Inspection on 24/04/06 for Springfield Nursing & Residential Home

This inspection was carried out on 24th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 &... 10/05/07

Springfield Nursing &... 05/10/06

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 24 and 25th April 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 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 Four Seasons Healthcare (England) Limited (Wholly owned subsidiary of Four Seasons Health Care Ltd) Mrs Helen Sellars 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.V287465.R01.S.doc Version 5.1 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 users 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. 29th November 2005 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. Sixteen bedrooms have en-suite facilities; the remainder have hand-wash basins installed. The home stands in its own grounds with ample parking facilities. It 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. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 5 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. Information received from the home on 19th April 2006 indicates the range of weekly fees is £312 to £450 for residents who are self funding. Additional charges are made for toiletries, hairdressing and newspapers. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place over 2 days and was carried out by 2 inspectors. At the time of the visit there were 52 residents accommodated in the home. The inspectors met with residents from each level and spent time observing interactions between staff and residents. Wherever possible residents were asked about their views and experiences of living in the home and some of their comments are quoted in this report. The inspectors met with several visitors to the home. Three visitors had also returned comment cards that were sent out before the inspection. Discussions were held with the new manager and twelve members of day and night staff. A tour of the premises took place. A number of documents and records were viewed, including information sent in by the manager before the visit. There had been one extra visit to the home in response to a complaint raised by an anonymous contact. The complaint was about lack of staff on night duty in one area of the home. The complaint was upheld and had been put right by the time of the visit. What the service does well: What has improved since the last inspection? Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 7 The complaints procedure had been changed to give residents and visitors clear information about how to complain. The procedure also gave some idea of how any complaints would be dealt with. Improvements to the environment continued. Outstanding repairs had been completed and more areas had been, or were due to be, decorated. A permanent manager, who had several years experience in running a care home, had been appointed. What they could do better: The information about the home given to new residents was not always accurate and up to date. They were not given information about the rules of the home until after they moved in, which could lead to misunderstandings. Not all residents were assessed before they were offered a place. This meant that staff did not have a clear picture of their needs, and how they would fit in at the home. Written care plans did not always give staff enough directions about what care the resident needed and sometimes residents did not receive the right personal care. Residents or their relatives were not generally involved in talks about their care. Staff understood about residents’ needs for privacy and dignity but there were times when they were not met. There were concerns that the residents’ medication was not managed safely. There had been very little progress made in this area since the last inspection. There were not enough suitable activities organised for residents who were not able to occupy themselves. One resident said, “it’s quite a nice place but there’s nothing to do all day.” Residents did not have many opportunities to go out and there were few links with the local community. 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. Low numbers of staff and high dependencies of residents at mealtimes meant that some residents had to wait to be assisted to eat their meals and the food was not at its best. Staffing levels were lower than at the last inspection. A number of residents, visitors and staff commented that there were not enough staff on duty in some areas of the home. Staff were concerned that standards of care had fallen and one visitor wrote, “There is not enough staffing cover for them to be able to provide care we pay for.” The way that new staff were recruited was not thorough enough. Background checks were not carried out in all cases and new staff were not supervised to make sure they were following the correct procedures. There was not enough training for new staff and existing staff had not completed required training. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 8 Residents did not have enough opportunities to make their views about the home known or to make suggestions for improvements. One resident said, “They don’t ask if we’re happy, they haven’t even got time to talk.” Not all staff were clear about what to do in the event of fire. The written procedure was not clear and a number of staff had not received fire safety training or been involved in drills. The manager must address these issues to ensure the safety of residents. Other health and safety training was not up to date. