Inspection on 12/03/07 for Springfield Nursing & Residential Care Home

This inspection was carried out on 12th March 2007.

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

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

Other inspections for this house

Springfield Nursing &... 18/09/08

Springfield Nursing &... 25/09/07

Springfield Nursing &... 28/11/06

Springfield Nursing &... 08/12/05

Springfield Nursing &... 15/08/05

Springfield Nursing &... 23/11/04

Springfield Nursing &... 22/06/04

Springfield Nursing &... 03/06/03

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Springfield Nursing & Residential Care Home 72 and 74 Havant Road Emsworth Hampshire PO10 7LH Lead Inspector Val Sevier Unannounced Inspection 12th March 2007 09:30 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 & Residential Care Home DS0000011519.V329483.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 & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Nursing & Residential Care Home Address 72 and 74 Havant Road Emsworth Hampshire PO10 7LH 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) (01243) 372445 01243 431644 Springfield Health Services Ltd Mrs Deborah Mary Powell Care Home 61 Category(ies) of Old age, not falling within any other category registration, with number (61), Terminally ill over 65 years of age (61) of places Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th November 2006 Brief Description of the Service: The home is owned by Springfield Health Services Ltd and is registered to accommodate up to sixty-one residents. The home is located in two houses that are separated by a quiet service road. The home was previously registered as two separate homes; number 72 being a care home providing personal care only and number 74 providing nursing care. Following an agreement by CSCI that one manager could effectively manage both homes, a further decision has been made to register both house 72 and house 74 as one care home. The registered persons have made the decision to accommodate up to 25 residents needing nursing care and these are accommodated across the two houses with appropriate nursing available. House 72 has three floors and house 74 two floors both being accessed by stairs and a passenger lift. Both houses have communal lounges and dining areas on the ground floors for the use of residents that both allow access into well maintained garden areas. The home has sufficient toilets and bathrooms to meet the needs of the residents. The fees are based on individual need and range between £560 and £900 per week. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: an unannounced visit to the home, which was carried out over two days on the 12th and 13th of March 2007, during which the inspector was able to have discussions with staff and have interaction with the residents at the home. During the visit to the home a tour of the premises was carried out which included bedrooms. Staff and care records were sampled and in addition to speaking with relatives, staff and residents, day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. The manager was available both days and the registered providers were available for questions and feedback. All staff were helpful throughout the inspection visit. What the service does well: Over the two days it was noted that residents receive support for a wide range of needs, which can be challenging both to them as individuals and to the staff. Training in dementia care is still being developed the support that the staff are able to provide was observed to be good, because it is now based on their knowledge, experience and training. This is supported by the new care plans, assessments and other written documentation. The home is ‘homely’, with bedrooms personalised and communal areas comfortable. The residents are encouraged to communicate freely about how they feel and what they want and this is being helped by new staff who have experience in dementia care, and the specialist assessment tools which is enabling the home to assess the outcomes of their support. Staff were seen to treat residents with respect and dignity and encourage risk taking as part of daily life activities. Relatives communicated in comment cards that they were in agreement that the attitude and level of care was very good. One relative commented, “the staff always listen to my relative and to any concerns that I have…they always let me know if there are any concerns”. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 6 The staff appear to be supported by the manager and the company to meet the support needs of the service users. The environment is comfortable and it was seen that individual needs have been addressed with equipment and safety measures at the home both in the communal areas and personal rooms. It was seen that health and safety is addressed with regular fire system checks and training. Maintenance checks were seen to be carried out regularly with equipment having an up to date service. What has improved since the last inspection? The home has responded appropriately to the Statutory Requirement Notice served in December 2006 with evidence of the following actions. A lot of concern was raised at the inspection in November 2006 about the care in house 74, this resulted in 32 requirements being made. During this inspection the inspector found evidence that these requirements for action had been met or would be met soon. At this inspection it was noted that since the inspection in November 2006 each resident has a copy of a reviewed service users guide and complaints procedure in their room. There is also a picture of their named nurse and key worker. Work is continuing at the home with support from a specialist in dementia, to assess how best to give information to those with diminished abilities whilst keeping their dignity. There were concerns raised about the assessment and care planning for individuals where they had a lack of capacity through dementia for example. On this occasion, the number of care plans for each individual was based on their needs and included personal care, oral hygiene, falls, communication, mobility, Parkinson’s and dementia. There were risk assessments and assessments for pressure area care, mobility and manual handling and nutrition. From these assessments it was noted there was information for staff to take, such as the number of staff and type of equipment needed to support the resident. For the new admissions the PAL (Pool Activity Level), assessment has been implemented and this gives a picture of an individual’s ability to carry out daily activities. It also has information for staff on how to support residents who have decreased abilities and helps them to focus on resident’s abilities not their inability. The manager explained that the homes philosophy is now based on a holistic approach, looking at the persona as a whole, and the inspector found that there was evidence that the staff understood this new way of working and that it was improving the support through understanding and communication of individual needs by staff. