Inspection on 06/05/08 for Springfield Care Home

This inspection was carried out on 6th May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Springfield Care Home 09/05/07

Springfield Care Home 09/06/06

Springfield Care Home 24/11/05

Springfield Care Home 22/07/05

Springfield Care Home 22/03/05

Springfield Care Home 07/07/04

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Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Springfield Nursing Home 17 Western Way Buttershaw Bradford West Yorkshire BD6 2UB Lead Inspector Liz Cuddington Key Unannounced Inspection 6th May 2008 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing Home DS0000055013.V363998.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 Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Nursing Home Address 17 Western Way Buttershaw Bradford West Yorkshire BD6 2UB 01274 694192 01274 294197 karen.coady@anchor.org.uk sharon.blackwell@anchor.org Anchor Trust 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) Care Home 98 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (98), of places Physical disability (2) Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The places for PD are for named service users only The places for DE(E) are for the named service users only Date of last inspection 19th February 2008 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 men and women 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. Information about services provided by the home is available in the home’s brochure and Service User Guide. These are kept in the reception area and can be taken by relatives or visitors, or they can be posted. Files containing this information are also kept in each person’s room. With effect from April 2008 the fees are from £377 per week for residential care, up to £620 per week for nursing care. These charges do not include hairdressing or chiropody and a separate list of charges for these and other services is available from the provider. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The purpose of this inspection was to assess the quality of the care and support received by the people who live at Springfield House. The visit to the home was carried out over one day by two inspectors. The last key inspection was in May 2007. Since the last key inspection one adult protection matter has been referred to Bradford Social Services. This has been satisfactorily resolved by the home’s management and Bradford Social Services. During this period three complaints have been made to us about the care and support provided by the home. These concerns have been investigated and appropriate action taken by the home. As a result of concerns raised with us, a random unannounced inspection took place on the 19th February 2008. Copies of the report of this inspection are available on request. Since the last key inspection the registered manager has been off work and an acting manager has been appointed. During the visit to the home we spent time talking to the people who live there, the visitors, staff and management. We also looked at the information about how people’s care and support is provided and examined the home’s records. A conversation with a health care professional about how they view the service provided for their clients gave useful information. We also sent questionnaires to the people who live at Springfield House, their relatives and health care professionals, but none were returned. Before the inspection, a self-assessment questionnaire was sent to the home for the manager to complete, which we have received back. We would like to thank the people who live at the home, their relatives and the staff, for their welcome and hospitality and for taking the time to talk and share their views during the visit. What the service does well: Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 6 Pre-admission assessments are thorough and make sure the home can meet people’s needs. The care plans on the residential unit were clear and easy to follow. The kitchen and the rest of the house is clean, safe and well maintained. The gardens are tidy and attractive. Everyone said that staff listen to them, and act on what they say. Visitors said they are always welcomed. Staff treat people with respect, care and consideration at all times. People are protected by the home’s recruitment procedures. This makes sure that staff are suitable to work in a care home. The home uses a range of quality assurance methods to assess the quality of the service and help to plan improvements to make sure the home is offering an appropriate service for the people who live there. The care plans on the residential unit are centred upon the needs and wishes of each individual and reflect their preferences, making sure people receive the care and support they need in the way they wish. We observed staff following good, safe practice when assisting people to walk, to transfer from a chair to a wheelchair and when using a hoist or a ‘stand-aid’. New care staff follow a recognised induction training course and twenty-six care staff have achieved their NVQ in care; eight staff are currently working towards the qualification. The residential unit manager has achieved the NVQ level 5 social work qualification. Other work related training is provided. What has improved since the last inspection? What they could do better: Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 7 The Statement of Purpose needs to be updated to fully reflect the services offered at the home. The daily records need to be more person-centred, to better reflect significant events for each individual. On the nursing unit, some aspects of people’s personal care need to be improved. The medication recording and administration must be improved, in order to make sure people receive the correct medicine as prescribed, and that the records are accurate. Where people are at risk from not eating or drinking enough, staff must make accurate records of everything people eat and drink to help make sure they receive sufficient, good nutrition and fluids to keep them as healthy as possible. The home’s management and staff should pursue their plans to provide a wider range of activities that people will take part in and enjoy. The home needs to develop better ways of understanding and meeting people’s diverse cultural needs. The home’s management need to make sure that all staff have taken adult protection training. For the well-being of the people who live at the home and the staff, as well as visitors, the noise levels, especially from the nurse call buzzer system, needs to be significantly reduced or eliminated. The home’s management needs to make sure that staffing levels in the home are based upon the needs and dependency levels of the people who live at the home. To maintain staff continuity, the management need to continue exploring ways to make sure that they reduce their level of staff turnover. For the safety and convenience of everyone, bathrooms and electrical fuse cupboards should not be used as storerooms. To protect people’s privacy, confidential information should be stored securely at all times. 