Inspection on 22/10/07 for Springfield Nursing & Residential Home

This inspection was carried out on 22nd October 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 &... 10/05/07

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 22nd October 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing & Residential Home DS0000022482.V348094.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.V348094.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) vacant post 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.V348094.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. 10th May 2007 2. Date of last inspection Brief Description of the Service: Springfield Nursing and Residential Home is registered to provide care to a maximum of 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. Levels 3 and 4 of the home are currently closed. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 5 The home is situated in a residential area close to local amenities. The main 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 22nd October 2007 the weekly fees ranged from £334.00 to £509.00. Additional charges are made for toiletries, hairdressing and newspapers. Springfield Nursing & Residential Home DS0000022482.V348094.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 22nd and 24th of October 2007. Two regulation inspectors and a pharmacist inspector carried out the visit. They were assisted by an expert by experience. This is a person who has experience of care services and understands the needs of older people. At the time of the visit there were 36 people accommodated in the home. 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. Six people living at the home were case tracked. This meant that the inspectors looked at their care plans and other records and talked to staff about their care needs. As part of the key inspection a number of surveys were sent out to; people living at the home, their relatives, staff working at Springfield and visiting health professionals. Comments received on the surveys have also been taken into account when writing the report. During the visit discussions were held with the temporary manager, several members of the staff team and some visitors. The inspectors looked round the home and viewed a number of documents and records. This report also includes information from the Annual Quality Assurance Assessment (AQAA), which is a self-assessment that the manager has to fill in and send to the Commission every year. What the service does well: Before anyone moved into the home the manager visited them to assess what care they needed and to make sure that their needs could be properly met at Springfield. A number of people using the service and relatives expressed satisfaction about the care and the staff. One person said, “I’ve no complaints about anything and I am happy here.” A relative wrote that staff were good at helping people, and another commented, “All the staff are very good, helpful and caring. There was an open visiting policy, which meant that people could see their relatives at any time. Visitors were made welcome and offered refreshments. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 7 Most people said they enjoyed the meals at Springfield. There was a varied menu and people could have something different if they wished. People using the service, and their relatives, were invited to fill in surveys about what they thought of the home. The manager had made an action plan to address any areas that people thought were not of a good standard. The manager carried out checks to make sure that the quality of care at the home was continually improving. People using the service and their relatives had a number of ways they could make their views known. 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? Although further improvements were still needed, most of the care plans seen were better than at the last inspection. They contained more information about what help the resident needed. Instructions for staff were also clearer. A number of staff had received further training in person centred care. This gave them a better understanding of the individual needs of people using the service, especially those with mental health needs. As a result people had more choice about their daily routines and lifestyles. The level of activities had improved, which meant that more people had opportunities for meaningful occupation. Everyone was given a programme of what was on offer for the month. One person said, “I have read the activity programme and choose if I want anything.” Another person said they enjoyed the film nights. A relative said she had heard about the activities and thought them a good idea. There had been some more improvements to the environment, which meant that people using the service had a more comfortable and homely place to live. For example, some areas had been decorated and had new carpets. One person remarked that they were happy with their room, which they had made their own. The level of staff training had improved since the last inspection. Accurate training records were in place. These showed that all staff had received or were due to receive training in health and safety as well as other relevant topics. The management of the home had improved. The temporary manager had set up a number of systems to improve the overall quality of care for people living at the home. A number of staff agreed that things were better since the temporary manager had taken over. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Springfield Nursing & Residential Home DS0000022482.V348094.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.V348094.