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 7 There had been concern at the last inspection that staff did not communicate well with the residents in house 74, and that interaction and support was poor. There was also concern that care staff were not supported by the nurse on duty at that time. On this occasion the inspector was able to observe and hear the interaction between the staff and residents and it was felt that staff supported the residents with dignity whilst supporting the areas where they needed extra support. There were three care staff on duty one lady who was quiet and she was complemented by two male staff, one of whom showed exceptional understanding and forethought of individuals needs, communicating with them appropriately and able to support other staff whose lesser experience was occasionally evident when managing the more mentally frail individual. All staff were observed to offer compassion and a caring attitude supporting residents in all aspects of care well. There had been concern at the last inspection that staff were not enabling residents to make decisions and have a choice within their daily lives or have appropriate social lives, because of poor communication and understanding. The inspector observed on this occasion that the home is working with new methods of enhancing the choices and daily lives of the residents that live there, with work taking place in matching expectations and preferences with interests and needs. This includes establishing in some cases new links with the local community. The complaints procedure has been reviewed and is available in all bedrooms that were seen over the two days; it still being reviewed to ensure that all residents, no matter their capacity, are enabled to express dissatisfaction with what is happening around them. Staff are receiving training in communication with those who have diminished capacity and how they may tell staff what life is like for them, even if this is not done verbally. At the last inspection there was concern that staff had not received training in the protection of adults. The inspector on this occasion was able to see from training records and from talking with staff that they have received training in the protection of vulnerable adults and this is also included in the two-week introduction for new staff. Concerns raised at the last inspection about the environment have been met, with alterations such as the nurse’s station having been moved out of the lounge area. No doors were seen to be wedged open and it was noted that door closures had been fitted to doors that residents requested to remain open. Both houses now have receptionists to greet people and there are signing in books in both houses to inform who is in the home in the event of a fire or emergency. Visitors and residents are able to exit the homes easily should they wish. A physiotherapist has assessed the environment and it was noted that action has been taken with moving furniture and equipment to enable staff to support residents. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 8 There was concern at the last inspection that there skill mix and number of staff was not appropriate to meet the needs of the residents. It was noted on this occasion that with the training that has taken place since the last inspection, and with new staff being appointed, that there was an appropriate and satisfactory level and mix of staff that ensured the needs of residents could be met. New care staff and nurses have been recruited since the last inspection and new posts have been created to support resident’s needs with a team of social care coordinators. There was concern at the last inspection that recruitment processes were not robust in protecting the residents and that new staff were not supported with a relevant and appropriate induction. It was seen on this occasion that the home had clear staff recruitment, training and development procedures that would ensure that service users were protected and supported. Several staff files were seen and the home had obtained all necessary checks and references before the staff had begun employment. The home has a trainer who has been in post since October 2006; she has developed the induction process for new staff and is developing the training for existing staff throughout the year. Supervision / mentoring is taking place with all staff having had an appraisal meeting during which competencies have been looked at training identified as needed. 