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Inspection on 08/12/05 for Springfield Nursing & Residential Care Home

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

This inspection was carried out on 8th December 2005.

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.

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

Staff at the home provide high standards of care with empathy in a wellmaintained and pleasant environment. Support is also provided to the relatives of those living at the home. Detailed information about the service provided by the home allows prospective residents to make informed decisions about the suitability of the home for themselves. The home operates effective quality assurance programmes, identifying shortfalls and putting actions in place to address them. Examples of this include the development of a new system for recording complaints and concerns, and revised method of recording and assessing staff training needs. Residents and their representatives are listened to and their concerns and requests acted upon. The registered persons recognise that those living at the home still wish to be involved in leisure and social activities. A comprehensive activity calendar is provided that is influenced by the wishes of the residents.

What has improved since the last inspection?

Using the quality auditing systems and listening to concerns raised by residents and their representatives improvements have been made in several areas. A new system for recording complaints and concerns allows the home to evidence the action they are taking as a result of concerns and complaints. This they believe can only enhance improvements in the quality of service provided at the home. A new system for assessing the training needs and documenting training received by staff has been introduced. This should make it simpler to ensure residents are cared for by staff that have the appropriate skills. A cold drinking water dispenser and fridge for fortified drinks has been provided in the dining areas in house 72 as a result of residents and their representative`s wishes. As a result of both houses being registered as one home, a revised statement of purpose has been produced.

What the care home could do better:

Some care planning does not detail the action to be taken to meet the identified needs of one resident. This needs to be addressed, although there is no evidence to suggest that this person is receiving inadequate care. The practice of administration and recording of the administration of medications does not completely assure the safety of residents. Recruitment procedures must ensure that obtaining two written references and satisfactory CRB and POVA clearance prior to a new worker commencing employment protects the wellbeing of residents. Shared toiletries in bathrooms could pose a risk to residents; risk assessments about this practice should be in place. The laundry floor needs to be of an impermeable surface and the walls of a surface that is easily cleanable. The provision of self-closing doors will ensure the privacy and dignity of residents using toileting facilities. Some fire doors had signage on that was confusing; the signage stated they should be locked, but as they are doors to linen cupboards the doors were not locked. There is a practice of resident`s bedrooms doors being held open with door wedges. Procedures for the delivering of meals to house 72 results in delays for some residents being served their meals. Conclusions following the two-day period in December 2006 suggested that staffing levels across the two homes were insufficient to meet the needs of all the residents. This was not found to be the case during the inspection period in March. It was suggested in December that the registration of one of the houses should be reviewed. This has now been addressed by the registration of both houses as one care home.

CARE HOMES FOR OLDER PEOPLE Springfield Nursing & Residential Care Home 72 and 74 Havant Road Emsworth Hampshire PO10 7LH Lead Inspector Gina Pickering Unannounced Inspection 10:30 8 December 2005 th 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.V271584.R03.S.doc Version 5.1 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.V271584.R03.S.doc Version 5.1 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 Springfield Health Services Mrs Deborah Redmond 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.V271584.R03.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2005 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 continue accommodating up to 25 residents needing nursing care in house 74 and up to 36 residents needing personnel care in house 72. They state that this will be kept under review, with staffing numbers being amended to reflect any changes in the occupancy of the home. 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. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a four-day period, commencing on 8th December 2005 and being completed on 23rd March 2006. Over the two-day period in December 2005 most of the service users were met, along with one visitor and staff members. Over the two-day period in March 2006 the records for four residents were looked at. Fourteen residents and two visitors were spoken with all of whom expressed satisfaction about the quality of food provided, the support and friendliness of the staff at the home, the cleanliness and décor of the home and the high standard of care delivered by staff. They all said that they are able to express any concerns to the management of the home and that these concerns are always acted upon. Ten staff members were spoken with, all of whom stated that they are happy working at the home and believe they are able to deliver