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Inspection on 09/05/07 for Springfield Care Home

Also see our care home review for Springfield Care Home for more information

This inspection was carried out on 9th May 2007.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

People are given information about the home and services provided that helps them to make the decision about whether or not it will be suitable for them. The home makes sure it can meet their needs by visiting them before any agreements are made to carry out a pre admission assessment. The home has been furnished and decorated to a good standard and is well maintained. Each corridor has comfortable lounge or lounge/dining rooms where people can sit and talk to each other, watch TV or listen to music. All bedrooms are single en suite that have been decorated and furnished to a very good standard. Some people had brought in their own belongings and furnitureto personalise their rooms, making them more comfortable and `theirs`. People said that the home and their rooms were kept clean and tidy. People said that the staff were kind, caring and respected their privacy giving the example that staff would knock on doors before entering bedrooms. They said that they could see their visitors in the privacy of their own rooms or in one of the lounges. They said they are helped to make choices and decisions about their daily life, for example when to get up, go to bed and where they want to spend their time be it in one of the lounges or their own room. The atmosphere in the home was friendly, warm and welcoming. It was clear that good relationships had been established between people living in the home, their visitors and staff. People said that staff were cheerful which was important to them and helped with the good general atmosphere of the home. Visitors said that they could come to the home at any time and that they were kept up to date with any changes affecting their relative. The survey forms returned and discussions with people living in the home and their visitors showed that they were satisfied with the care and other services provided by the home and it`s staff.

What has improved since the last inspection?

As a result of the concerns around care practices in the home comprehensive internal audits have been carried out, which included getting the views and opinions of residents, their relatives and other people who visit the home. Action has been taken to rectify the shortfalls identified and improve the quality of services provided. The actions have resulted in better outcomes for people living in the home and a more positive and supported staff team. Staff said that they were enjoying the extra training that had been provided and felt better equipped to look after people and meet their needs. They were positive about the changes that had been made saying that communication had improved, they felt well supported by the management team and that the general management and organisation of the home was better. The manager has revised the interview and selection processes for staff to make sure that people with the knowledge and expertise needed by the home were recruited. The interview processes for nurses and care staff now include assessments of their skills and competency relevant to the role they are applying for. A new care plan format has been introduced by the organisation. This is now being used in the home and staff involved with writing care plans have received training to use the new records properly. Good progress has been made since the last inspection in making sure that each person living in the home has a care plan in place that provides staff with guidance about how to meet most of their identified needs.

What the care home could do better:

The management team must continue to implement the action plans they have put in place, making sure that the positive changes continue and that that people living in the home consistently receive a good quality service.

CARE HOMES FOR OLDER PEOPLE Springfield Nursing Home 17 Western Way Buttershaw Bradford West Yorkshire BD6 2UB Lead Inspector Nadia Jejna Unannounced Inspection 9th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing Home DS0000055013.V321128.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.V321128.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 j.butterworth@anchor.org.co.uk susan.austin@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.V321128.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 9th June 2006 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. Information about services provided by the home is available in the homes 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 resident’s room. With effect from April 2006 the weekly fees are from £390 per week for residential care, up to £520 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.V321128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The first visit was made on 9th May 2007 by two inspectors and a second visit on 14th may by one inspector. The home did not know that this was going to happen. Feedback was given to the management team during and at the end of the visits. Before visiting the home the inspector asked for information which included asking about what policies and procedures in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, menus used, staff details and training provided. Comment cards were sent to the home to be given to residents, their relatives and other visitors to find out what their views of the home were. At the time of writing this report three people who live in the home and seven relatives responses had been returned. In order to find out how well staff knew residents care plans were looked at during the visit and residents, visitors and staff were spoken to. Other records in the home were looked at such as staff files, complaints and accidents records. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the people who live there. Since the last inspection there have been a number of serious complaints about the standards of care provided to people living in the home. These have been referred both to CSCI and the local authority adult protection unit. The home has worked in partnership with these agencies to investigate the complaints and taken action to deal with identified problems. They have been proactive in identifying where the problems were and when new ones were found they referred them to relevant agencies. What the service does well: People are given information about the home and services provided that helps them to make the decision about whether or not it will be suitable for them. The home makes sure it can meet their needs by visiting them before any agreements are made to carry out a pre admission assessment. The home has been furnished and decorated to a good standard and is well maintained. Each corridor has comfortable lounge or lounge/dining rooms where people can sit and talk to each other, watch TV or listen to music. All bedrooms are single en suite that have been decorated and furnished to a very good standard. Some people had brought in their own belongings and furniture Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 6 to personalise their rooms, making them more comfortable and ‘theirs’. People said that the home and their rooms were kept clean and tidy. People said that the staff were kind, caring and respected their privacy giving the example that staff would knock on doors before entering bedrooms. They said that they could see their visitors in the privacy of their own rooms or in one of the lounges. They said they are helped to make choices and decisions about their daily life, for example when to get up, go to bed and where they want to spend their time be it in one of the lounges or their own room. The atmosphere in the home was friendly, warm and welcoming. It was clear that good relationships had been established between people living in the home, their visitors and staff. People said that staff were cheerful which was important to them and helped with the good general atmosphere of the home. Visitors said that they could come to the home at any time and that they were kept up to date with any changes affecting their relative. The survey forms returned and discussions with people living in the home and their visitors showed that they were satisfied with the care and other services provided by the home and it’s staff. What has improved since the last inspection? As a result of the concerns around care practices in the home comprehensive internal audits have been carried out, which included getting the views and opinions of residents, their relatives and other people who visit the home. Action has been taken to rectify the shortfalls identified and improve the quality of services provided. The actions have resulted in better outcomes for people living in the home and a more positive and supported staff team. Staff said that they were enjoying the extra training that had been provided and felt better equipped to look after people and meet their needs. They were positive about the changes that had been made saying that communication had improved, they felt well supported by the management team and that the general management and organisation of the home was better. The manager has revised the interview and selection processes for staff to make sure that people with the knowledge and expertise needed by the home were recruited. The interview processes for nurses and care staff now include assessments of their skills and competency relevant to the role they are applying for. A new care plan format has been introduced by the organisation. This is now being used in the home and staff involved with writing care plans have received training to use the new records properly. Good progress has been made since the last inspection in making sure that each person living in the home has a care plan in place that provides staff with guidance about how to meet most of their identified needs. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield Nursing Home DS0000055013.V321128.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.V321128.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, 2, 3 and 5. 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. People are given enough information about the home and the services provided to be able to make an informed decision as to whether or not it will be suitable for them and meet their needs. EVIDENCE: Information about services provided in the home has been produced by the organisation in the Statement of Purpose. This is a corporate document used in all the organisations homes. The information should be specific to the home and the range of people’s needs that can be met by the skill mix of staff employed there. The manager said she has recognised this and is putting together a document that is specific about Springfield and the services provided. Because of the problems the home has been experiencing over the last five months there have been no admissions since the end of March 2007. The Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 10 home said that this has given them time to identify where the problems were, take appropriate action and make sure that they were meeting the needs of people already living there. Visitors spoken to during the visit said that they had chosen the home for their relatives. They had visited to look round before making the decision and they had all looked at other homes as well. They said they had been received all the information they needed to make the decision by the staff who showed them round and the brochures they were given. They were very satisfied with the services provided in the home and the care their relatives were receiving. The care plan for somebody who had been admitted in March was seen. It showed that a pre admission assessment had been done. There was enough information in this document for the home to say that they could meet this persons needs. The individual and their visitor were seen during the visit. They were satisfied with the services provided and said that they were settling well. They said the staff were very kind and caring. Other care plans looked at showed that the organisations new pre admission and day of admission assessment documents had been used. They included the reasons for the admission, key objectives for the placement, a description of the homes ability to meet the persons needs along with details about their personal and health care needs. The information recorded helped staff to start the individuals care plans from the day they moved into the home. Information from surveys sent to people living in the home said that: • They had received contracts. • They had been given enough information about the home. Information from relative’s surveys and people spoken to in the home said that: • They had been given enough information about the home. • The needs of their relatives were usually met. One said that they thought at times there were not enough staff on duty to meet the needs of people with dementia. • The needs of people with English as their second language may not always be met because of communication difficulties. • The staff are very cheerful, which is important to my relative and me. Springfield Nursing Home DS0000055013.V321128.