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 & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 9 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 & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 10 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): Standards 1,2 3,4 &5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is developing its understanding of residents needs using the assessment process giving a consistent approach. The admissions process provided prospective residents and their families with details and opportunities to enable them to make an informed decision about admission to the home. EVIDENCE: There was concern at the previous inspection that residents were not being enabled to partake in the decision making process of moving to the home and that information was not easily available enabling people to make decisions. At this inspection it was noted that since the inspection in November 2006 each resident has a copy of a reviewed service users guide and complaints Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 11 procedure in their room. There is also a picture of their named nurse and key worker. Work is continuing at the home with support from a specialist in dementia, to assess how best to give information to those with diminished abilities whilst keeping their dignity. Residents spoken with had difficulties and where possible had been involved in the decision making process of moving to the home. Many described relief at being able to relinquish responsibility for decision-making, feeling content that the biggest decisions they had to make was what to do with their time or what to have for lunch. They felt reassured that the relationship that they had with the staff enabled them to say if they were not happy with anything and relatives spoken with over the two days also felt that if they had concerns that they could speak to staff. The home has begun training with staff on dementia, communication and assessing capacity. This training/ information is being offered to relatives by the manager in meetings themed around understanding dementia and asking ‘do you have difficulty talking with your relative’. Residents who had moved to the home since the last inspection who were able to comment said that they had been able to meet the manager and look at information about the home but due to their physical frailty – as they had been in hospital, they had been unable to visit the home beforehand and had trusted their representative to make the decisions about the home. The inspector viewed six files three from house 74 and three from 72 and it was noted that there were full pre admission assessments. Areas assessed included physical and mental needs, communication, medication, Next of Kin, preferred name and history of falls. This assessment was complimented by further assessments such as Bartel and nutritional screening. The home has also introduced Pool Activity Level (PAL), assessment and is using this for all residents admitted to the service. It looks at abilities of individuals and their strengths and what staff need to do to fill in the gaps. Whilst it has been completed for all new residents to the home there was also evidence that this is in place for other residents and it is and will be used to review the needs of those individuals. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been an improvement in the care plans with needs being identified and information for staff available on supporting these needs. There was concern that this was not evident in the care plans for pressure area care. The storage and administration of medication was seen to have improved with residents being protected with a better understanding by staff. Residents were seen to be treated with respect and had their dignity upheld. EVIDENCE: The inspector spent two days at the home day one was spent in house 74 and day two in house 72. On both days the care plans and assessments were seen for six individuals (three from each home). The medication administration records and storage were seen in both houses. The inspector spent day one of the inspection in house 74, where there had been concerns at the last inspection in November 2006. There were three care staff on duty supported Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 13 by a trained nurse and the social care coordinator who is new in post having been at the home for three weeks. There had been concerns at the last inspection about the care practices an understanding of staff of the needs of the residents in house 74 where the majority of the residents have diminished mental capacity, having dementia. The inspector was able to speak with two relatives, several residents and some staff as well as being able to observe and hear interaction between the residents and staff, supporting them on the day. The inspector viewed three care plans, which contained a pre admission assessment, and care plans according to need. The number of care plans for each individual was based on their needs and included personal care, oral hygiene, falls, communication, mobility, Parkinson’s and dementia. There were risk assessments and assessments for pressure area care, mobility and manual handling and nutrition (which included weight). From these assessments it was noted there was information for staff to take, such as the number of staff and type of equipment needed to support the resident. For the three new admissions the PAL assessment has been implemented and this gives a picture of an individual’s ability to carry out daily activities. It also has information for staff on how to support residents who have decreased abilities and helps them to focus on resident’s abilities not their inability. Whilst it is understood that there is a big change in the homes philosophy, there was evidence that the staff understood this new way of working and that it was improving the support through understanding and communication of individual needs by staff. All the care plans in both houses, were seen to have information regarding healthcare needs such as opticians, dentist, chiropody and skin care. However it was noted that there was a lack of evidence on how pressure care was given by staff with no consistent records in either house of the two individuals seen, that needed care in this area. This was discussed with the manager on both days of the inspection. The inspector was able to observe and hear the interaction between the staff and residents and it was felt that staff supported the residents with dignity whilst supporting the areas where they needed extra support. There were three care staff on duty one lady who was quiet and she was complemented by two male staff, one of whom showed exceptional understanding and forethought of individuals needs, communicating with them appropriately and able to support other staff whose lesser experience was occasionally evident when managing the more mentally frail individual. All staff were observed to offer