Inspection on 10/05/07 for Springfield Nursing & Residential Home

This inspection was carried out on 10th May 2007.

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

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

Other inspections for this house

Springfield Nursing &... 29/04/08

Springfield Nursing &... 22/10/07

Springfield Nursing &... 05/10/06

Springfield Nursing &... 24/04/06

Springfield Nursing &... 29/11/05

Springfield Nursing &... 27/07/05

Springfield Nursing &... 19/09/04

Springfield Nursing &... 21/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Springfield Nursing & Residential Home Preston New Road Blackburn Lancashire BB2 6PS Lead Inspector Jane Craig Unannounced Inspection 07:00 10th May 2007 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 Home DS0000022482.V330815.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 Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfield Nursing & Residential Home Address Preston New Road Blackburn Lancashire BB2 6PS 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) 01254 263668 01254 690461 None Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) *** Post Vacant *** Care Home 70 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (30), Mental Disorder, excluding learning of places disability or dementia - over 65 years of age (30), Old age, not falling within any other category (38), Physical disability (25), Physical disability over 65 years of age (25), Terminally ill (5) Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 70 service users to include:Up to 38 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 30 service users in the categories of DE(E) or MD(E) (over 65 years of age, Dementia or Mental disorder not including learning disability) requiring personal care. Up to 25 service uisers in the category of PD or PD(E) (Physical Disability) requiring nursing care. Up to 5 service users in the category of TI (Terminally Ill) requiring nursing care. 1 named service users in the category of DE (Dementia under 65 years of age) requiring personal care. 1 named service user in the category of DE (Dementia under 65 years of age) requiring nursing care. Should any of the service users under 65 years of age either leave the home or attain the age of 65 years, an appropriate variation must be made. The registered provider should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 5th October 2006 2. Date of last inspection Brief Description of the Service: Springfield Nursing and Residential Home is registered to provide care to up to 70 adults who need help with personal care or who have nursing needs. Springfield is a detached building standing in its own grounds. Accommodation is provided on four floors, referred to as Levels. Each Level is regarded as a separate unit and accommodates a different resident group. Each Level has its own communal facilities, including lounges, dining areas, snack kitchens and bathrooms. A total of sixteen bedrooms have en-suite facilities; the remainder have hand-wash basins installed. Level 3 of the home is currently closed. The home is situated in a residential area close to local amenities. The main Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 5 road to Blackburn town centre runs outside the driveway and bus stops are a short walk away. Information about the home is sent out to anyone making enquiries about admission. Copies of Commission for Social Care Inspection reports are available from the home manager on request. On 11th May 2007 the weekly fees ranged from £321.50 to £533.00. Additional charges are made for toiletries, hairdressing and newspapers. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Springfield Nursing and Residential Home on the 10th and 11th of May 2007. Two regulation inspectors and a pharmacist inspector carried out the visit. At the time of the visit there were 38 people accommodated. The inspectors met with a number of people using the service and spent time observing their interactions with staff. Wherever possible they were asked about their views and experiences of living in the home and some comments are quoted in this report. The inspectors met with 2 relatives and a visiting professional. Three relatives and two health care professionals sent back surveys but none were returned by the people using the service. Discussions were held with the manager and several members of day and night staff. A tour of the premises took place and a number of documents and records were viewed. This report also includes information submitted by the manager before the inspection visit. What the service does well: People who were thinking of using the service were assessed before they were offered a place at the home. This meant that staff had a better understanding of what care the person might need and whether it could be provided at the home. A number of people using the service and relatives expressed satisfaction about the care and the staff. One person said, “I am quite independent but they are always there if I need them.” Another said, “I love it here, it’s great, they’re so good with me.” A relative said, “I can’t fault the care,” and another wrote, “My relative is very comfortable at this home.” Visitors to the home were satisfied with the open visiting policy which meant that there were no restrictions on people using the service being able to see their relatives. A relative had written to staff to thank them for their support and attention to the family members during a very difficult time. People who were able to comment said that the meals were good and one said they were “spoilt for choice.” If someone did not want any of the choices on the menu they could always ask for an alternative which meant they could always have something they liked. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 7 The manager made sure that the home was well maintained and equipment was serviced regularly. This helped to make the home safe for the people who lived and worked there. What has improved since the last inspection? What they could do better: Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 8 Care plans, especially those for people with dementia, did not always tell staff enough about peoples’ individual needs and the care they should be receiving. Not all plans were up to date and advice from healthcare professionals had not been added. This meant that staff did not always have the right directions, which resulted in some peoples’ needs not being met. Risks to residents’ health were not always monitored thoroughly enough and action was not always taken to reduce the risks. Medication was not managed safely. There had been very little progress made in this area since the last inspection and outcomes for people using the service remain poor. Although the staff understood that people had a right to privacy and to be treated with dignity, there were a few instances where this understanding was not shown. A healthcare professional indicated that the service could be improved by respecting peoples’ privacy. There were not enough suitable activities organised for people who were not able to occupy themselves, which meant that there were a number of people whose social and recreational needs were not met. The lack of written information on care plans meant that staff did not know enough about residents’ likes, dislikes and preferences when they needed to help them make choices. The manager and senior staff should ensure that all background checks are carried out on staff before they start working at the home. This is so that they can be sure that the staff are fit to work with vulnerable people. Despite a previous requirement, substances that could be potentially harmful to people were not locked away. 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 Home DS0000022482.V330815.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 Home DS0000022482.V330815.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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process ensured that people had enough information to make a decision as to whether the home was suitable for their needs and gave staff a clear understanding of the individual’s needs and how they were to be met. EVIDENCE: The statement of purpose and service user’s guide were on display. They had been revised since the last inspection but some of the information was out of date by the time of the visit. Relatives indicated that they, or the prospective service user, were given sufficient information about the home to assist them to make a choice. They were able to visit the home and meet staff if they wished. Health or social services professionals generally assessed people before referring them to the home. The manager or other senior staff also assessed prospective service users so that they could be sure that the staff and facilities Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 11 at Springfield could meet their needs. Staff said they received enough information from the assessment to understand the person’s needs before they were admitted. Intermediate care is not provided at Springfield. Springfield Nursing & Residential Home DS0000022482.V330815.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): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff did not have access to accurate and up to date directions on care plans, which resulted in some peoples’ health and personal care needs not being met. Medication practices did not safeguard people using the service. Staff practices sometimes compromised peoples’ privacy and dignity. EVIDENCE: All people using the service had been reassessed using a new assessment tool. Assessments on Level 1 were not complete in full but the others provided a good picture of what the person was able to do independently and also helped staff to identify areas where a care plan should be written. Care plans for people using services on Level 1 were approximately a year old. Although they were reviewed every month the evaluation notes did not show what progress the person was making towards meeting their goals. In two cases the plans had not been updated even though it was clear from reading daily notes, talking to staff and observing care, that the peoples’ needs had changed. Care plans for people with dementia were not person centred and in Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 13 most cases the directions for staff were not relevant. Care plans for people on Levels 2 and 4 had been re-written and some showed improvements. There was no evidence that people using the service, or their relatives, were consulted in care planning or reviews. This meant that people were not able to make decisions about how and when they wanted care to be provided. One relative said that she had not seen her relative’s plan until five months after it had been re-written, and only then because she asked to see it. Despite these shortfalls five relatives said that they were kept informed about important issues. Health care risk assessments were not always completely accurate; for example, assessments of falls did not always take into account medication, which meant that the risks could be greater than indicated. The risk assessments were not always updated, for example one person had had three falls in a month but their assessment still indicated they were low risk, therefore a management plan was not drawn up. Plans were not always drawn up even when assessments indicated high risks. For example, two residents were at high risk of developing pressure sores but there were no plans in place to assist staff to minimise the risks. Moving and handling plans and practices had improved. Staff said that the manager was “very strict” about that. There was evidence that residents were referred to appropriate professionals for health care. However, advice was not always incorporated into the care plans. For example, a health care professional said they had advised staff to assist one person to elevate their legs but there was nothing written in the care plan to direct staff to do so. This meant that staff had to rely on verbal messages, which increases the risk of mistakes and inconsistency. Advice was not always acted upon. For example, a doctor had advised that one resident