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 adequate. This judgement has been made using available evidence including a visit to this service. The lack of information about the service meant that people thinking of moving into the home may not have sufficient information to assist them to make a decision. EVIDENCE: The service user’s guide was in the process of being updated to include details of the new manager. New copies were to be distributed to people using the service and anyone thinking of moving into the home. There was no statement of purpose. The manager took steps to rectify this and said that the document would be made available as soon as possible. People were generally referred to Springfield following a needs assessment by health or social care professionals. The manager also assessed anyone thinking of moving into the home to ensure that the facilities at Springfield and Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 11 the skills and experience of the staff team were sufficient to meet the person’s needs. Standard 6 was not applicable. Intermediate care is not provided at Springfield. Springfield Nursing & Residential Home DS0000022482.V348094.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 adequate. This judgement has been made using available evidence including a visit to this service. Although improving, the lack of consistency in health and personal care planning and delivery could compromise people’s safety or result in their needs not being met. EVIDENCE: Six sets of care records were inspected as part of the case tracking process. Others were looked at in less detail. All six contained a completed dependency assessment. The assessments were designed to be started pre-admission, then built upon as staff became more familiar with the person. Some of the assessments contained very detailed information, which gave a good sense of the person’s abilities as well as needs. Others were brief and not particularly informative. Some of the assessments had been updated when the person’s needs had changed but because not all of the documents were dated it was difficult to be sure that all information was current and up to date. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 13 Care plans were generated from the assessments. There were some general improvements in the quality of the care plans. Staff were receiving training to assist them to write more individualised plans. One member of staff said, “documentation is more detailed and person centred.” Some plans were highly personalised and instructions for staff were clear and detailed. This helped to make sure people received care in the way they preferred. For example, some plans stated how and when the person wished to receive personal care, their preferences for clothing and information about food preferences. Other plans did not address people’s needs or wishes as identified in their assessments. For example, one person’s assessment indicated that they were sometimes unsettled and wished to leave. There was no plan to instruct staff in the best way to help the resident. Another person’s assessment indicated how often they preferred a shower but their care plan gave different directions. Care plans were reviewed every month. Some of the summaries gave a good account of the care given. Others showed a lack of understanding about where information should be recorded. For example some reviews were more instructive than the care plans. Care plans were not always updated when the person’s needs changed, which meant that staff could be giving out of date care. This is particularly important given the high use of agency staff. Only one of the plans contained evidence of consultation with the resident or their relatives. The manager and staff said that meetings were being arranged with family members but not all had taken place yet. Each care file included appropriate health care risk assessments. However these were not always updated when the person’s needs changed. For example, one person had had multiple falls but their risk assessment had not been altered and there was no plan to help with prevention. Another person was at high risk of developing pressure sores but the corresponding plan was not adequate. Risk assessments and checks of bed rails had improved since the last inspection. There was evidence that residents were referred to appropriate professionals for health care. However, advice was not always incorporated into the care plans or acted upon. For example, one person had been prescribed nutritional supplements after seeing the dietician but they were not being given. There were mixed views about the standard of care at the home. Some residents and relatives who returned surveys indicated that they were satisfied with the level of care and the service met their needs. However, one relative expressed concerns about care practices and another about the administration of medicine to their relative. Both were advised to speak with the manager. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 14 Most staff had received training that covered core care values. People were assisted with personal care in private. Staff hung notices on bedroom doors to alert people to knock and wait for permission to enter. All the bathroom and toilet door locks were working. One member of staff discussed how she ensured people were treated with dignity by giving them choices and “not treating them like children”. Another said that the training in person centred care had helped a lot. There were still occasional staff notices in people’s rooms or in other resident areas. For example, there was a bathing list on the wall on Level 2. The company had also issued notices to be put up in bedrooms where bedrails were in use. These looked institutional and out of place in rooms that were otherwise homely and personalised. The medicines policy was available within the home providing guidance in the handling of medication. Staff spoken with said that the manager carried out audits (checks) of medication handling and they knew that record keeping was an area they needed to continue to improve. There were still some ‘gaps’ but a sample audit of records and blistered medication showed that medicines were mostly administered as prescribed. But, where e.g. ‘one or two’ tablets were prescribed the actual dose given was not always recorded. Some records still listed medication that staff thought had been ‘stopped’. To reduce the risk of mistakes a note should be made on the administration record when medicines are ‘stopped’. Examples were seen where verbal dose changes were clearly recorded but this was not always the case. As a result. one medicine was given differently from the recorded instructions