compassion and a caring attitude supporting residents in all aspects of care well. Staff spoken with were able to discuss the new PAL assessment and said that they found it easy to understand and felt it gave them a clearer picture of how Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 14 to meet the needs of individuals. They also confirmed that they had received training in dementia care and communication some had completed both parts of this training. The training is being carried out initially by a Specialist in dementia care and then by the manager and social care coordinator who has had experience with working with the mentally frail. They have completed a train the trainer’s course run jointly between Hampshire Council and the dementia specialist. There was concern at the last inspection of the moving and handling of residents and fluid and nutrition levels. It was noted in care plans seen that there was a nutritional assessment which included fluids. Staff were observed to support residents with their meals and where individuals were frail staff ensured that they had food and fluids. There were drinks available in the lounges on small tables within reach of the residents. These were in addition to the drinks mid morning and lunchtime. Staff were seen and heard to encourage individuals to take drink and eat. Whilst the majority of the residents in house 74 are frailer than those in the other house, it was noted that one resident went to hospital on their own on the day of the inspection – their choice and another was able to request a doctor, and a glass of red wine before lunch. In house 72 on the second day t was noted that whilst the majority are more independent of staff support, there are a few individuals who are frail and need a lot of support from staff with one being cared for in bed. Medication was seen as a concern at the last inspection. It was noted that all care staff who administer medication or who support the trained nurse in this, have received competency based training since the last inspection. This applies to both houses. The medication records and storage were seen and were appropriate to the needs of the residents and in line with the homes policy and current guidelines. Regular checks of stock are undertaken by staff to ensure that there is no over ordering and that medication remains in date. All residents were seen to have been assessed for capacity and understanding to self medicate, several residents hold their own medication whist the majority of it is inhalers there was one who administers other medication. They have safe and locked storage for these medicines. Fridges in both homes were seen to have their temperatures checked and recorded daily and these were in within the advised limits. The cupboards for storing controlled medication in both homes are now fixed to the wall inside another locked cupboard. It was further noted that the home was disposing of medication inline with guidelines and policies. Care staff spoken with indicated that they had undertaken medication training and were more confident in administering and questioning any concerns. There had been concern at the previous inspection that there were prescription creams and toiletries such as hairbrushes and razors left in communal toilets and bathrooms. Whilst undertaking a tour of the home it was noted that there Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 15 were no personal toiletries or prescription creams left in any bathroom or toilet. The two houses are different in that they offer a different support, in house 72 people are more able and independent; able to speak their mind freely without impairment, in house 74 residents need to be supported in the majority of cases, for their interaction to be meaningful. The staff working in house 74 on the day of the inspection were observed to work well with the residents offering a balance of support whilst enabling the individuals to participate in daily life. In house 72 on the second day of the inspection, it was noted that the interaction was not impaired, and that staff interacted with residents well, relatives and residents were complimentary about the care and support given by staff and of the activities available to them. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is working with new methods of enhancing the choices and daily lives of the residents that live there, with work taking place in matching expectations and preferences with interests and needs. This includes establishing in some cases new links with the local community. Residents are now being supported to exercise choice and control over their daily life activities which needs to be sustained. The meals being offered were seen to be nutritional and a choice was available. EVIDENCE: Since the last inspection the manager has been given an activities budget, she has also appointed an activities coordinator, one assistant and another has been appointed and is waiting for recruitment checks to be completed. These individuals are there to support the residents in carrying out identified social activity either as individuals or in groups. The senior coordinator has experience of working with people who are mentally frail and is supporting the manager in training other staff in working with people who have dementia and Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 17 communicating with those individuals who experience difficulties because of their dementia. The PAL assessment also has a social care component, which helps staff to support social activities for residents. It has been identified in house 74 for example that one person used to play snooker regularly the social care coordinator is planning how this can be facilitated again, looking at transport and access. Another individual who has recently moved to house 72 used to play bridge, a skill that others in the home do not have or an interest they do not want. The social care coordinator has found a community bridge group and is helping the individual regain their confidence before attending the group soon. Activities were seen taking place on both days of the inspection pampering and one to one activities on the first day and arts