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 Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 6 does not apply People who use the 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 Statement of Purpose does not yet fully reflect the service. People are assessed before they are admitted to the home, to make sure their needs can be met. EVIDENCE: A relative of somebody who had been admitted recently from hospital for respite care, told us that they had visited the home to look round and been given all the information they needed to decide that the home would be suitable for them. We looked at the pre admission assessment and saw that it had been done while the person was still in hospital. There was enough information on it for Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 10 staff to be sure they could meet this person’s needs and prepare a care plan for them. The pre-admission assessments in people’s care plans on the residential unit were very detailed and formed the basis for the care plans. The Acting Manager has started to revise the home’s Statement of Purpose, to make sure it reflects the services offered by the home. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 11 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, 9 & 10 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and healthcare needs are not fully met. People are not fully protected by the medication administration systems. Staff treat people with respect, care and consideration at all times. EVIDENCE: The basic care plans for two people who had recently moved into the residential unit had been completed within two days of admission. The residential unit is using a new care plan format. The care plans we looked at were clear and easy to follow. They detailed how each person’s care and support was to be given, with all the key information completed. The plans reflected the people’s assessed needs and showed where they and their families had been involved. They also included information about people’s life histories and their likes and dislikes. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 12 Each section of the plan included all the areas of personal and health care the person needed, the outcomes and any risks. Some of the wording was repetitive, saying the same thing but using slightly different words. The plans for people who had lived at Springfield for a longer time were similar to the new plans, but included monthly evaluations and more detail where necessary. The care plans on the nursing unit showed that information is not being recorded in the individual care plan sheets regularly. This means that it is difficult to see how the individual has spent their day or what support they have been given. We were told that staff should write what has occurred each day in the relevant care plan. For example, when somebody has been helped with his or her personal care there should be an entry to this effect in their personal care plan. If something happens that staff need to be aware of, such as a doctors visit or an accident, it is recorded in the Alert record sheet. People’s weight is taken each month and notes made on any significant changes. We looked at four care plans for people with nursing needs. Care plans should identify an individual’s needs and provide guidance to staff about how to meet those needs. The quality of the information that was given to staff was variable. The management team said they are aware of this and are in the process of looking at all the plans to make sure that they are detailed and individual to the person they have been written for. We found that information not properly completed in the care plans included: • Some forms not dated and signed by the person completing them. • For one person the risk assessment and care plan for using bedrails did not show that the person or their relatives had been involved with the decision to use them. It did not say who checked them or how often. We were told that the maintenance member of staff did these checks regularly and kept records; this should be reflected in the care plans. • The care plan for somebody who is diabetic said that the blood glucose levels were recorded twice daily but there was insufficient information about where the results were to be recorded, what were acceptable levels or what to do if they were too high or too low. There was no guidance for staff about how to make sure they were not always using the same injection sites when giving the person their insulin. • The personal hygiene care plans were not individual to people’s abilities, needs or preferences. • The pressure area care plan for somebody who had been admitted to the home with a pressure sore showed that the tissue viability nurse had been involved, which is good practice. They were being nursed on a specialist alternating air mattress but there was no information about what the settings should be or how often the person’s position should changed. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 13 The management team told us that they were developing a team of link nurses and care assistants to attend meetings and receive training updates on different areas of care such as skin care, infection control, continence and palliative care. These people would be responsible for making sure staff were kept up to date of changes to good practice in these areas. The manager said she would look at adding falls and diabetes to this list. We saw that specialist pressure relieving equipment has been provided for a lot of people. Some of it was not being used correctly. We saw somebody sitting on an alternating air cushion that was ‘self sealed’ so it would not deflate. It was not attached to the air pump that would make it work properly. We asked staff about it and they thought it was being used correctly. Some of the men on the nursing unit had not been shaved that morning and some people needed better nail care. We were told that the organisation had revised their medication policies and procedures in June 2007. Since then the Royal Pharmaceutical Society has rewritten its guidance for administering medicines in care settings. The management team were advised to make sure their medication policies and procedures reflect this new guidance. The nursing and residential units each have named staff who are responsible for medication co-ordination. The medicines are kept safe and secure and the Medicines Administration Record (MAR) charts are securely stored. For security, the medicine cabinets were locked during the time between giving each person their medication. Most of the medicines are supplied by the pharmacy in a monitored dosage system, but some is received in the original packaging. The MAR charts, which must show clearly the quantities of medicines received and in stock for each person, were examined. We looked at the way medications are looked after in one section of the nursing unit. We found that there were some gaps on the Medication Administration Record (MAR) charts where staff should have signed to confirm that the person had been given their medication. This means that there is risk that people have either not been given their medication, or been given it twice. One person had refused one of their medications for over a week. This treatment is important for the person, but the care plan did not say if the GP had been contacted about it. Another person had been without one of their medicines for more than a day. The MAR chart showed that the pharmacy had not issued any tablets for the Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 14 beginning of that month but they had been given them up until the day before, when the supply ran out. There was no indication that any tablets had been carried forward to the new month’s supply. A new supply of these tablets was delivered to the home later in the day. We found large supplies of two medicines for one person that clearly indicated they were not being given the medication as prescribed by their GP. This person is given all their medications through a gastric feeding tube, which means that this accumulation could probably not be explained as a refusal to take their medications. On the residential unit there were also gaps in the MAR charts where staff should have signed to confirm medicines had been administered. A check of the quantities of medicines administered, compared with the amounts received and in stock showed that, with one exception, the medicines records were accurate. The controlled drugs records were accurate and controlled drug storage was secure. We spoke with one of the District Nurses who commented that there has been an improvement in the way staff on the Residential Unit follow the health care advice given by visiting health care professionals. She said that people’s health care is improving. We observed staff following good, safe practice when assisting people to walk and transfer from, for example, a chair to a wheelchair. Staff also followed good practice when assisting people to transfer using a hoist or a ‘stand-aid’. Their manner in each instance was calm and they maintained people’s dignity. We saw staff knock on people’s bedroom doors before entering and were told that they respected people’s privacy. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 15 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 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to take part in activities, but the choice is limited. People are offered a good choice of meals to make sure their dietary needs and preferences are met. EVIDENCE: The care plans we looked at on the nursing and residential units included a life history telling the reader about the person and what their interests, likes and dislikes were. This information could be used to plan suitable activities for people. This should take into account the religious and cultural needs of people from different ethnic backgrounds. The management team told us that two activities co-ordinators had recently been employed and their role would be to make sure that all people had access to an activity programme that that was tailored to their needs, wishes and abilities. During the visit we saw some activities taking place. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 16 People sitting in one of the nursing unit lounges looked bored. Some people told us that there was not much to do and that staff chose the TV programmes. Staff interactions were varied. Some staff were very good at making people feel important and valued. Some staff were more ‘task orientated’. For example, somebody asked to be taken out into the garden and one carer answered while they were walking away from them. The person then asked again and the carer called across the room that somebody was coming. Care is provided to people from different ethnic backgrounds. From talking to them and the staff we found that there was a reliance on relatives bringing them foods that reflected their cultural background, rather than it being provided regularly from the kitchen. One person of Hindu faith was going to be given liver for lunch and staff had not checked the origins of the liver to make sure it did not contravene their religious beliefs. We asked the cook and were told it was lamb’s liver and would be suitable. Before lunch on the nursing unit people were asked which choice of main course they wanted from the planned menu. The management team told us that staff should be showing people both meal choices when serving food, so that they can choose what they want from looking at the meals. They told us that alternatives are offered. People said that they enjoyed the breakfasts and lunches but that the teatime meals could be better. We spoke to the chef who told us that the menus were going to be revised and the teatime choices were going to be looked at. During lunch the people in the nursing unit dining room were using a variety of cups and glasses to drink juice from and staff were using a cup rather than a jug or ladle to pour custard onto the puddings. Many people on the nursing units