appropriate care to all living at the home with the provision of relevant training, resources and staffing levels. Discussions were held with the manager and two of the directors as part of the inspection process at both the two day period in December 2005 and the two day period in March 2006. What the service does well: Staff at the home provide high standards of care with empathy in a wellmaintained and pleasant environment. Support is also provided to the relatives of those living at the home. Detailed information about the service provided by the home allows prospective residents to make informed decisions about the suitability of the home for themselves. The home operates effective quality assurance programmes, identifying shortfalls and putting actions in place to address them. Examples of this include the development of a new system for recording complaints and concerns, and revised method of recording and assessing staff training needs. Residents and their representatives are listened to and their concerns and requests acted upon. The registered persons recognise that those living at the home still wish to be involved in leisure and social activities. A comprehensive activity calendar is provided that is influenced by the wishes of the residents. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Some care planning does not detail the action to be taken to meet the identified needs of one resident. This needs to be addressed, although there is no evidence to suggest that this person is receiving inadequate care. The practice of administration and recording of the administration of medications does not completely assure the safety of residents. Recruitment procedures must ensure that obtaining two written references and satisfactory CRB and POVA clearance prior to a new worker commencing employment protects the wellbeing of residents. Shared toiletries in bathrooms could pose a risk to residents; risk assessments about this practice should be in place. The laundry floor needs to be of an impermeable surface and the walls of a surface that is easily cleanable. The provision of self-closing doors will ensure the privacy and dignity of residents using toileting facilities. Some fire doors had signage on that was confusing; the signage stated they should be locked, but as they are doors to linen cupboards the doors were not locked. There is a practice of resident’s bedrooms doors being held open with door wedges. Procedures for the delivering of meals to house 72 results in delays for some residents being served their meals. Conclusions following the two-day period in December 2006 suggested that staffing levels across the two homes were insufficient to meet the needs of all the residents. This was not found to be the case during the inspection period in March. It was suggested in December that the registration of one of the houses should be reviewed. This has now been addressed by the registration of both houses as one care home. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 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 & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Prospective residents are able to make decisions about the home by the provision of detailed information about the home that includes a clear statement of terms and conditions of residency at the home. A procedure for the assessment of prospective residents is in use and utilised well to ensure that prospective residents needs will be able to be met. The home does not provide intermediate care. EVIDENCE: During the course of the inspection the homes registration changed. This made the statement of purpose that originally covered the two homes appropriate. However following the change of registration the statement of purpose has been revised to reflect the changes. All persons expressing an interest in the home receive a brochure that contains the recently revised statement of purpose and further information about the home. The statement of purpose contains all details laid down by the Care Home Regulations. This includes information about the range of needs the home is intended to meet, admission criteria, the arrangements for reviewing care plans, and the relevant qualifications of the providers, manager and those working at the home. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 10 Further information in the brochure includes service users views of the home, information about fees and services they cover, the home environment including communal facilities and bedrooms and details of the home quality assurance programmes. Statements of terms and conditions of residency at the home clearly state what services the fees cover and what additional services such as newspapers, hairdressing are not covered by the fee. The room occupied by the resident is stated clearly in the document. Details about shared rooms and the options available to a resident when a person vacates a shared room are clearly documented. A senior member of the care team carries out comprehensive pre-admission assessment of all prospective resident’s personal, social and health needs. A decision is then made whether the home will be able to meet that persons needs. All residents move into the home on a four-week trial period that is detailed in their terms and conditions of residency at the home. One resident and his relative spoke about receiving lots information and assessments whilst in hospital, but were unable to clearly indicate which information was from the home or other sources. The home does not offer intermediate care. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Most resident’s social, personal and health needs are met by comprehensive assessments, care planning and involvement of health care professionals. However there are incidents where a plan of care is not developed for an identified need. Some improvements are needed in medication administration to fully assure the wellbeing of residents. Residents are confident that their privacy and dignity is upheld at the home. EVIDENCE: Care plans contain assessments of the resident’s personal, health and social needs. A plan of care is produced indicating the need identified, the goal the resident is striving to achieve and the actions to be taken to meet that goal. Additional assessments are included for nutrition, tissue viability, dependency and the risk of falls using professionally researched tools. All assessments and plans are reviewed on a monthly basis, or more frequently if needed, and amended to reflect changing needs of the resident. Discussions with residents and staff evidence that staff at the home encourage residents and their representatives to input into the care planning process. It was noted and discussed with the manager that although most care plans were comprehensive one resident did not have a plan stating the action to be taken Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 12 to meet an identified need. Observation and discussion with care staff and the resident evidenced that although a plan of care was not in place staff were addressing this person’s needs appropriately and with sensitivity. Some of the residents at the home exhibit signs of developing mental frailty. The home is not registered to accommodate persons with mental frailty or dementia. Documentary evidence and discussion with the manager indicate that persons are not admitted to the home with dementia. Support is sought from relevant healthcare professional to assist and advise with the care of residents at the home if such problems arise. The manager said that if the mental conditions of a resident deteriorates to a level that the home is unable to care appropriately for that person advice will be sought to find an alternative care home where staff have the skills to meet that persons needs. Training for staff about the care of persons suffering from dementia has been implemented. This is as a result of an awareness of the manager that many residents may develop some degree of mental frailty that would not be of a severity that would necessitate a move to an alternative care home. Residents are registered with a local GP practice. Residents are able to keep their GP’s if previously living in the local area. Residents spoken to say that staff contact their GP’s promptly to request visits if they are feeling unwell. One visitor said that her relative’s health care needs have been extremely well met by all staff at the home. GP’s were observed visiting the home to attend to residents health needs. There was no evidence in discussion with residents, relatives, staff and in documentation to indicate delays in seeking GP consultations for residents during the two-day period in March, however this had been highlighted as a concern in December. Details of health care professionals consultations, action and advice are recorded in residents’ documents. Separate policies and procedures are in place for the administration of medications for house 72 and house 74. The administration of medications was observed in both houses. In house 72 medication administration records are accurately maintained, but residents are not witnessed taking their medications; medications are given to them in medication pots but they are left to take the medications themselves. In house 74 staff witness residents taking medications, but there are gaps in the administration records with no reasons documented for medications not administered to residents. For all residents there is a risk assessment procedure to assess whether they are safe to self-administer medications. No residents were self-administrating medications in March. Medications are stored in a safe, secure manner. A record is kept of all medications received into each house and any medications that are returned to the pharmacy. Residents say that staff respect their privacy and dignity. It was observed that staff have a friendly working relationship with residents. Shared rooms have screening to protect the privacy of residents when receiving personnel care. Some bathrooms have incontinence pads stored on open shelving. It would create a more pleasing environment of these were stored in cupboards rather than open shelves. No breaches of dignity and privacy were observed during March, but on three occasions in December personal care was observed being provided in partial Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 13 view in the toilet in the reception area of house 72. The manager said that there is a plan to change some toilet doors so that they swing fully shut, this is detailed in the homes business plan for the year 2006 –2007. This will reduce the risk of resident’s privacy and dignity being breached whilst using these facilities. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 The home provides stimulating and varied activities, including accessing the community, to enrich the life of residents with staff at the home acknowledging the interests and social needs of those living at the home. Residents are confident they will be supported to have choice and control over their life; this includes being able to receive visitors when they wish to. The provision of good food in pleasant surroundings enhances the well being of residents. EVIDENCE: As part of the assessment and care planning process a social profile is made up of each resident. There is a varying degree of comprehensiveness in these profiles. Information in these profiles allows the activity coordinator to plan activity and entertainment programmes that will interest the residents. Resident’s expressed huge gratitude for the events organised by the home, some of which include day trips to places of interest, pub meals and theatre trips. Residents say they are encouraged to join with activities but ultimately it is their personal choice whether to take part and all staff at the home respects their decision. Information is made available to all residents about forthcoming activities; some residents say it will be helpful to have this information in larger writing. This was discussed with the manager who agreed to address this request. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 15 A policy of open visiting, as stated in the home’s brochure, allows residents to receive visitors when they wish. Visitors were observed being made welcome at the home. Two visitors spoken with said that they are made welcome when ever they visit, one visitor said that as well as her relative being looked after at the home she felt she was also being cared and supported by the home. Information is available to residents about advocacy services. Information supplied to residents prior to moving into the home state that they are able to bring personal possessions into the home. Speaking to residents and viewing some bedrooms evidenced that this practice happens. A four weekly rotating menu plan is in place that gives residents choice at all meal times. At both inspection periods residents said that they could not always remember what they had ordered for meals. Residents suggested ways in which this could be addressed. This was discussed with the manager, who said that this problem had already been identified and that the kitchen staff were exploring methods to ensure that residents were aware of their menu choices. Residents have the choice of taking their meals in company in the dining areas of the houses or in private in their own rooms. One resident spoke of his appreciation that he was able to have his lunch at an early time so he could watch sports on television in his room. Staff were observed assisting residents at lunch with sensitivity. Attention was given to serving a meal of the wished size to each resident. Resident’s likes and dislikes are known by the cook who is able to incorporate this into her meal planning. Residents said that they enjoy the meals at the home. Delivery of the meals at house 72 poses some problems; meals are prepared in the kitchen in house 74 and transferred across to house 72. This causes some delays in the serving of meals at house 72. The manager in consultation with the residents is exploring methods to address this situation. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Residents and their relatives are confident in the knowledge that any concerns complaints they have will be acted upon promptly. All staff are aware of issues regarding the protection of vulnerable adults thus ensuring that all residents are protected from the effects of abuse. EVIDENCE: A complaints procedure is displayed in each house and is available within information that all interested person receive about the home. The procedure includes time scales for responding to complaints. Following a quality audit the system for logging complaints has been altered. The new system allows for more in-depth details of the process taken to address complaints and also includes concerns that would not have previously been logged as complaints. The manager said that it is anticipated that this will be a useful tool to evidence that the home continues to strive to improve its service by responding to concerns as well as complaints. Residents and relatives say that they feel confident to raise concerns with the manager at the home and that they are satisfied with responses given to concerns and complaints the have made. Policies are in place about the protection of vulnerable adults that are in line with the Hampshire procedure for protection of vulnerable adults. All staff receive a comprehensive information booklet about abuse and the protection of vulnerable adults on commencement of employment at the home. Staff spoken to were aware of the effects that abuse might have on residents and the action to be taken in the event of a suspected case of abuse. Action taken Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 17 by the home and social services in response to allegations of abuse at the home in the last twelve months are appropriate to the situation and evidence that the manager and home will take correct action in the case of an allegation of abuse. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Residents live in an environment that is well maintained and decorated in a fashion that they are content with. Hygiene and cleanliness of the home is generally good contributing to the wellbeing and health of the residents at the home. EVIDENCE: The home is separated in to two houses. House 72 has 36 beds and at the present time accommodates residents needing personal care. House 74 accommodates up to 25 residents requiring nursing care. A tour of the environment of each building was undertaken, viewing communal areas as well as a sample of bedrooms. The general environment was clean and free from offensive odours. The décor and furnishing of all areas is of a homely nature. Residents and visitors offered positive comments about the decor and furnishings at the home. Both houses have large, pleasant dining and lounge Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 19 areas that open up onto the garden areas. House 72 has had the dining area extended to create a pleasant conservatory area that opens up onto a patio area. Residents stated that they are looking forward to using this area in the warmer months. A cold-water dispenser and