and crafts on the second day. The residents in both houses appeared to enjoy the days events seen. The range of activities available in both homes were seen for March they included arts and crafts, games, a pamper morning with a reflexologist, reminiscence, a harpist, an entertainer, a clothing show in addition to celebratory lunches themed for St Patrick’s day, St David’s day and Red Nose day. There was concern expressed at the last inspection that there was a lack of consultation, communication and support at mealtimes for those individuals living in house 74. During this visit it was observed that residents were offered a choice of where they sat, staff gave support appropriately and aids such as plate guards and adapted cutlery were seen being used where it had been assessed that they would help. There was communication between the staff and residents and amongst the residents there was laughter and comments on the meal of the day. The inspector was able to speak with the cook and kitchen assistant and they have also received training since the last inspection on communicating with individuals with dementia. They said that this has proved useful and thought provoking as the menu has been reviewed and they have considered alternate ways of communicating choices, such as with the use of pictures. Whilst it is in its early stages the examples they have used so far have helped individuals with reduced capacity to express their choices in what meals they would like to eat. The cooks are also due to attend a two day course on nutrition in June 2007. The staff were seen to engage with residents on both days in the two houses, supporting individuals as needed. Residents in both houses were able to express their opinions about the meals that they had over the two days, verbally or by smiling and using their own ways of expressing what they thought. Springfield Nursing & Residential Care Home DS0000011519.V329483.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): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their views are known to staff and are fully taken into account. The manager has established a sense of openness at the home so that relatives and residents can voice their concerns. Staff also feel that they can voice concerns especially regarding the care of the residents. EVIDENCE: There was concern expressed at the last inspection that only the residents in house 72 could be assured that their concerns would be addressed and that residents in house 74 were receiving a poor service as the practice was judged to be abusive and detrimental to residents health and well being, due in part to vulnerable residents being unable to make their wishes known and not being supported. The complaints procedure has been reviewed and is available in all bedrooms that were seen over the two days; it still being reviewed to ensure that all residents, no matter their capacity, are enabled to express dissatisfaction with what is happening around them. Staff are receiving training in communication with those who have diminished capacity and how they may tell staff what life is like for them, even if this is not done verbally. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 19 Relatives spoken with in both houses feel confident that they can complain if dissatisfied and some expressed that they were looking forward to the information that was going to be made available to them at the next meeting. Staff spoken with said that there had been changes at the home since the last inspection and 8 staff that were employed at that time have left. They feel that this combined with the training and the new documentation is helping them to support the residents better. There have been no complaints or allegations received at the commission since the last inspection. The manager said that there has been one complaint received by the home concerning an agency nurse on duty on the weekend before the inspection; a relative had made the complaint. The manager planned to write to the agency regarding the matter and feedback to the relative. It was seen that staff have received training in the protection of vulnerable adults since the last inspection, and this has now been included in new staff induction. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 20 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): Standards 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are suitable for the care of residents with the appearance of the home creating a comfortable and safe environment for those living there. EVIDENCE: There were concerns raised following the last inspection regarding crossing over between the two homes of staff with laundry and meals, the open access of the two homes, fire doors being wedged open, storage, cross infection possibilities, leaving toiletries in communal areas, cramped space and safety of moving and handling. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 21 A tour was undertaken of both houses over the two days, all communal areas were seen and a sample of bedrooms where permission was gained where possible from residents to see their private rooms. A physiotherapist has visited the home to assess all the communal areas (2/2/07) and has supported the home in assessing space and equipment needs for residents. This lady visits the home weekly and is available more often if needed. The report was seen and it was noted that the manager has acted upon its recommendations on living space, moving and handling, equipment and the purchase of new drug trolleys to assist staff. The nurse’s station that was in the lounge area of house 72 is now relocated and this is where handover takes place. The access to both homes is now limited from the outside through a keypad however people can exit easily if they so wish. There is a signing in book for all visitors in each house. It is inevitable that staff cross over between the two houses with the laundry being in one house and the kitchen in the other. The manager has organised that this is kept to a minimum as much as possible with only the kitchen assistant’s crossing over with the meals and likewise the laundry staff with the clean linen etc. the manager has recruited