and it was not possible to tell whether this was being done correctly or in error. Stock control and ordering of medication had improved but it was of concern that one person had missed a laxative for 11 days because the medicine had not been written onto the new administration record. Records did not always show whether GP advice had been sought if someone chose to mostly refuse their medication. Advice is needed to help ensure that people get the most suitable treatment. The administration of nutritional supplements was poorly recorded and needs improvement to ensure they are given correctly. Staff said that more carers had completed certificated medication training and that the manager checked the way they handled medicines in the home before they were allowed to manage a medication round alone. This assessment of staff competency should help to improve medicines handling at the home. Medicines were securely stored within the medication rooms but the room on level 1 needed clearing out as it was still used to store things that had been Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 15 kept there when it was an office e.g. old kettle and phone books. Staff said one cupboard had not been unlocked for ages; it contained unwanted medicines that need to be sent for safe disposal. Springfield Nursing & Residential Home DS0000022482.V348094.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 good. This judgement has been made using available evidence including a visit to this service. Daily routines and meals suited the majority of people living at the home. Improvements in the level of activities meant that more people were being assisted to meet their social and recreational needs. EVIDENCE: Some assessments included information about people’s preferred daily routines, meal preferences and social activities. One member of staff talked about the benefit of having this information on record as it helped staff to assist people who were not able to tell them what they liked. Staff were working towards including this information on care plans so that it became part of everyday care. Routines had improved and were led more by the needs of people using the service than the needs of staff. For example, on arrival to the home there were only two people up on Level 1. A member of staff said that people were no longer assisted to get up and dressed unless they wanted to. Two other members of staff talked about how the recent training in person centred care had helped them to understand about the importance of giving Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 17 people choices and meaningful occupation. For example one member of staff discussed how enabling a resident to have a small job helped them to feel responsible and valued. A full time activity organiser had taken up post since the last inspection. Although the person in post was an experienced carer, she had not received any training in providing activities. The manager said that relevant training had been sourced and would take place soon. The inspectors were told that the current budget for activities also limited the programme. The programme included one to one time with residents who did not or could not join in with the groups. A monthly activity programme was sent round to everyone so that they knew what was on offer. One resident said, “I have read the activity programme and choose if I want anything.” Another said, “I’m going to the coffee morning – it’s the only thing I go to, it makes a change.” On the day of the visit the expert by experience attended the morning activity. Although it was well attended and people seemed to enjoy it, it was felt that the session could have been improved even further if the organiser had had more time to prepare. Staff were very positive about the activities which one described as, “brilliant.” One member of staff said that film night was so well attended there were only about 4 people left on the unit. There was an open visiting policy. Staff were seen to greet visitors and offer them a drink. Relatives were invited to social events such as the cheese and wine evenings. Contact with the local community was still limited but residents could book one to one shopping trips on a Wednesday with the activity organiser. Most people, including those who returned surveys, said they liked the meals. One person commented that they didn’t like meat very much but there was always something suitable for them. Another person said that they were offered an alternative whenever there was something on the menu they did not like. The cook said she spoke to people when they came into the home to find out their likes and dislikes and if they had any special requests or diets. Menus were not planned by people using the service, although they had opportunities to make suggestions. Meals generally looked appetising but one person was being assisted to eat a pureed meal that had all components mixed together. Dining tables were set and people were served on trays in their rooms if they wished. Staff were Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 18 available to provide assistance but there was a short time during the first day of the inspection when people were left unsupervised in the dining room. Menus and records of meals showed that people were offered a varied and balanced diet. A new document had been produced by the company giving information and advice about specialist diets, nutritional values of food and locally appropriate menus. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 19 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. Procedures were in place to ensure appropriate responses to formal complaints and explicit allegations of abuse but less obvious incidents may go unrecognised. EVIDENCE: The complaint procedure was displayed in key areas of the home. The procedure explained how to make a complaint and included information about who to contact if the matter could not be resolved. People who returned surveys indicated that they knew who to speak to if they were not happy. Records showed that formal complaints were acted upon and efforts made to resolve matters. There had been 2 complaints since the last inspection, one directly to the home and the other via the Commission for Social Care Inspection. One was upheld and the other partly upheld. Complaints relayed to staff were still not being passed on to the manager. For example, a relative said she had made a number of concerns known to staff but there was no record of this on the complaints log. The manager said that Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 20 all staff were due to receive customer service training which should address the issue. Staff had access to the Blackburn with Darwen policy and procedure relating to safeguarding adults. There was also a policy and guidance specific to Springfield. Training in safeguarding was ongoing. The staff spoken with during the inspection were aware of their roles and responsibilities in reporting any allegations to their line manager and outside the home if necessary. Unexplained bruising and other injuries were recorded and audited by the manager every month. A member of staff had recently reported a significant unexplained injury to a duty manager in the absence of the home manager. The injury had been taken seriously and relatives had been informed. However, an investigation had started prior to the incident being referred to social services under safeguarding procedures. This indicated that there could still be some misunderstandings about the safeguarding procedures. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, not all areas of the home were clean, comfortable and safe. EVIDENCE: There was an ongoing plan of routine maintenance. The building was well maintained and there were no obvious outstanding repairs. Several areas had been redecorated since the last inspection and there were a number of new carpets. Most bedrooms were personalised with small items of furniture, pictures and ornaments. One person said he was very happy with his room, which he had made his own. A relative commented that they were pleased with their mother’s room. Only one person made a negative comment about their bedroom, saying it was not as warm as the corridor. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 22 The Annual Quality Assurance Assessment (AQAA) indicated that a complete refurbishment of the home was planned for 2008. There was still no evidence that people were being asked as a matter of routine whether they wanted a lock on their bedroom door. Some locks had been fitted on Level 1 to ensure that people could have privacy when they were in their bedrooms. However, these were not of the type that could be locked when the resident left the room. This meant that some people, who were disorientated, were still going in other people’s rooms and touching their belongings. At the time of the visit most areas of the home were clean and free from unpleasant odours. People living at the home who returned surveys indicated that it was always like that. However, there were some areas that needed some attention. A number of chairs were stained and some had food debris on the arms and down the sides. The satellite kitchen on Level 2 was in need of deep cleaning and refurbishing. A family member who returned a survey commented that their relative’s room was in need of dusting and polishing. Staff had received infection control training and they were seen to wear gloves and aprons when helping with personal care. One member of staff said that protective clothing was always available. The laundry was adequately equipped for the size of the home and there were sufficient hours allocated to laundry staff. There were mixed comments about the laundry. One person said, “There’s no problem with my laundry. It comes back clean and ironed,” but a relative commented that items disappeared and the care of the clothes was not good. The manager said that there was a new system planned for the laundry. The Commission for Social Care Inspection had received a complaint about people having problems gaining access to the home since the closure of Level 3 (ground floor), especially out of hours. At the time of the inspection a relative said the home had a reputation for being difficult to get in to. The expert by experience also said it took her three attempts before the intercom was answered. The present system also meant that people were let into the building without their identity being checked, which could put people living at the home at risk. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, people using the service were not always supported by a consistent and appropriately trained staff team. Recruitment practices were not thorough enough to provide complete safeguards. EVIDENCE: The duty rosters showed that there were usually enough staff on duty in relation to the number and dependency ratings of people living at the home. Although staff were very busy, the pace was not as hectic as at previous inspections. However, there was still a high percentage of agency staff being used. The manager said that the closure of Level 4 would help to improve staffing numbers and she was actively recruiting care staff at the time of the visit. The temporary manager had audited all staff files and ensured that everyone working at the home had a current CRB disclosure. The files of two new staff were inspected. The main pre-employment checks, such as CRB checks and references, had been carried out. However, one person had not dated their employment history, which meant that it could not be verified. This had not been explored during the recruitment process. One person did not have a health declaration on their file. Other documents, such as proof of identity, were still held by the person who applied for the CRB Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 24 disclosures even though both disclosures had been returned over a month ago. The manager had one set returned at the time of the visit. All new staff went through an induction programme relevant to their post. Registered nurses had a short induction that orientated them to the home and to relevant policies and procedures of the company. The programme for care staff followed the Skills for Care common induction standards. Staff were mentored through a comprehensive workbook, which included training on core values and equality and diversity. Staff said that opportunities for other training had improved. One said that there was some training almost every day and another said, “training has definitely improved; everyone is now trained to a tee.” Two staff also commented that practice had improved because of the training. The training matrix showed improvements in the levels of training in safe working practice topics. Dates were planned for staff who had not yet attended. The training plan included estimated dates for completion for all staff. Most staff working with people with dementia had received training in person centred care. It was planned for this to be rolled out to other staff. Information on the AQAA indicated that all senior care staff either held or were working towards NVQ level 3. Over 50 of other care staff were enrolled on the NVQ 2 course but were not close to completion. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems were being put into place to improve the organisation and management of the home for the benefit of the people living and working there. EVIDENCE: The home was without a registered manager at the time of the visit. A temporary manager had run the home since July. Several members of staff commented that improvements had been made in this short time. One said that the manager “ is directing us in the right way.” Two others said there had been a lot of changes for the better. A permanent manager has been appointed and starts in November. There is to be a short handover period. Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 26 The internal audits seen at the previous inspection had been redone since the temporary manager took over. Although the audits identified shortfalls in several areas, the manager and staff were working towards improving the quality of care at the home. The company was also monitoring the service closely to ensure that the manager had sufficient support and resources to carry out the planned improvements. The service did not have the Blackburn with Darwen quality assurance award but was due to be assessed sometime in the new year. People using the service and their relatives also had opportunities to make their views known. They were invited to complete surveys which were distributed by the company. The manager had also held a resident and relative meeting and another one was being advertised. The company acted as appointee for five people. At the time of the visit the arrangements for handling residents’ monies were under review. The records were being audited and a regional finance team were managing the accounts. As a consequence the records were not available for inspection on the day of the visit. The manager had access to petty cash, which enabled people to withdraw small amounts of money immediately. Servicing and testing of the fire system, equipment and alarms was up to date. Most staff had received fire safety training and the rest had a firm date to attend. All the staff spoken with were aware of the procedure to follow in the event of a fire. Certificates were available to evidence maintenance of electrical installations and gas equipment in the home. All electrical appliances had been safety tested. As previously required, accidents involving people living at the home were recorded and audited monthly. Despite a previous requirement, caustic denture cleaner was seen in two 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.V348094.R01.S.doc Version 5.2 Page 27 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 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 2 X X 2 Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 28 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 31/12/07 2. OP7 15(2) 30/11/07 3. OP8 13(4)(b-c) Health care risk assessments must be kept under review and strategies to control risks must be changed as the level of risk changes. (Timescale of 31/10/05 not met) 17(1) Sch 3 (i) 30/11/07 4. OP9 Full and accurate records of all 30/11/07 medicines received, administered and leaving the care of the home must be maintained to ensure people are given the correct DS0000022482.V348094.R01.S.doc Version 5.2 Page 29 Springfield Nursing & Residential Home medication. (Timescale of 10/06/07 not met) 5. OP9 13(2) Staff must administer medication 30/11/07 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. (Timescale of 10/06/07 not met) 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. (Timescale of 30/06/07 not met) 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) 30/11/07 6. OP29 19(4) Schedule 2 7. OP38 13(4)(a) 30/11/07 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 DS0000022482.V348094.R01.S.doc Version 5.2 Page 30 Springfield Nursing & Residential Home 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. 2. 3. 4. OP7 OP9 OP12 Care records, including assessments and care plans should be dated so that people can be sure they are up to date. MARs should be kept up to date and have only currently prescribed medication listed. The member of staff responsible for organising activities should have training in providing activities for people with dementia. 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. In order to fully safeguard people using the service, any significant unexplained injuries should be referred to social services’ protection team before undertaking an internal investigation. Arrangements for access to the home should be reviewed to ensure that people visiting the home can gain entry but the safety of people using the service is not compromised. Training should continue in accordance with the training plan to ensure that people using the service are supported by an appropriately qualified and skilled staff team. The Commission for Social Care Inspection should be notified of the outcomes and any action to be taken in respect of the review into peoples’ finances. 5. OP16 6. OP18 7. OP19 8. OP28 OP30 9. OP35 Springfield Nursing & Residential Home DS0000022482.V348094.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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.V348094.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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