should have increased fluids but this information was not transferred to the care plan. A relative raised concerns that the doctor’s advice was not always carried out, which was confirmed by looking at records. Relatives who completed surveys and spoke with the inspectors indicated that their relatives’ needs were met at the home. One relative said that they “couldn’t fault the care.” People using the service said, “they take care of us very well,” and “the staff are very obliging, always asking me if they can get me anything.” Healthcare professionals who returned surveys indicated that peoples’ health care needs were usually met and one who spoke to the inspector said that the staff made timely referrals, which resulted in service users’ having access to the correct treatment. Staff said they received instruction about respecting peoples’ privacy and dignity and gave examples of personal care being conducted in private. However, there were some practices that infringed residents’ rights to privacy and dignity. Staff were not always sensitive when asking people about their Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 14 toileting needs. They did not always lock toilet doors when they were assisting people and there were three toilets and bathrooms without working locks. Two members of staff were observed entering bedrooms without knocking. A healthcare professional wrote that they had been asked to provide treatment in a communal area and commented that the service could be improved by respecting privacy. Policies and procedures for the safe handling, recording and administration of medication were available, but were not reflected by current practice. It was not always possible to see exactly what medication residents had received and when. A sample audit showed that some residents had not been given enough medication, whilst others may have received too much. Some medicines could not be accounted for. Residents are at serious risk of harm if they are not given their medication correctly. Stock control was poor. One resident had been without medication for 4 days and two residents had had no medication for 3 days. The health and wellbeing of residents is at serious risk of harm if adequate supplies of their medication are not available. When medication was not given, the reason was rarely recorded. Verbal dose changes had not been accurately recorded. Handwritten entries on Medication Administration Record charts (MARs) had not been checked, dated and cross-referenced to the care notes. In some cases it was not possible to see when medication had been started, discontinued or what dose had been prescribed. A large number of Medication Administration Record charts still listed items that were no longer prescribed and this lead to confusion. Individual written guidance was often unavailable for the administration of nutritional supplements, thickening powders and when required medication. This meant that staff did not have enough information to be able to give these products effectively and safely, particularly to residents with dementia. Poor record keeping puts the health and wellbeing of residents at serious risk of harm. Not all medication was stored correctly. Oxygen cylinders were not chained or on trolleys. Eye drops had not always been dated on opening and this placed residents at risk of being given out of date medication. Insulin in current use was kept in the fridge, against guidance issued by the manufacturers. The medication fridges were not maintained within the recommended temperature range and one medication room was particularly hot (34°C). Medication must be stored at the correct temperature in order to ensure its effectiveness and safety. Evidence was available that only some staff had been assessed as competent to handle medication before taking on this responsibility. The health and Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 15 wellbeing of residents is at risk of harm if medication is administered by staff who have not been shown to be competent in this area. The service did not fully assess the quality of handling, recording and administering medication. This failure meant that shortfalls and errors had not been identified and no action taken to improve. The health and wellbeing of residents is at serious risk of harm if the quality of the medication services offered is not regularly monitored and action taken to ensure that it is safe and correct. Springfield Nursing & Residential Home DS0000022482.V330815.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): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all people using the service had sufficient choice and control over their lives or had their social and recreational needs met. EVIDENCE: The staff said that they no longer got people up very early in the morning or put people to bed early at night in order to assist colleagues with their workload. This was apparent on the day of the visit. On Level 2 there were only a few people up at 7am and there was no one dressed and lying on their bed. All the people who were up on Level 1 were awake. Other routines had been changed to reflect the needs of people using the service rather than the staff. For example, people on Level 2 were served their breakfast when they wanted them instead of having to wait until everyone was up, as used to be the case. Lunchtime routines on Level 2 had also improved. Catering staff assisted with serving meals which freed up a carer to assist people in the dining room who needed supervision and prompting. There had been no improvements in the level of social and recreational activities available to people using the service. Some people were able to meet their own needs, for example, one person said, “I like to spend my time Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 17 reading and they have a good selection of large print books.” However, there were others whose needs were not met. One person said, “I don’t do anything, that’s really the only gripe I have,” and another said, “I am still bored and fed up.” Records of activities and daily care notes showed that some people on Level 1 