are at risk of losing weight or not drinking enough fluids and their dietary intake is being monitored. We were told that foods are enriched using butter and cream where appropriate. We looked at the food and fluid intake records and found that they were not being completed consistently. At 3pm many of the charts only had entries for breakfast. The records for the previous day stopped at teatime and suggest that people did not get anything to eat or drink after 5pm. There is a large gap between teatime and breakfast the next day. There was nothing to show that they had been given something at suppertime or through the night. We were told that people can have snacks and drinks on request at any time, but often the people who are most at risk of not eating or drinking enough are those who cannot ask or help themselves. The management told us that nutrition is a key priority and action was being taken to make sure people have sufficient, suitable food and drink to meet their dietary needs. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 17 On the residential unit people were offered juice with their meal and were also offered a glass of wine. The tables were nicely laid and had flower decorations, salt and pepper and a selection of sauces. The staff were not consistent when they told people the choice of main course or dessert, which could be confusing. It would be clearer, in some cases, to show people what the alternatives were, rather than just naming them. People who did not want what was available chose an alternative. For example, one person just wanted toast and another had a poached egg. People who needed some assistance or encouragement to eat their meal were offered help discreetly. People told us the food was good and they enjoyed their meals. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 18 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 & 18 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Most people are aware of how to raise a concern or make a complaint if they are dissatisfied with the service. Not all staff have received suitable adult protection training or have read the policies and procedures, which make sure that people at the home are safe. EVIDENCE: The organisation has a complaints procedure that is clear and easy to follow. It is included in the information packs given to people and displayed in the reception area. At the last key inspection in May 2007 we told the manager that the home should make sure that accurate records are kept of any meetings and discussions with people and staff when investigating complaints. We found that this is still not being done consistently. The complaints register indicated that nine complaints had been received since May 2007 around a variety of issues. These included dissatisfaction with the standards of care and services provided to people, items going missing and not enough staff on duty. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 19 We looked at the complaints records. This showed that not all of the complaints in the register had been logged on the organisation’s complaint record forms. Those that had been recorded did not have information about the outcomes of investigations or meetings held with relatives. When looking at staff files we found a letter of complaint from a member of staff about a shift not being covered. This had not been logged as a complaint, but dealt with as a separate issue and placed in the staff file. The complaints procedures should be used regardless of who is making the complaint. In February 2007 we carried out a random inspection as a result of information received from people with concerns, this had not been logged in the complaints register. There has been a change in the management team in the last two months and we were assured that the systems for dealing with complaints would be reviewed so that all the information about how they have dealt with complaints, and the outcomes, will be available. A visitor told us that they had complained about their relative wearing other people’s clothes more than once. They were unhappy that this happened because there were more than enough clearly labelled clothes for them. Some people are now using a ‘communication book’ that is kept in their relatives’ room. It is used for the relatives and staff to leave messages and comments for each other and is intended to identify and deal with any concerns before they become a bigger issue. A visitor told us that they found this useful. The organisation revised the policies and procedures around adult protection in July 2007. The manager said that this file was in their office. We spoke to three staff during the visit and none of them had read the policy in full. The home must make sure that all staff are made aware of the new policy and guidance so that they will follow the correct course of action should they see or suspect that people are at risk. The care plan for one person said that the person could be resistive to care and that they should be told it ‘is not acceptable behaviour’. This entry had been made a long time ago and it was of concern that it had not been picked up by staff reviewing the plan and dealt with as a possible area of abuse. Staff should have looked at why this individual was resistive to care and see if they could identify the reasons and put a more appropriate care plan in place. The management team said this would be rectified immediately. Not all staff have received adult protection training. One nurse, who had been employed nearly a year ago, said they had not done it yet. It is particularly important that the nurses do this training as it is likely they will be the person care staff will report abuse to and they will be expected to initiate the adult protection procedures. The manager told us that dates for this training had been arranged in June and July 2008 to make sure that all staff had received Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 20 it. In addition to this the manager and three senior staff are attending a two day course for managers about safeguarding that is run by Bradford Social Services’ adult protection unit. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 21 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, 20, 25 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe, comfortable and generally well-maintained environment, although some areas were cluttered and the sound of the nurse call buzzer was very loud and intrusive. EVIDENCE: The nurse call system uses an audible buzzer to alert staff when someone needs assistance. This is very loud and can be heard throughout the home. It was particularly intrusive as it was in use almost constantly. Staff said they can still ‘hear’ the sound when they have left work. In addition, the televisions were on loudly in many bedrooms. Some people did not appear to be watching the television but were unable to turn it off themselves. Some people did have music playing instead. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 22 On the residential unit the shared areas were kept clean and tidy. On the nursing unit there were items stored in two bathrooms, which meant these bathrooms were not available to be used by people. In one of the bathrooms there was a wheelchair, a full laundry bag, a trolley with various items on it, a screen, a waste bin without a lid and a pressurerelieving cushion. Another bathroom had a dirty commode pan left on the floor and a hoist sling had been left lying on top of the clinical waste bin. The washbasin in this room was dirty. Some of these practices increase the risk of cross infection. The rest of the house was clean and fresh and the linen cupboards were kept tidy and well organised. Outside the gardens looked tidy and well cared for. There were tables and chairs set out on a patio area and people sat out there during our visit, as the weather was warm and sunny. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 23 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 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not enough staff are employed to meet people’s needs at all times. People are protected by thorough recruitment procedures, which ensure that staff are suitable to work with people who live at the home. Training is provided to make sure staff have the skills and knowledge they require to meet people’s needs. EVIDENCE: We were told that the number of staff on duty reflects the needs and numbers of people living in the home. On the nursing unit we saw that the staff were busy all the time and did not have much time to spend with people. At around 11 am there were four people sitting in the lounge and there were no staff around for a period of fifteen minutes. Many of the people on the nursing unit either stayed in their rooms by choice or were being nursed in bed. The care record charts for some of these people were incomplete, showing that staff either did not have time to fill them in or people were not being attended to as often as they should be. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 24 Relatives of people on the nursing unit told us that often there were not many staff on duty and ‘the girls were always rushed’; one person said it was worse at weekends. Staff said it would be nice if they could have a bit more time to spend with people. When talking to staff it was clear that staffing levels were worked out on numbers rather than on people’s needs and levels of dependency. The management team must look at people’s needs and dependency levels, in order to make sure that enough staff are on duty at all times to meet those needs. Consideration must be paid to key times of the day, such as mealtimes, when many people on the nursing unit need help to eat. Detailed records of staff training are kept. A lot of the training is provided ‘inhouse’ by the organisation and the home’s training manager, who is an NVQ work based assessor. We talked to staff about the training they had done. They told us that they had taken courses including the following: • Back care; moving and handling • Fire safety • One day dementia care course; some staff had completed a more in depth, five day course • Protection of vulnerable adults • Palliative care • Food hygiene • Health and safety • Emergency first aid. The management said that training around dementia care was being provided for staff, so that they could meet people’s needs if they had a diagnosis of dementia in addition to their other care needs. New care staff follow a recognised induction training course, which provides a good basis for them to continue on to the National Vocational Qualification (NVQ) in care. Twenty-six care staff have achieved their NVQ at level two or above, and eight are working towards the qualification. The residential unit manager has achieved the NVQ level five social work qualification. We looked at four staff files to make sure recruitment procedures are safe and protect the people who live at the home. The recruitment process is thorough and includes an interview and obtaining two satisfactory references. The records confirmed that staff have all had Criminal Records Bureau (CRB), and Protection of Vulnerable Adults (POVA) register checks. All the files include copies of training certificates and other necessary information. The newer staff files are well organised. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 25 The last twelve months has seen a high level of staff turnover, with forty-three full and part-time care and nursing staff leaving the home. The home’s management is aware of this and is taking steps to improve staff retention. The acting manager has started providing regular one to one supervision for the staff and holding regular team meetings, where staff can make their views known. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home needs to continue to make improvements, in order to make sure it is being run and managed in the best interests of the people who live there. EVIDENCE: There has been a change in the way the home is being managed since the last key inspection in May 2007. There is currently an acting manager in post. On the day of our visit she had been there for just over four weeks. Before that the organisation’s project manager had been based at the home for a short time. During this period a number of quality assurance audits were carried out to see if the home was being run and managed in the best interests of the people living there. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 27 An experienced agency nurse has been contracted to work three days a week to provide clinical support to the staff. She will be working in a supernumerary capacity and has been given a list of priority areas that need to be looked at. For the first week she is looking at nutrition and will then move onto medication and care planning. We were told that she would be spending time talking to staff, looking at records and observing practice to evaluate what is being done and to identify areas for improvements. Systems will then be put in place to make sure consistently good care is provided. The nursing unit has created an open office in the area between two bedrooms at the far end of a corridor, extending the area where the nurses’ desk was positioned. It is now a full office with a desk and two filing cabinets filling the area between the bedroom doors. Notice boards with memos, staff information and training dates have been put up. Information about people was left out and the filing cabinets were open so the care files could be taken out by anybody passing. There is a telephone here and calls are made and received when confidential matters are discussed in an area that is not private. This does not promote respect for confidentiality and it intrudes into the lives of the two people whose bedrooms are nearby. In the same area on the residential unit there is one small, uncluttered desk and a telephone; there was no confidential or other information on view. To protect people’s privacy, all confidential information should be securely stored in accordance with the Data Protection Act 1998. The laundry is suitably equipped and well organised. The kitchen was awarded two stars out of a possible five, at the last environmental health inspection. The manager said they are in the process of dealing with the issues raised by the inspector. The electricity fuse cupboard by the crowded nurses’ area at the end of one corridor was being used as a stationery store. This could present a significant fire hazard. The equivalent cupboard on the residential unit housed a few items, but no stationery. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 28 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 2 2 2 Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation Requirement Timescale for action 30/09/08 12, 14, 15 In order to make sure individual needs are met, the work started on making sure that detailed individual care plans are in place for each person living in the home must continue. They must clearly show how all assessed health, psychological, personal and social care needs will be met and include information about all actions taken; providing an accurate picture of the persons medical, physical, psychological and social well-being. The care plans must be kept under review and reflect changing care needs. People must be consulted and their wishes and feelings taken into account when planning and providing care. They and/or their representatives must be involved in this process where possible. (Previous timescale of 30/04/08 not met). Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 30 2. OP8 Schedule 4 (13) 12(1) Where people are at risk from not eating or drinking enough, staff must make accurate records of everything people eat or drink, to help make sure they receive sufficient, good nutrition and fluids The manager must make sure that practices, procedures and record keeping around the administration of medication makes sure that prescribed medications are given correctly and records are up to date and accurate. This will avoid the risk of error and people will receive the correct medication. (The original timescale of 01/06/07 was extended). (Previous timescale of 28/02/08 not met). 30/06/08 3. OP9 13 30/06/08 4. OP27 18(1)(a) The home’s management needs to make sure that staffing levels in the home are based upon the needs and dependency levels of the people who live at the home. The manager must make sure that that the planned training programmes are continued and that all staff receive appropriate training. Training about how to meet specialist needs of people living at the home must also be provided, such as dementia, pressure area care, stroke illness and diabetes. This will equip staff to maintain the health, safety and well being of people living in the home and themselves. 31/08/08 5. OP30 18(c) 30/09/08 Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 31 (The original timescale of 30/09/07 was extended). (Previous timescale of 30/03/08 not met). The home’s manager must make application to the CSCI in order to undergo the registration process. It is an offence to manage a care home and not be registered. (The original timescale of 30/06/07 was extended). (Previous timescale of 30/03/08 not met). 7. OP38 13(4) Electricity fuse cupboards must not be used storerooms as this could present a significant fire hazard. 30/06/08 6. OP31 9 31/07/08 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 OP1 Good Practice Recommendations To provide relevant information about the home, the manager should make sure that the Statement of Purpose is individual to the home and reflects the services it provides. The registered person should consider using a record sheet in order to show when people and/or their representatives have seen and agreed their care plan, been informed of changes and involved in reviews. The daily records need to be more person-centred, to better reflect significant events for each individual. The manager should make sure that the personal history and activity records are fully completed and used by staff DS0000055013.V363998.R01.S.doc Version 5.2 Page 32 2. OP7 3. 4. OP7 OP12 Springfield Nursing Home 5. 6. 7. 8. 9. OP12 OP16 OP18 OP22 OP37 to inform them of people’s individual likes and preferences. This information should then be used to plan activities according to individual needs The home needs to develop better ways of understanding and meeting people’s diverse cultural needs. When investigating complaints, the manager should make sure that accurate records are kept of any meetings and discussions with people and staff. The manager should make sure that all staff receive training about adult protection and abuse. Equipment should not be stored in the bathrooms where it restricts access to the facilities. To protect people’s privacy, confidential information should be stored securely at all times, in accordance with the Data Protection Act 1998. Springfield Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Nursing Home DS0000055013.V363998.R01.S.doc Version 5.2 Page 34 - 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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