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 and 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. Health and personal care needs are being met but the care plans do not always provide enough detailed guidance to staff about how to meet an individual’s needs. EVIDENCE: A new care plan format has been introduced by the organisation. This is now being used in the home and staff involved with writing care plans have received training to use the new records properly. Good progress has been made since the last inspection in making sure that each person living in the home has a care plan in place that provides staff with guidance about how to meet most of their identified needs. Seven care plans were looked, five on the nursing unit and two on the residential unit. The layout of the plans and the documents to be used has been set out by the organisation. The plans were not easy to follow and there was a lot of repetition. Information about an individuals strengths, abilities and needs was Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 12 found at the end of the plan; in some of the plans it had not been used in the guidance about how to meet that persons needs. These plans did not give a picture of the person they were about and did not show that they or their relatives had been involved. It was clear that staff on the nursing units were using a nursing/medical approach to writing the care plans rather than being person centred. Examples were given to the management team where care staff had talked about what they did to meet an individuals needs but which were not detailed in the care plans. Other areas of specialist care needs did not have enough guidance. For example one person had a care plan for elimination that covered looking after a urinary catheter and constipation. There was not enough detail in the plan about what was being done to meet these care needs. The management team said that they would look at this. Information about visits from other healthcare professionals was recorded. They showed that people received visits from their GP, district nurses, opticians, dentist, and chiropodists as required. Where people need specialist equipment, such as pressure relieving mattresses and cushions this have been provided. The manager said that links have been made with the falls prevention team and the tissue viability nurse. Senior staff have been nominated as link nurses to attend training and then provide specialist support to people and staff as needed. The manager said that medication audits are carried out regularly. As a result of these some problems with the systems for dealing with peoples medications have been found. These have included where doses have not been given as prescribed and medication records (MAR) not being kept accurately. The manager said that appropriate action has been taken in all cases and medical advice sought if needed. Investigations have been carried out and staff involved given counselling and training updates. MAR charts were looked at on one of the nursing units and the residential unit. An issue where medical instructions had not been followed correctly was identified on one of the MAR charts seen on the nursing unit. The manager said that it would be investigated and appropriate action taken. Information from people living at the home said that: • They usually got the care and support they needed. • The staff would usually listen and act upon what they said. • They received the medical help and support they needed. Information from relatives and visitors to the home said that: • They were aware of the care plans and kept up to date with any changes affecting their relative. • Their relative received the care and support they needed. • One said that they were delighted with the care and support their relative received and that the staff were friendly, helpful and caring. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. 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. People exercise choice and control over their lives and maintain contact with family and friends. EVIDENCE: There were relatives visiting the home throughout the day. They said they could visit at any time and were always made to feel welcome. This said this was one of the reasons why they liked the home and were happy with the services provided. People living in the home said that they could choose how and where to spend their time, when to get up and go to bed, whether they wanted to eat their meals in the dining areas, lounge areas or their own rooms. Staff said that they encouraged and helped people to make decisions about their daily life. Peoples preferred daily routines were seen in some of the care plans. The care plans looked at had information in them about people’s social care needs which included different cultural and religious needs. For a person of the Hindu religion this information had been provided by the relatives. The Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 14 manager said that information about different cultural, religious and ethnic backgrounds would be provided for staff. A list of dates when a representative from the local Anglican church visited to perform a service for all those people who were interested was displayed. The manager said that a lay server from the Catholic church also visits every week and that visits from the priest can be arranged on request. On the residential unit there are daily activities organised by staff with help from the activity coordinator. These include group activities as well as one to one sessions to talk, do manicures or play games. It was clear that staff on this unit consider the needs and abilities of all the people in the unit. Since March 2007 a second activities coordinator has been in post. This person has a long background in care work and said they were keen to improve and increase the range of social and leisure activities offered to people living in the home. They were hoping to enrol on training sessions specific to their role and would be visiting other homes in the organisation to look at what they did. The PIQ said that every Monday to Friday each morning one to one sessions are held with people reluctant to leave their rooms or join in with group sessions. After this each weekday afternoon nominated as arts/crafts, music and quizzes, or reminiscence sessions with flash cards. It said that these can change if there are outings or entertainers booked. This information was only seen on the residential units. The manager said it should be clearly displayed i9n all communal areas. Copies of four weeks menus were sent with the PIQ. These showed there was variety and choices of main course at all meal times. The chef had been in post for four weeks. In that time he had spoken to people living in the home and changed the menus taking their likes and preferences into account. He said that food comment books were being used in each dining area and action would be taken as appropriate for comments and requests made. He said that he made a point of seeing people most days to get their views and would make sure he saw new people when they moved in to find out what their preferences were. He said he is looking for ideas and information about meals for people from different ethnic and cultural backgrounds. Meals and specialised diets are being provided for people who are vegetarian, Afro-Caribbean and from eastern European backgrounds. He is aware of different ways to enrich foods for people at risk of losing weight and is due to attend training about nutritional needs soon. People said that the food was good; they had noticed improvements over the last month or so and looked forward to mealtimes. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. 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 is being proactive in making sure that people’s concerns are listened to, taken seriously and acted upon which means that people in the home feel safe. This could be supported by more complete records. EVIDENCE: Since the last inspection June 2006 there have been seventeen complaints about poor standards of care. Ten of these were made direct to the home and investigated by the management team. In October 2006 an anonymous complaint about poor standards of care in the home was referred to the local authority adult protection unit. Further referrals were made by other healthcare professionals who had visited the home. The homes management team and the organisation have worked closely with the adult protection team and CSCI to investigate the complaints and identify where faults and problems where. Their investigations were detailed and thorough and action plans were put in place to deal with identified problems. These included providing additional training and support to staff. The organisations disciplinary procedures were followed and appropriate action taken to make sure that people living in the home were safe and protected. From March 2007 there has been one complaint about the use of a deceased persons wheelchair. Information received from surveys and people seen during Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 16 the visit and said that they would speak to the management team if had concerns. Some said that they had done so and were happy with the responses and outcomes. The complaints dealt with by the home were looked at. The records kept said that actions would be taken but there was no follow up to say whether or not this had been done. They also referred to meetings with the complainants but there were no records of the content and outcomes of these meetings. The manager was advised to keep clearer records that would provide clearer evidence of action taken in response to a complaint. Copies of both the organisations and the local authorities adult protection procedures were seen in the home. Nearly all the staff have received appropriate training. The manager was advised to attend the 2 day training programme about abuse and adult protection for managers that is provided by the local authority. Staff said that they would not hesitate to report actual or suspected abuse to the person in charge. Some were aware that they could use the whistle blowing policy and report directly to the adult protection unit or to the CSCI. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 17 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, 21, 24, 25 and 26. 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. People live in a comfortable, clean, safe and well maintained home. EVIDENCE: The home is clean, tidy and well maintained. There were no odours in the areas visited. Information from people living at the home and their relatives said that it was usually kept clean. There were comments about areas that might need particular attention, such as chair arms, that were passed to the manager. The most recent fire safety officer’s report was in January 2006. Copies were sent to the home and CSCI. There are communal lounge and or dining areas on each corridor and residents can choose where to sit. They have been comfortably furnished and provide views of the neighbourhood. There are gardens to the rear of the building that Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 18 are easily accessible via the ground floor lounge. The gardens have been made safe and secure and plans are in place to enlarge the seating area and make the gardens more attractive to look at and use. People have single, en suite rooms that are furnished and decorated to a high standard. Many had brought in small items of furniture as well as pictures and ornaments to personalise their rooms. None of the bedrooms have private bathing facilities but there has been ample provision of assisted bathing, shower and toilet facilities that are accessible to people of all abilities. The laundry is a good size and has been well equipped. The room becomes hot very easily and can be too hot to work in comfortably. An air conditioning unit has been fitted to provide staff with a comfortable working environment. There was good provision of protective gloves and aprons for staff use to reduce the risk of cross infection. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. 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. People living in the home are protected by the safe and robust recruitment procedures. Their needs are being met by a staff team who are receiving more training that will better equip them to do so. EVIDENCE: Earlier this year areas of the home have been designated as either nursing or residential. This has allowed the development of team of care staff who work mainly in the residential unit with the support of the district nurses to meet their specialist healthcare needs. The rest of the home has been divided into three areas with teams of staff allocated to them. The management team said this has been to provide better continuity of care to people. Staff rotas for each unit in the home were sent with the PIQ. The manager said that the numbers of staff on duty were monitored and would be increased if needed. Information from staff, people living in the home and their visitors was that there were usually enough staff available and on duty. But all commented on the high use of agency staff. All were aware of the homes efforts to recruit permanent staff and that things would be much better when this was completed. The manager said it was hoped this would soon and she was waiting to complete pre employment checks