had not participated in any activity since November last year. Staff working with people with dementia had not received any training in providing activities for people with specialist needs and staff spoken with showed a lack of understanding. The 20 hours allocated to the activity co-ordinators were usually spent arranging large group activities. There was little evidence that anyone unwilling or unable to join in were offered any alternatives. None of the care plans seen included a care plan or programme to meet social care needs. There had been no improvements in the level of information recorded about the likes, dislikes, preferences and routines of people using the service. At least two of the plans seen did not record the religion of the person and none had any information about the person’s wishes regarding attending services. The lack of records meant that staff, who sometimes had to make choices on behalf of people using the service, had very little background information on which to base their decisions. There was an open visiting policy. One relative said he was made to feel welcome and staff usually made time to have a word with him. There were very limited opportunities for people to go out unless it was with their relatives. The menus and records of meals showed that people using the service were offered a balanced diet with variety and choice. There was a table with a choice of cold drinks and biscuits set out during the day for people on Level 4 to help themselves. People using the service generally said they enjoyed the food. One said, “the food’s marvellous and you’re spoilt for choice,” and another said, “the food’s good and you get plenty.” People had choices, for example, one person said, “I don’t always like the meals but we get round it, for example I have had baked potato and cheese today.” Another person was given a different dessert when they said they didn’t like what was on offer. However, the relative of one person, who was not able to make their views known or ask for anything different, raised concerns that they had little variety and always had the same breakfast. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service were protected by the policies of the home but lack of staff training may result in the policies not being put into practice. EVIDENCE: The complaints procedure displayed around the home indicated how to make a complaint and to whom. The procedure did not include information about timescales, which meant the complainant would not know when they could expect an acknowledgement or response. Relatives completing surveys indicated they knew how to make a complaint. There had been one complaint to CSCI, which was investigated by the manager and found to be partially upheld. There was a record of the issues, investigation and outcome. Records showed there had been no complaints directly to the home since the last inspection. However, a relative said that they had some concerns about a health care issue and had spoken to staff on the appropriate Level but nothing had been done. It became apparent that these concerns had not been passed on to the manager to be dealt with as a complaint. Staff had not received training in dealing with complaints, as recommended after the last inspection, but this training was expected to become available in the near future. Staff had access to written guidance on safeguarding adults. Seven members of staff had received recent training and it was planned that it would be Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 19 available to all grades of staff in the future. All staff spoken with were aware of the need to report any allegations to the manager of the home. However, some staff were not clear about reporting to external agencies when necessary. There had been one safeguarding referral since the last inspection. An investigation and subsequent monitoring had been undertaken by social services. Springfield Nursing & Residential Home DS0000022482.V330815.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): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people using the service had a comfortable, clean and homely place to live. EVIDENCE: Improvements to the environment noted at the last visit had been built on. The timescales set for areas of redecoration and renewal had been met. Bedrooms were redecorated before a new occupant moved in. Dining rooms on each Level had new furniture. Some bedrooms had new furnishings and several bedroom carpets were on order. One person said, “it’s very well kept, lovely furniture,” and a visitor said they were happy with their relative’s bedroom, which was very comfortable. Some locks had been fitted to bedroom doors. There was no evidence that people using the service were asked whether they wanted a lock on their door and one person said they had had to ask staff. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 21 The outside of the home and the grounds were well maintained. People on Level 1 had access to a secure garden. At the time of the visit most areas of the home were clean, tidy and fresh smelling. However, areas that were not in constant use did not appear to be checked regularly. For example a bath was badly stained for over 24 hours and had to be brought to the attention of staff. There was written guidance on infection control and handling laundry and waste. Staff used protective clothing. Concerns were raised during the last two inspections about clean clothing being put in the wrong rooms and not being looked after properly. The manager had allocated a member of staff to take responsibility for ensuing laundry was put away properly and there had been no complaints about the laundry in the past few months. There were still a few beds on Level 1 that had flat and misshapen pillows, which looked as though they would be uncomfortable for the people using them. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service were not always supported by appropriately trained and skilled staff and shortfalls in recruitment practices meant that they were not fully safeguarded. EVIDENCE: The ratio of staff to people using the service had improved since the last inspection. Staff themselves said the levels were sufficient to meet the current needs of the people on each level of the home. There had been no negative comments from relatives and health care professionals about the staffing numbers. People using the service and their relatives made some very positive comments about the staff. One person said, “the staff are very obliging,” and another said “whoever picks them does a really good job.” A relative wrote, “The staff seem to be more organised,” and another said the staff were “very good.” There were, however, concerns raised by a relative about the number of agency staff being used on Level 2. A health care professional also wrote that Springfield suffered from a high turnover of staff and use of agency staff who did not know clients well enough to make informed judgements. The manager was aware of the difficulties created by the use of agency staff, which she said had decreased and was continuing to be addressed. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 23 The files of four new staff were looked at. One of the staff only had one reference on file. Another applicant had a gap in their employment history with no evidence that this had been explored. All of the staff had started work as soon as their POVA first check was returned but there was no evidence that three of them had been supervised whilst waiting for their full CRB disclosure. The company had changed the style of the application form and applicants completing the new form were not asked to provide a statement as to his or her mental and physical health. Nor were they asked for details of any criminal offences, which meant that until their CRB disclose was returned, there was no record of this information on their file. The manager stated that all four staff had received induction training and records were submitted following the visit to evidence this. The new induction training pack met the common induction standards and included an assessment in each area. A health care professional commented that in their experience care staff did not have the right skills and experience to meet peoples’ needs. Another indicated that they sometimes did. The manager was working towards improving training opportunities. Some staff had attended or been nominated to attend courses to enable them to train other staff in health and safety topics. There was a three monthly training schedule which, when completed, will ensure that all staff receive mandatory training over the twelve month period. A few staff had also attended courses on tissue viability, care planning, and dementia care. The manager stated that training in dementia care mapping and person centred care planning was to be made available to staff in the next few months. Records submitted by the manager showed that over 50 of care staff were qualified to NVQ level 2. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was run by an experienced and qualified person. Improved quality monitoring systems meant that people using the service had some involvement in the development of the service, however, some unsafe health and safety practices put people at risk. EVIDENCE: There had been some changes to the upper management structure of the company, which the manager said had resulted in her feeling more supported. The manager, a first level nurse, had been appointed over twelve months ago but at the time of the visit the Commission for Social Care Inspection had still not received a complete application for registration. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 25 Staff who were spoken with said that the home was managed well. One said that they found the manager approachable and could go and see her at any time. Another said “the home is better managed, the place looks better, feels better and there is a better atmosphere.” The change in atmosphere and attitude of the staff towards the manager and each other was apparent to the inspectors throughout the course of the visit. The quality monitoring exercise started before the last inspection had been completed. Results of surveys from people who use the service and/or their relatives were analysed and any issues identified as problematic were addressed via an action plan. One example was of relatives raising the issue of shortfalls in personal care, mainly oral hygiene and nail cutting. The staff had ensured that everyone had a relevant care plan and staff are to receive training in safe nail cutting from the podiatrist. The company had also introduced an internal audit of care practices, records and procedures. However, on this occasion the audit had failed to highlight some of the unsafe medication practices or shortfalls in care plans mentioned in this report. The manager also had plans to set up a quality monitoring group for the home which would provide people who use the service and relatives with opportunities to be involved in auditing and developing the service. The organisation acted as appointee for three people who used the service. As this was a recent action, there were no records to audit. There were computerised records of money handed over for safekeeping and any transactions made on behalf of people using the service. Following a previous requirement all care plans and medication administration record (MAR) charts seen included photographs of the service user. With the exception of one, accidents recorded in daily notes were also recorded on appropriate accident reports which meant that they were included in the accident audit for that person. Certificates were available to evidence maintenance of electrical installations and gas equipment in the home. All electrical appliances had been safety tested. A new fire procedure was on display in key areas of the home. The procedure was vague about staff roles in the event of fire. However, all but one member of staff spoken with were aware of which grades of staff attended the fire panel and which staff stayed with service users. Most staff had received fire safety training and been involved in practice drills. Despite a previous requirement, caustic denture cleaner was seen in some unlocked bedrooms. This potentially hazardous substance was accessible to anyone who had access to the room, including people who would not recognise the danger of ingesting such items. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 2 Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement People using the service and/or their relatives must have opportunities to be involved in drawing up their care plans so that they can have a say about how their care is to be provided. (Timescale of 31/01/06 not met) The registered person must ensure that the plan is kept under review and necessary amendments are made so that staff have up to date and accurate directions about the care to be provided. (Timescale of 31/05/04 not met) Timescale for action 31/07/07 2. OP7 15(2) 31/07/07 3. OP8 13(4)(b-c) The registered person must ensure that any potential risks to residents’ health are assessed, monitored and strategies to control the risk drawn up. (Timescale of 31/10/05 not met) 17(1) Sch 3 (i) 31/07/07 4. OP9 Full and accurate records of all 10/06/07 medicines received, administered and leaving the care of the home must be maintained to ensure people are given the correct DS0000022482.V330815.R01.S.doc Version 5.2 Page 28 Springfield Nursing & Residential Home medication. 5. OP9 13(2) Staff must administer medication 10/06/07 in accordance with the prescribers’ instructions so that people who use the service receive the correct amount of medication at all times. Directions should be clearly recorded so that staff know how to give the medication correctly. There must be an effective system in place to audit medicines management within the service in order to ensure that people who use this service are receiving the correct medication. Staff who are authorised to handle and administer medication must receive appropriate training and be assessed as competent to perform these duties in order to protect people who use the service. 10/06/07 6. OP9 24(1) 7. OP9 18(1) 10/06/07 8. OP9 13(2) There must be adequate supplies 10/06/07 of medication available at all times so that people who use the service receive their medication correctly. The registered person must 31/05/07 make sure that the way staff speak to people using the service and assist them with their personal care promotes their rights to privacy and dignity. (Timescale of 30/04/06 not met) The programme of activities must be revised to ensure that people using the service have access to a range of activities appropriate to their diverse DS0000022482.V330815.R01.S.doc 9. OP10 12(4)(a) 10. OP12 16(2) (m-n) 30/09/07 Springfield Nursing & Residential Home Version 5.2 Page 29 interests and abilities. (Timescale of 31/10/05 not met) 11. OP29 19(4) Schedule 2 The registered person must ensure that all pre-employment checks are carried out and all information and documents are obtained before a member of staff commences work at the home in order to ensure that the staff are fit to work with vulnerable people. Staff commencing work before a full CRB disclosure is returned must be supervised by an experienced member of staff to ensure that vulnerable people are not put at risk from staff who have not had all checks completed. (Timescale of 01/12/05 not met) 12. OP38 13(4)(a) Open storage of potentially hazardous substances such as denture cleanser must be assessed for the risks they present to people using the service and action taken to reduce any identified risk. (Timescale of 30/04/06 not met) 31/05/07 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user’s guide should be revised so that people who are considering moving into the home have accurate and up to date information about the services and facilities provided. DS0000022482.V330815.R01.S.doc Version 5.2 Page 30 Springfield Nursing & Residential Home 2. OP9 Dose changes should be clearly recorded on the MARs and signed by two members of staff, so that residents receive the correct dose of medication. Changes should be crossreferenced in the care notes and where possible, confirmed in writing by the prescriber. Temperatures of medication storage rooms should be monitored and maintained below 25°c Temperatures of medication fridges should be monitored and maintained between 2-8°c The opening date should be recorded on all short-dated products to ensure medication is not given when it is out of date. MARs should be kept up to date and have only currently prescribed medication listed. 3. OP12 Staff should have access to training on providing occupation for people with dementia to ensure that they have the knowledge and skills to provide meaningful activities to people with specialist needs. Care plans should include information about the likes, dislikes and preferences of the people using the service, so that staff have some background information when they need to make choices and decisions on their behalf. Staff should receive training on how to deal with complaints so that people using the service, and their relatives, can be confident that their complaints are responded to appropriately The wishes of people using the service with regard to locks on their bedroom doors should be sought, recorded and actioned. The manager should continue to move ahead with the training in safe working practice topics, person centred care and safeguarding adults, to ensure that people using the service are supported by staff who have the right knowledge and skills to meet their needs. The manager should submit an application for registration as soon as possible. The manager should make sure that all accidents are DS0000022482.V330815.R01.S.doc Version 5.2 Page 31 4. OP14 5. OP16 6. OP24 7. OP30 8. 9. OP31 OP37 Springfield Nursing & Residential Home recorded on the appropriate forms to ensure that they are included in the accident audit for that person. Springfield Nursing & Residential Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB 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 Home DS0000022482.V330815.R01.S.doc Version 5.2 Page 33 - 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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