CARE HOMES FOR OLDER PEOPLE
Springfield Nursing Home 17 Western Way Buttershaw Bradford West Yorkshire BD6 2UB Lead Inspector
Nadia Jejna Unannounced Inspection 24th November 2005 10:15 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 Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Springfield Nursing Home Address 17 Western Way Buttershaw Bradford West Yorkshire BD6 2UB 01274 694192 01274 601960 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) Anchor Trust Mrs Wendy Garland Care Home 98 Category(ies) of Old age, not falling within any other category registration, with number (98), Terminally ill over 65 years of age (1) of places Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The place for TI(E) is for the named service user only. Date of last inspection 22nd July 2005 Brief Description of the Service: Springfield House is a registered care home with nursing. It is situated in a residential area approximately 2 miles from Bradford city centre. Accommodation is provided for up to for 98 male and female service users in single en suite rooms in two wings over three floors. Spacious lounge and dining areas are provided on each floor. There is disabled access to all floors via 2 shaft lifts. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections. This is the fourth inspection, with one of these being as a result of a complaint made directly to the CSCI. The last inspection in July 2005 showed that the home had not made progress towards meeting requirements and recommendations made at previous inspections. At that inspection there were 16 requirements and 6 recommendations made as a result. The purpose of this inspection was to monitor the home’s progress towards meeting the requirements made as a result of the last inspection and to assess whether the care given to residents meets minimum standards. Records were looked at, areas of the home were seen, care staff were seen carrying out their work; discussions on an individual and joint basis, were held with staff, the manager, visitors, and residents. Survey cards had been left at the home previously for residents, their relatives and visitors to complete and return to the Commission for Social Care Inspection (CSCI). At the time of writing 2 had been received. The inspection started at 10:15 and ended at 17:30. The people who live in the home prefer the term residents, and this is the term that will be used throughout this report. What the service does well: What has improved since the last inspection?
The recruitment procedures have been made more robust and the manager makes sure that all required pre employment checks are in place before offering a job to a prospective employee.
Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 6 Induction training is to the Sector Skills Council standards for care workers. The manager said that personal development portfolios are going to be introduced for all staff. Towel rails have been fitted in the en suite toilet facilities in the new extension. Air vents have been fitted to the laundry area in order to improve the ventilation and working conditions for staff. 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.
Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 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 Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 There is a risk that residents needs will not be met. Pre admission assessments are carried out but the information is not used to determine whether or not the home will be able to meet the identified needs. Residents have been admitted who do not fall within the home’s registration categories. EVIDENCE: The care plans showed that a senior member of staff visits prospective residents to assess and identify their needs in order to make sure that they can be met. Staff said that the information in the pre admission assessment gave them enough detail to start the care plan. Copies of assessments from social workers and other healthcare professionals are obtained. It was clear that the information is not being used properly as a number of residents clearly had dementia and mental health care needs as their primary reason for needing 24 hour residential and or nursing care. The home is not registered to provide this type of care and appropriate staff training has not been given. There is a risk that the needs of these residents will not be met. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 9 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 The needs of many residents are not being met. There are no clear lines of responsibility for making sure that care plans are followed through or kept up to date. There appears to be a culture of blame with excuses for why the care plans are not completed or not in place. The practices around dealing with medication were unsafe and place residents at risk. EVIDENCE: Four care plans were looked at in detail. These showed that: • For one resident who had been in the home for 9 days there was no care plan in place. The file contained copies of some assessments and the daily records. • The care plans did not identify all residents’ needs. Examples included no information about mouth care for a resident who could not eat or drink for medical reasons, no information about why suction was being used for a resident, how to reduce the risk of falls. • The care plans that were in place lacked detail and clarity about how an individual’s needs were to be met. Examples included no information
Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 10 • • • about how urethral catheter care was to be given, how to meet hygiene needs according to the individuals needs and abilities. Appropriate health monitoring records were being completed at intervals but if the individual was identified as at risk appropriate care plans were not put in place. There was nothing to show that the resident or their relatives had been involved with the care planning process. The care plans were not being evaluated or updated monthly or more often if resident’s needs changed. Serious shortfalls with the care plans have been identified at previous inspections and requirements made have not been met. During discussions there was shifting of responsibilities for producing care plans and blame put elsewhere. The registered manager and responsible person must take urgent action to protect and promote the health, safety and well being of residents. The home was in the process of changing the supplying pharmacy and starting to use a blister pack monitored dosage system (MDS). Policies and procedures are in place, which include the changes in the law around disposal of medications from nursing homes. While looking at one resident’s care plans and their medication administration records (MAR’s) it was clear that there was cause for serious concern. An entry in the daily records stated that the medications were out of stock. When the MAR’s were checked it was clear that the medicines had been out of stock and therefore not given for 3 days. The resident had mental health needs and prescribed tablets were to help with preventing deterioration in mood and temperament. The daily records showed that there had been a change in the resident’s behaviour patterns. Also there were 2 sets of MAR’s for the same period of time, one printed copy from the pharmacy and one handwritten by staff. The information on the handwritten chart had not been copied correctly and there was a high risk that the wrong dosage of medication was being given. This issue was pointed out to the manager and operations manager who said that immediate action would be taken. Staff interactions with residents were friendly and polite. Residents’ preferred names were recorded in the care plans and used by staff. Residents said that staff respected their privacy and knocked before entering their rooms. Residents said that they were satisfied with the care being provided and that the care workers were kind, attentive and hardworking. One visitor was pleased to say that the carers put the residents first. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 11 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): Residents are able to maintain contact with family and friends. EVIDENCE: Personal and social history records were seen in the care plans but they were not always completed. The social care record for one resident had last been completed in August 2004. Residents said that they choose when to get up, go to bed and where and how they spend their days. Many residents stayed in their rooms watching television and others spent time sitting in the lounges. Visitors said that they could come and see the residents at any time and that staff made them feel welcome. There was evidence that staff were interacting with individuals throughout the day. Service users said they were happy with the care they received. One service users relative was very happy with the care her mother receives and had seen substantial improvement in the health and well being of their relative. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 12 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 Complaints are acknowledged but the home is not being pro active in addressing the issues and investigating why people are complaining or seeking out any common issues in an effort to improve systems of communication. EVIDENCE: The complaints procedure is displayed in the reception area. Leaflet’s are also available as part of the Service User Guide and separately. A record of complaints received, investigations and responses made are kept. Four complaints have been received since the last inspection, 3 direct to the home and another, which was investigated by the CSCI. Concerns documented in a care plan review had not been appropriately addressed with the family, it was clear that the family had questions regarding the care of their relative. If the home continues to leave issues unaddressed the number of complaints may increase. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 13 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): 26 The manager has acted in the best interests of the staff working in the laundry. EVIDENCE: The areas of the home that were visited were clean and tidy and there were no smells. Following the last inspection, when a requirement was made about working conditions and ventilation in the laundry, air vents have been fitted and the manager has requested that an air conditioning unit be installed before next summer. The laundry assistant said that it was much more comfortable now. The fluff that was gathering on top and behind the dryers had been removed. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 14 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 The numbers of staff on duty are appropriate for the needs and numbers of residents in the home. EVIDENCE: Staffing levels are being maintained by using agency nurses and care staff. The manager said that the same staff are requested wherever possible in order to provide some continuity for the residents. The number of staff on duty is determined by the size and layout of the home as well the number of residents. The manager is aware that needs and the dependencies of the residents must also be taken into consideration. Two staff files were seen. These showed that: • Fully completed application forms were in place. • Only the last 10 years employment history had been requested and the interview records did not show that gaps in employment had been explored. • POVA and enhanced CRB disclosures were in place. • 2 written references had been obtained. • Copies of the organisations staff handbook had been issued. • Health questionnaires had been completed. Induction training is provided but the records kept do not show when staff started and completed the training. The manager said that the training is to Sector Skills Council standards and that there are plans to introduce a new personal development portfolio for all staff.
Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 15 The staff training records were not reviewed in detail as the timescale for meeting the requirement made during the last inspection is not due to be met until 31 March 2006. But as a result of serious concerns identified about meeting the health care needs of residents the requirement will be extended to state that the nursing staff must be made aware of their personal and professional responsibilities and accountability for their actions taken and not taken. Staff said that they had received training in care planning by nurses from the Primary Care Trust and that in house training had included health and safety, infection control, diabetes and using syringe drivers. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 16 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 and 32. The home is not being managed effectively or in the best interests of residents. EVIDENCE: During the inspection the registered manager was very open about the problems the home was having in meeting the standards. She was very aware of what needs to be done but has not able to improve the standard of care to her satisfaction. On speaking to the manager and staff at all levels it was clear that there is no cohesion in their approach. There is a culture of not accepting responsibility and there were no clear guidelines as to who is responsible for making sure that care plans are kept up to date. The manager is adamant that qualified staff have the responsibility, yet on speaking to staff they say they may start a plan but this will be passed onto
Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 17 someone else if not completed but that person is not named so the chain of responsibility is lost Meetings are being held regularly for residents and relatives and records are kept. Staff said that meetings are held but that they had recently changed to floor meetings where staff working in a particular team meet as a unit. Staff said there is an agenda but they do not see it before the meeting. They said that they didn’t always feel represented when decisions were made but did think the training was good and that the team worked well together. Staff feel confident that they can speak to the manager if they have problems and concerns. The manager said that separate meetings are held for the nurses, care staff and the domestic staff. The manager said this was the best way of increasing attendance and giving staff the freedom to express any concerns or ideas. Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 18 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 2 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X X X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 X X X X X X Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 19 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 OP3 Regulation 14 Requirement Timescale for action 31/01/06 2 OP4 3 OP7 The registered manager must make sure that the information from pre admission assessments is used to determine if the home can meet the needs of the residents. 14 Residents must not be admitted 31/01/06 to the home outside of the homes agreed registration categories and numbers. The manager must make sure that the home can meet the assessed needs of all residents. Where it has been identified that this is not being done, the manager must make sure that these placements are reviewed. 31/03/06 12, 14, 15 A plan of care must be in place for each service user, which details clearly how all assessed health, psychological, personal and social care needs will be met. These must show all actions taken and provide an accurate picture of the service users medical, physical, psychological and social well-being. The care plans must be kept under review and reflect changing care needs. Service users must be consulted
DS0000055013.V268516.R01.S.doc Version 5.0 Springfield Nursing Home Page 20 4 OP8 13, 14 5 OP9 13 6 OP16 22 7 OP18 13, 18 8 OP20 23 and their wishes and feelings taken into account when planning and providing care. The service user and/or their representatives must be involved in this process where possible. (The timescale was first made in the inspection reports dated March, May and July 2005. It has not been met and a new date has been put in place.) Appropriate assessments to monitor service users health and psychological care needs must be carried out; this must include falls risk assessments. Records must be fully completed. Where a risk is identified appropriate action must be taken and records kept. (The timescale was first made in the inspection reports dated March, May and July 2005. It has not been met. A new date has been put in place and additional actions required.) The registered manager must make sure that practices, procedures and record keeping around the administration of medication ensure the safety and well being of residents. Steps must be taken to make sure that nurses follow the homes procedures and the NMC guidelines. The registered person must make sure that all concerns and complaints are investigated and dealt with appropriately. The registered person must make sure that all staff receive training around abuse awareness and adult protection. (This standard was not assessed during this inspection. The timescale has not been altered.) The registered person must make sure that safe, suitable,
DS0000055013.V268516.R01.S.doc 31/03/06 24/11/05 31/03/06 28/02/06 28/02/06
Page 21 Springfield Nursing Home Version 5.0 9 OP26 13, 23 10 OP30 18 pleasant outdoor sitting areas are provided for residents. (This standard was not assessed during this inspection. The timescale has not been altered.) Plans and timescales must be forwarded to the CSCI showing when suitable arrangements will be put in place to adequately ventilate the laundry area in warmer weather. The training plans for the home must make sure that staff receive the required training in subjects related to the health safety and well being of themselves and residents as well as training that is relevant to the specialist needs of residents living in the home. (This standard was not assessed during this inspection. The timescale has not been altered.) In addition - The registered person must take steps to make sure that the nurses are made aware of their personal and professional accountability. The manager must complete the registered managers award. (This standard was not assessed during this inspection. The timescale has not been altered.) The registered person must make sure that the home is effectively managed in the best interests of the residents. The systems for providing formal staff supervision must be reveiwed to make sure that it is provided at least 6 times a year. Staff providing supervison must receive appropriate training to enable them to do so. (This standard was not assessed during this inspection. The timescale has not been altered.)
DS0000055013.V268516.R01.S.doc 30/04/06 30/03/06 11 OP31 9 30/04/07 12 OP32 21 30/03/06 13 OP36 18 30/03/06 Springfield Nursing Home Version 5.0 Page 22 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 Staff involved with care planning should receive appropriate training around writing care plans and person centred care. The registered person should consider the use of a record sheet in order to document and acknowledge when service users and or their representatives had seen and agreed the care plans, been informed of changes and involved in reviews.(This recommendation was first made in May and again in July 2005. it has not yet been met.) The manager should make sure that the personal history and activity records are fully completed and used by staff to inform them of residents individual likes and preferences. (This recommendation was first made in July 2005. It has not yet been met.) A minimum ratio of 50 trained members of care staff (NVQ Level II or equivalent) should be achieved by 31.12.05. (This standard was not assessed during this inspection and the recommendation has been carried forward.) The outcomes of the quality surveys should be made available to all interested parties. The next survey should include relatives, visitors and other interested parties. (This standard was not assessed during this inspection and the recommendation has been carried forward.) 2 OP12 3 OP28 4 OP33 Springfield Nursing Home DS0000055013.V268516.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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