another receptionist that works mornings in house 74 to assist visitors and take phone calls etc. this helps to monitor who is in the building. No doors were seen to be wedged open; the manager explained that doors that had been kept open now had automatic door closures on them. It was noted that all doors that were designated to be kept shut, were seen to be shut over the two days the inspector was there. During the tour of each house and during the time spent there it was noted that staff did not leave items such as razors and creams in communal areas. Training has taken place about cross infection and health and safety and notices to remind staff have been placed in appropriate areas. It was noted that the manager carries out regular audits of the environment, which identifies the areas needing improvement. At the time of the inspection the double room in house 72 was being decorated, recarpeted and a second vanity unit had been fitted. The downside to this that due to the lack of storage, all the items from that room were being stored in the shower room and bathroom on that floor. There was still a choice of bathroom available to the residents on other floors. Both houses were clean and without odours. The home is nicely decorated and the décor is pleasant and liked by the residents who were complimentary regarding the facilities and the gardens. The comments made by residents and relatives included: • “Oh! yes they are particular about keeping it clean, the windows and so on, I think they also look after the building”. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 22 • • “It is kept spotless and the building itself is kept up with decoration”. “I am a painter and decorator and I think that it is well looked after and maintained, everything the gardens and so on. They certainly keep the place clean”. The home has a good supply of wall-mounted hand disinfection points and the communal toilets had disposable hand towels provided. Overall the majority of comments made by residents were that, “Rooms and surroundings are always clean and well looked after” Springfield Nursing & Residential Care Home DS0000011519.V329483.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): Standards 27, 28 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was an appropriate and satisfactory level and mix of staff that ensured the needs of residents could be met. The home had clear staff recruitment, training and development procedures that would ensure that service users were protected and supported. EVIDENCE: Following the last inspection the manager stated that several staff had left either through choice or following disciplinary procedures. As a result new staff have been appointed nurses, care staff and ancillary staff. The manager has also recruited a social care team (two have started the third is waiting for final checks to be completed), whose role is to support the care staff and nurses in the provision and the enabling of social time for residents. The social care coordinator has been in post for three weeks following an initial two-week induction; he has experience of working with older persons and particular with dementia. He has recently attended the train the trainer’s course with the manager so that the staff at the home can receive training in dementia care and communication. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 24 On the first day of the inspection the inspector was able to speak with three new staff that had started that day and had begun their two week induction, and a nurse who was coming to the and of her induction. The home has a trainer who has been in post since October 2006; she is a trained nurse, NVQ level 3 trainer and assessor. She has introduced a new induction programme that can take up to twelve weeks to complete it is based on competency, assessment and understanding. The initial induction is over two weeks with the staff receiving a common foundation in care, health and safety, fire, dementia, moving and handling. They also work supervised for the second week with another member of staff. At the end of this initial two weeks there is a review of the induction and an individual learning plan formulated. After the first two weeks new staff carry on with their induction training receiving training in communication, equality and diversity, protection of vulnerable adults (POVA), care planning, medication, health and safety, fire, first aid, cross infection, moving and handling, continence, illness e.g. Parkinson’s and wound care. This training is also available for other staff e.g. care staff, nurses, and ancillary staff and is being programmed to happen on a regular basis. New ancillary staff also receive training in dementia and communication and have their own induction into their positions at the home. Staff have received training by a specialist in dementia, and this is being built on by the manager and social care coordinator. Other training seen to have been planned for staff includes: * Anaphylaxis) – April 2007 * Diabetes March 2007 * POVA 13th March 2007 * Essential care skills at St Richards November 2007 * One member of staff – a nurse – is to attend a train the trainer course in infection control in June 2007, so that this can be passed to others. * The two cooks are to attend a two day course on nutrition at a local college in June 2007. * Food hygiene April 2007 * Oral hygiene training over three sessions in May 2007 The rotas for the home were seen and in house 72 there were three care staff during the day and a nurse or senior care assistant (assistant team leader) with two staff and usually a nurse at night or a senior. In house 74 there are three care staff and a nurse on during the day and a carer and nurse at night. During the day the care staff and nurses are supported by the manager, the social care team, ancillary staff (cook, housekeeper, kitchen assistant and laundress), handyman and receptionist /administrator. There were concerns at the last two inspections that the recruitment process did not protect the residents with checks not being completed before Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 25 employment started. The inspector viewed four files for new staff and noted that all checks had been carried out before staff had begun work. Comments from staff indicated that they had received training since the last inspection, that they felt that the care had improved with the training now available, that they felt supported and due also in part to the change in philosophy of the home. Springfield Nursing & Residential Care Home DS0000011519.V329483.