fridge containing fortified drinks for the use of the residents is situated in the dining area of house 72. The manager said this was done in response to requests by residents and relatives. Bedrooms contain personal items of resident. Bedrooms have door locks and residents are able to lock their doors if they choose. Bathrooms were noted to have unnamed toiletries in them. The manager said that the home provided these toiletries for residents to use if they wish; the manager agreed that a risk assessment for this practice would be done and the results acted upon. In December 2005 one bathroom was being used a storage area for furniture belonging to a deceased resident. This did not appear to have an impact on the residents. If rooms are to be used for an alternative function there should be documentation available to show that the impact this will have on residents has been considered. All bathrooms were available for use in the March visit. A handyman is employed by the home who has responsibility for the general maintenance of the home. A small kitchenette is located on the ground floor of house 72. This is used for the preparation of light meals for the residents in house 72. During the March visit the flooring was being replaced in the kitchenette. Redevelopment and refurbishment for this area are identified in the home’s business plan for the year 2006 to 2007. Policies and procedures are in place about infection control, and hygiene within the home. A team of cleaners is employed who with the assistance of care staff keep the home clean and free from offensive odours. Residents said that the home is always clean and tidy. The laundry facility for the home is located in house 72. The laundry is small but functional. The flooring and walls were not of the required finish; the registered provider gave his assurance that the floor surface would be given an impermeable finish and that the walls would be made good so that they are easily washable. Despite the laundry being small, residents say that generally there are no problems with having their laundry returned to them. The laundry contains facilities to iron clothing and sort out clothing for residents. One visitor said that she takes her relative’s washing home as there had been delays in the past getting clean washing back. Residents say that it is a rare occurrence that clean laundry is not ironed. The member of staff working in the laundry during the inspection said she enjoys working at the home and is able to fulfil her role despite the size of the laundry. Hand washing facilities and hand gels are sited in prominent places to further enhance infection control measures in the home. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 Recruitment practices do not fully ensure the protection of the people living in the home. Resident’s health and well being are protected by the number, skill mix and training of staff at the home EVIDENCE: Staff employed at Springfield Nursing and Residential home are generally allocated to work in either house 72 or house 74. However there is some movement of staff across both homes to allow for covering for staff sickness and holiday leave. Staff said that they are happy to spend time working in both houses. Since the home has been registered as one care home the registered providers and managers have made a decision to continue to have residents needing nursing care in house 74 and residents requiring personal care in house 72. This, they said, will be kept under review and staffing levels will be adjusted according to any changes that are made in the residents needs. Each house has a senior member of staff responsible for the day-to-day running of the home. Residents say there is enough staff to meet their needs. Delays in answering call bells were observed in December 2005 but call bells were observed being answered promptly during the two days in March. Residents state that call bells are always answered quickly. Some staff indicated that it would be nice to have extra members of staff at times to be able to spend more time giving residents emotional support, by spending more Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 21 time talking with them. Observation, however, indicated that staff do spend time talking with residents. An activity co-ordinator is employed to assist arranging activities and excursions for residents. The home is committed to having a care work force that consists of at least 50 NVQ 2 trained carers. At the present time 79 of carers have achieved or are in the process of achieving, as a minimum, NVQ level 2 in care. Recruitment procedures are in place. Two staff files were looked at, one of which had only one satisfactory reference on file. The manager said that another one had been received, but was unable to locate it during the course of the inspection. Neither was there any evidence of CRB or POVA clearance for this person. The manager was reminded that all staff must have satisfactory CRB and POVA clearances as well as two satisfactory written references before commencing employment. All staff receive a job description. This is kept on their training and development file. One staff member is employed as a handyman and care staff, for this purpose he has been supplied with two job descriptions. A new system for recording staff training is in the process of being introduced, that allows for an assessment of staff training needs. This process includes all staff, whether newly employed or having been employed at the home for a long while, undertaking induction training meeting Skill for Care guidelines. Staff discussed the training they have undertaken in the past year. They believe they have received appropriate training and support to equip them with the skills to meet resident’s needs. This was supported in conversations with residents and relatives. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Residents live in a home that is managed in a manner that allows all residents and staff to input into the running of the home. Good practices ensure that residents’ financial interests are safe guarded. The health and safety of residents is generally well protected by practices at the home EVIDENCE: The registered manager, Deborah Redmond has been employed as manager for ten 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 registration of both houses as one care home, the management structure for each home has been slightly altered. Deborah Redmond is responsible for the over all management of the care home. Each Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 23 house has a separate member of staff who is responsible for the day-to-day running of the house, both of which have achieved the registered managers award. There are clear liners of accountability between the registered providers, the manager and the rest for the staff team. Staff said that their views about the running of the home are listened to by the manager and acted upon. The home has registered with two quality assurance programmes. Examples of change of practice and procedures following quality audits have been noted through out the inspection e.g. improved complaints recording. Residents confirmed that they are able to attend residents meetings. But most of them said that they are able to approach the manager with any issues and that she will address their concerns promptly. The home handles small amounts of residents’ monies. Monies are stored in a safe; all records of incomings and outgoings are recorded in a book. Representatives of the residents deal with the main finances of residents. Health and safety policies are in place. Staff receive training about various topics in health and safety. Records indicate that not all staff have attended the recommended twice-yearly fire safety training. The manager described how this issue was being addressed. The cook said that all kitchen staff and care staff receive training about food hygiene. Substances hazardous to health are stored in locked areas. The manager supplied a list of equipment and services and their maintenance dates. A sample of service certificates was seen evidencing that all services and equipment are maintained to the recommended guidelines of the manufacturers. The manager and handyman are in the process of completing the fire risk assessment for the whole home. Many residents’ bedroom doors are wedged open despite being fire doors. Details of this have been included in the fire risk assessment, as advised by fire safety officers the manager said. Advice is being sought form Hampshire Fire and Rescue Service as to whether this acceptable practice. Several storage cupboard doors had signs on stating they were fire doors and should remain locked. In practice these doors are being left open, as access is needed by all staff to obtain linen and equipment. Concern was raised that as these doors are being left open, a culture might develop where doors that should be locked are in fact not locked. This was seen to be the case when a door into a boiler room was left unlocked; this could pose a risk to residents who might wander into it. A new lock was put on this door during the second day of the March visit, and the manager gave her assurance that the door would be kept locked. Risk assessments for the environment are displayed in relevant areas of the home. Each staff has a separate risk assessment relating to their individual job description and role. Auditing of residents accidents allows staff to address recurring themes and reduce the risk of individual residents falling. Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 24 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 X 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 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 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 Springfield Nursing & Residential Care Home DS0000011519.V271584.R03.S.doc Version 5.1 Page 25 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 15 Requirement The registered persons must ensure that a plan of care is drawn up for all identifies needs of residents. The registered persons must ensure that the administration of medications to residents is witnessed; all administered medications are signed for on the administration record and that reasons are documented for medications not administered The registered persons must risk assess the current practice of providing shared toiletries in bathrooms for residents. The results of this risk assessment must be acted upon. The registered persons must ensure that the recruitment practices adhere to current CSCI policy and guideline about criminal Records Bureau Checks that is available on the internet. The registered persons must ensure that two satisfactory written references have been obtained before a person commences employment at the DS0000011519.V271584.R03.S.doc Timescale for action 31/03/06 2 OP9 13(2) 30/04/06 3 OP26 13(3&4) 30/04/06 4 OP29 19 31/03/06 5 OP29 19 31/03/06 Springfield Nursing & Residential Care Home Version 5.1 Page 26 6 OP38 13(4) home. The registered persons must endure that notices on the fire doors accurately reflect whether they must be kept locked or not. 23/04/06 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.V271584.R03.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: 0845 015 0120 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.V271584.R03.S.doc Version 5.1 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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