for a number of potential staff. The manager said that the interview and selection processes for staff have been changed to make sure that people with the knowledge and expertise Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 20 needed by the home were recruited. The interview processes for nurses and care staff now include assessments of skills and competency relevant to the role they are applying for. Training information sent with the PIQ showed that not all staff have yet received training needed to maintain health, safety and well being of residents and themselves or to meet peoples specialist care needs. But training provision has increased over the last six months. Action plans show that this will continue and the manager said that additional topics about specialist health care needs would be added. She said that the district nurses have been asked if they can provide some training for care staff on the residential unit. Staff said they have had a lot of different training sessions this year. They were very positive about it and said it had been very helpful. They were enthusiastic about the support and encouragement they were getting from the management team to do more training that would develop them as individuals and help them to provide better care to people living in the home. Staff files for the two most recent employees were looked at. These showed that: • Appropriate pre employment checks had been carried out. • Interview records were kept, including a pre interview questionnaire. • They had started the organisations induction training programme which is equivalent to Skills for Care common induction standards. The PIQ said that eighteen staff out of thirty-nine had achieved a qualification equivalent to NVQ level 2 and nine more were working towards it. Some of the staff said they were being helped and encouraged to go on and work towards achieving level 3. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35, 36 and 38. 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 management and organisation of the home has improved which means that people living there now benefit from a well run service. EVIDENCE: The manager has been in post since May 2006. But from October 2006 to April 2007 she was on long-term sick leave. She has not yet made application to become registered with CSCI but did confirm that this would be done within the next few weeks. There have been a number of problems in the home during the time that the manager was sick. The organisations quality management team and project manager have been closely involved with the home over this time. They carried out a number of internal quality audits to identify where problem areas Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 22 are in the home and developed action plans deal with them. The CSCI met with management team in December 2007 to discuss concerns about services provided at the home and agree a way forward. Copies of action plans were provided showing what had been done and what would be done to make sure that people living in the home received a good standard of care. Information from staff shows that improvements have been made. Comments made included: • The home appears more organised, staff know what they are doing and there is better team work. • The training has increased. • The management team are approachable and supportive. • There have been regular staff meetings to discuss some of the problems and what is being done to deal with them. • Communication in the home has improved. Examples given included the ‘shift handover’ where staff have fifteen minutes to handover to the next team/shift of care staff for that unit. Also regular meetings between people in charge of different departments in the home such as housekeeping, maintenance and kitchens. The manager said that she hopes to start a residents and relatives committee that will be led by them. She has sent out letters inviting people who are interested to contact her. The most recent survey of the views of people living in the home was done in December 2006. The results have been put together and made available to interested people. The administrator acts as appointee for one resident at the request of the family and holds money in safe keeping for some of the residents. Records of monies received and returned are kept using the organisations computerised systems. The PIQ said that policies and procedures in place which are reviewed by the organisation at regular intervals and changes made as required. The PIQ said that maintenance and safety are checks carried out at regular intervals of electrical, gas and moving and handling equipment and that records are kept. The manager said that staff are having one to one and group supervision sessions. Senior staff are going to receive training in order to provide this. Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 4 X X 4 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 X 3 Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 30/07/07 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 and 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. 2. OP9 13 The manager must make sure that practices, procedures and record keeping around the administration of medication DS0000055013.V321128.R01.S.doc 01/06/07 Springfield Nursing Home Version 5.2 Page 25 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. 3. OP30 18 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. The 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. 30/09/07 4. OP31 9 30/06/07 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 The manager should make sure that the Statement of Purpose is individual to the home and the services it provides. When the revised document is ready it should be made available to all interested parties. DS0000055013.V321128.R01.S.doc Version 5.2 Page 26 Springfield Nursing Home 1. OP7 The registered person should consider using 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. The manager should make sure that the personal history and activity records are fully completed and used by staff to inform them of resident’s individual likes and preferences. This information should then be used to plan activities according to individuals needs The manager should make sure that accurate records are kept of any meetings and discussions with people and staff when investigating complaints. The manager should make sure that all staff receive training about adult protection and abuse. 2. OP12 3. OP16 4. OP18 Springfield Nursing Home DS0000055013.V321128.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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. 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