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): Standards 31, 33, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a clear view for the home and offers leadership with staff being aware of their roles and responsibilities. The systems for service users consultation are good, with a variety of evidence that indicates service users views underpin all self-monitoring, review and development by the home. The health, safety and welfare of service users are protected. A track record is now needed for evidence that improvements are sustained and completed in full. EVIDENCE: Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 27 The registered manager has been employed as manager for eleven years. Her qualifications are listed in the statement of purpose and include NVQ level 5 in operational management and MSc in Gerontological practice. Following the last inspection, the manager with the registered provider has looked at the requirements made and actioned them all; they have either been completed or are due to be soon. The requirements that have to be met are those around training, which was seen to be planned over the next few months. Other requirements such as recruitment, health and safety and fire, action has been carried out to meet these requirements. The other area of concern at the last inspection was related to staffing and the attitude or lack of skill of staff to support he needs of the residents in house 74 where there were identified mental health needs. During the time spent in house 74, it was observed that staff had a good understanding of the needs of the residents and in one case showed excellent skills in communication and support. There was evidence of training, improved recruitment practices, new posts created to support the needs of the residents in both houses, and plans to continue the training and development of staff. The manager explained that supervision had been reviewed and that there were three types of support available, competence based e.g. medication moving and handling and communication, value based – the interaction between the individual staff member and the residents and performance based – if there is an issue. Since the last inspection all staff in both houses have had a competency meeting and assessment for individuals issues such as medication and moving and handling. The inspector saw a sample of records from these meetings. The trainer is supervising new staff and the manager is currently establishing a mentorship for all staff which will then be used as supervisor / supervisee meetings. The manager has reviewed the quality audit process with questionnaires now available for relatives and residents. For individuals where there are communication difficulties through dementia, the manager plans to use Bradford University’s well-being / ill-being assessment to assess whether the service provides a good out come for people or not. The inspector has experience of this tool and has used it, this tool can be useful in establishing not only the outcomes of the service for residents but it can also highlight training issues for staff. There were a range of written policies and procedures available for staff to refer to as guidance and to inform their practice. These included the following: • Admission, discharge and transfer of residents • Human Rights • Confidentiality and access to personal records Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 28 • • • • • • • • • • Abuse of the person Restraint Guidelines for use of mechanical restraint Drug administration Self administration of medication Infection control Complaints procedure Whistle-blowing Sexuality Health and safety at work It was noted that meetings for all staff have been arranged throughout March 2007 and different times to accommodate them. There are also meetings arranged for relatives and a newsletter has been written to describe the changes at the home and the new philosophy. The manager showed the inspector the manual that she has produced based on Bradford University’ ‘Proactive Therapeutic Environment Assessment’ which looks at the environment and the interaction of residents and staff. Each member of staff will be given a copy of the manual (approximately 11 pages), which forms the basis of the homes philosophy. It explains how this conclusion was drawn and has led to the care pathway – which was seen in all care plans reviewed. A brief description of this manual and its outcomes has also been included in the newsletter to relatives and residents. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. passenger lift and hoists; fire safety equipment; portable electrical equipment; hot water system; etc. There were contracts in place for the disposal of clinical and household waste. Records were kept of accidents. Staff said that they attended regular and compulsory fire and other health and safety training. There was a fire risk assessment for the premises and regular risk assessments of the premises and working practices were undertaken. Guards covered all radiators in the home and all windows above the ground floor were fitted with restrictors. Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 29 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X 3 X 3 Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 30 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 OP8 Regulation 17 1(a) Sch 3 (3)(k) Requirement There must be clear information for staff to follow on how to care for pressure areas and a record kept of when and how this is done. Timescale for action 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Springfield Nursing & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 & Residential Care Home DS0000011519.V329483.R01.S.doc Version 5.2 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!