month. These are unannounced visits to the home that can be carried out at any time of the day. A report is written on the findings and are then discussed with the manager with a copy available at the home for the inspector to see during inspection visits. No personal money is held by the home. All invoices are passed to the relatives, representatives or to the person using the service for them to settle. All necessary health and safety certificates are in place and we also observed a range of policies and procedures relating to health and safety. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans available in the home should be reviewed to ensure they contain all of the necessary information and risk assessments to enable staff to deliver adequate care. These care plans should then be agreed by the people using the service and reviewed regularly. To ensure that staff and people who use the service have detailed information available to them to enable good standards of care are carried out. 05/11/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 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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