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 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.V287465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents did not have complete and accurate information on which to base their decision to enter the home. Lack of complete assessments before admission may result in residents’ needs not being understood and met. EVIDENCE: The statement of purpose and service user’s guide had been revised but still contained inaccurate and out of date information. The manager stated that the service users guide was sent out to prospective residents. Copies were also available in the foyer of the home. Two residents and a relative who were asked could not remember receiving the information but also said they were not really bothered. Contracts were on the files of residents who were self funding but these had not been signed by the resident or their relative as accepted. There was no evidence that recently admitted residents had received a statement of terms and conditions of residency. The document could not be located at the time of the inspection visit. The service users guide indicated that residents do not Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 11 have sight of the terms and conditions until after their admission, which meant they did not have full and accurate information about the rules of the home before their admission. Six of the residents who were case tracked had been admitted in the past five months. Of these, only two had been assessed, by senior staff from the home, before being offered a place. The assessments were thorough and identified residents strengths and needs. However, only one had been used to inform the resident’s initial plan of care. None of the residents had received written confirmation that their needs could be met at the home. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were not always met and some staff practices ignored residents’ privacy and dignity. Some medication practices were not safe and placed residents at risk. EVIDENCE: Seven of the eight residents case tracked had written care plans. The standard of the plans varied between areas of the home. The plan for a resident on Level 3 was detailed and provided staff with information as to how the resident’s personal, health and social care needs were to be met. Several staff said that plans were not used as working documents and they had no time to read or write in them. Plans for residents on Level 1 did not always address the needs highlighted in assessments or progress notes. Plans did not reflect the specialist needs of people with dementia and psychological health care plans were not personalised. Directions to meet residents’ individual personal care needs were not detailed enough. A visitor remarked on the poor hygiene of a resident who was known to be resistive to care. Another resident did not receive appropriate eye care on the day of the visit. There were no social care Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 13 plans. Standard care plans for assisting residents in case of fire must be reviewed as they may conflict with the fire procedure for the home. There had been some improvements to care plans on Level 2 but they were not consistent. Despite previous requirements, not all plans provided directions to assist with oral care. Only one resident had a care plan to address psychological health care needs. There were no social care plans. Staff reported that not all residents on Level 2 received the correct level of personal care, for example, bathing because of a lack of staff. There was no care plan in place for the resident case tracked on Level 4 despite them having physical health care needs that required close monitoring. Only one of the plans showed evidence of consultation and agreement with the resident or their relative. One resident said they were aware they had a care plan but had never been consulted about it. Another said, “No-one has sat down with me and talked about my problems and how I’m going to be cared for.” Plans were generally reviewed every month but not always updated in accordance with changes in need or care. Only two of the plans seen included the residents’ wishes with regard to care during a terminal illness and after death. The registered person has consistently failed to address a number of the issues highlighted above. There were major shortfalls in meeting standard 7 and outcomes for some residents were poor. With the exception of the resident on Level 4, all plans included risk assessments to monitor moving and handling, nutrition, continence, and pressure sore risk. General risk assessments were used for falls and other specific hazards. These were not always complete and strategies were not always in place where risk was identified. Staff expressed concerns that residents on Level 2 may be at risk of losing weight due to changes in their eating patterns because of staff shortages. One resident had lost weight but other residents’ case tracked had not been weighed. One resident said they believed they had lost weight but there was no weight record on their care plan. Some residents had care plans to assist staff to monitor ongoing health care needs such as diabetes and chronic breathing problems. There was evidence that the residents who were case tracked had appropriate access to health care professionals. Most residents made positive comments about the level of care but one resident said that he was not kept informed about issues to do with his health. Relatives made mixed responses, some were satisfied but others felt that things could and should be improved. Not all residents who were self medicating had been assessed. One resident on Level 1 was observed to be unsafe administering her own medication. The medication was not included on the Medication Administration Record (MAR) chart and the staff were not aware of the prescription details. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 14 There were inadequate records of medication received and disposed of. There were gaps on MAR charts with no explanation as to why medication had not been given. Creams and other external preparations were not always signed for. Cream prescribed for one resident was found in another resident’s room. Handwritten amendments on MAR charts were not always witnessed. A number of residents were prescribed medication to be taken only ‘when required’. Some residents had very clear criteria for when medication should be given but others did not. Variable dose medicines were not clearly recorded so staff would not be aware of how much of the medication a resident had taken. Medication storage areas were safe, clean and tidy. Hand-washing facilities had been provided on Level 2, as previously required. There were no excess stocks of medicines but medication belonging to deceased residents was found on Levels 4 and 2. Storage temperatures on Levels 1 and 2 were monitored and satisfactory. Levels 3 and 4 were not recorded. Controlled drugs were stored correctly and records were accurate. There was a contract for the disposal of medication and records were kept. However, three lots of controlled drugs, no longer in use, had not been disposed of. Thirteen members of care staff were undertaking training in handling medication. Care plans made reference to ensuring residents’ privacy and dignity when providing personal care and staff gave examples of how this was achieved. Residents said that they had privacy in their rooms and staff knocked on the door before coming in. During the course of the visit staff were observed talking to residents respectfully and sensitively. However, some of the practices observed compromised residents’ privacy and dignity. Residents on Level 2 were left sitting in wheelchairs all morning. Two residents on Level 1 were being assisted to eat at the same time. A number of residents on Level 1 were not wearing tights, stockings or socks; there was no reason for this recorded in their care plans. A notice for staff, which gave details of a resident’s personal care, was on display in the dining room on Level 3. Areas of concern were identified by an anonymous contact in April 2006 about continence management and pain control. These issues were looked at during the visit to the home. Two care plans seen had not been amended to reflect changes in residents’ continence needs, which meant that those residents may not receive appropriate care. There were no residents at the time of the visit who reported or were observed to be in pain. Records of medication demonstrated that pain killers were given as prescribed. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A significant number of residents had limited choice and control over their lives and many were under stimulated. Residents were offered a nutritious and healthy diet but mealtimes were not pleasant and social occasions for all residents. EVIDENCE: There were only a small number of residents who were able to talk about their daily life in the home. These residents’ comments included, “it’s great,” “it’s very nice here,” and “it’s smashing here, you won’t find anything wrong.” A few residents kept themselves occupied during the day but most relied on staff support. There were a number of negative comments about the lack of organised occupation and activity within the home. One resident said, “It’s quite a nice place but there’s nothing to do all day,” another said, “I’m bored, all I do is watch TV.” A relative commented that residents were under stimulated. There was a limited activity programme organised by a part time co-ordinator. However, the amount of time allocated to activities was insufficient to cater for the number of residents over the four floors and to meet their various needs. Care staff said they did not have the time to provide regular activities and most residents were not engaged in any meaningful occupation throughout the course of the inspection. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 16 There was an open visiting policy. Visitors said they were made to feel welcome and they were kept informed about their relative’s condition. Several residents went out regularly with their families but there were few opportunities for others to go out. Two of the residents spoken with said they went out into town with staff. One said that it didn’t happen very often because staff had to do it in their own time. There were few links with churches and schools in the local community. A few residents, who were able, made choices about their daily routines. One resident said, “I get up at any time, it just depends on what kind of a night I have.” Another resident said she chose to spend most of her time in her room and have her meals there. The care plan for one resident showed that she had an agreement with staff not to check on her at night because she did not wish to be disturbed. However, many residents were unable to make informed choices and decisions. Staff said they made choices on behalf of those less able residents by getting to know them and their likes and dislikes. However, only two of the plans seen included any information about residents’ preferences for routines, food and activities. This means that essential information was not passed on to other staff. In addition, two members of staff said that, because of staff shortages on days, the night staff on Level 2 were getting residents up, washed and dressed, unless they specifically said they did not want to get up. Few residents on Level 2 were able to express a choice. This issue had also been raised as an anonymous concern in January 2006 and again in March 2006. Records of menus showed that residents were offered a varied and nutritionally balanced diet. Special diets were catered for. Residents were generally very complimentary about the food. Comments included, “we eat very well,” “the food’s good, you get a choice,” “marvellous,” and “you even get a choice of diabetic puddings.” Mealtimes on Levels 1 and 2 were not relaxed, social occasions. Ten residents on Level 2 required physical assistance with their meals and others needed supervision. Staff said that they had to rush residents and some meals had to be reheated in the microwave. A number of staff and one visitor also commented that, because of staff shortages, breakfasts were not finished until 10.30 to 11am. This meant that some residents were not hungry at lunchtime. The daily notes for one resident stated, “small dinner taken due to late breakfast due to short staff.” Concerns about food were identified by an anonymous contact in April 2006 and were looked at during the visit to the home. It was found that residents on Levels 1 and 2 sometimes had to wait to be assisted to eat and their food had to be reheated. The reasons given for this was lack of staff at mealtimes. All residents were seen to receive their full meals and drinks. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a satisfactory complaints system but the lack of adequate records may prevent potential weaknesses in the home from being highlighted. The manager and staff were aware of adult protection issues which meant that any allegations would be dealt with appropriately. EVIDENCE: The complaints procedure displayed around the home included all the required information. A relative said that she had reported an incident that had been dealt with satisfactorily which gave her confidence to report any other issues. Two residents said they had made minor complaints that had been dealt with but there were no records of these. Records that were in place were much improved, with evidence of investigation and actions taken. Staff had not received training in receiving and handling complaints as recommended following the last inspection. The Commission for Social Care Inspection had received four anonymous complaints since the last inspection. All of them were partly true. Staff had written guidance in the protection of vulnerable adults. Although not all staff had received training, all those asked during the visit were aware of their responsibilities in reporting allegations of abuse. All were aware of how to report outside the home if necessary. There had been two allegations of abuse since the last inspection. Both had been reported and dealt with appropriately by the manager. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24, 25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further improvements to the environment meant that residents had a comfortable, homely place to live. EVIDENCE: There had been further improvements to the environment. Most of the maintenance and repairs identified during the last inspection had been carried out. There were plans for redecoration to some areas of the home and new dining furniture had been ordered for Level 2. The shower room on Level 1 was out of action following a flood but staff said it was being attended to. The programme to fit radiator guards was well underway. The manager stated that the remainder would be fitted in accordance with the risk assessment. Most residents spoken with were satisfied with their bedrooms. One said, “it’s very nicely decorated and it’s clean,” and another commented, “my room’s very nice, I’ve brought pictures from home.” Despite previous recommendations to enhance residents’ privacy, locks were still not being fitted to bedroom doors as a matter of routine. One member of staff confirmed Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 19 that residents were not asked about locks. Only two residents expressed dissatisfaction about this during the visit. The home was clean and tidy at the time of the visit. There were no offensive odours. Staff were observed wearing protective clothing and clinical waste and laundry were handled appropriately. The laundry was adequately equipped and there were sufficient hours allocated to laundry staff. However, two visitors expressed concerns about the state of clothing in residents’ bedrooms. Clothing was put away un-ironed and in the wrong rooms. Another relative complained about pillows that had been laundered and returned out of shape. These concerns were brought to the attention of the manager. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Shortfalls in staff recruitment and training place residents at risk. EVIDENCE: Staffing numbers on Levels 1 and 2 had been reduced since the last inspection. Two members of staff and a visitor to Level 1 indicated that there were not always enough staff to respond to the needs of residents. On the day of the inspection there was a lack of supervision of residents in the communal lounge and at mealtimes and shortage of staff time contributed to the lack of stimulation and occupation observed. Residents, visitors and staff on Level 2 commented on the shortages of staff. One resident said, “it’s very disorganised here. There’s not enough staff.” A visitor who completed a comment card stated, “There is not enough staffing cover for them to be able to provide care we pay for.” Four staff said that poor staffing levels and increased dependencies of residents had resulted in a fall in standards of care. The Commission for Social Care Inspection received 2 anonymous complaints in December 2005 and January 2006 expressing concerns that the night time staffing numbers on Level 2 had been dropped resulting in lack of supervision and attention to residents. Staffing numbers had been restored but nursing staff said they were still off the floor for at least 2 hours whilst doing medicine rounds on the other units. The manager was confident that this would improve as care staff completed medication training. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 21 Files of four new employees were inspected. Two commenced work after the initial pre-employment check (POVAfirst) but there was no evidence that they were appropriately supervised until their full CRB disclosure was returned. One member of staff was working at the home without a POVAfirst check. None of the files contained all of the required information and documents. All but one of the new staff spoken with said they had received some induction training. They described being shown around the home and looking at policies and procedures. However, there was no evidence of any induction training on the files. Training records for other staff were not up to date. Some staff had received training in continence management and protection of vulnerable adults since the last inspection but there was no evidence of other courses. Not all staff working on Level 1 had received appropriate dementia care training. Only 30 of care staff were trained to NVQ Level 2 or above. Training in safe working practice topics was not up to date. Inappropriate moving and handling of residents had been raised as a concern by an anonymous contact in April 2006. At the time of the visit staff were seen to use the correct equipment and techniques but the fact that several staff were not trained in up to date techniques may place residents at risk of injury. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Instability within the management of the home has contributed to the lack of improvement in management practices. Residents did not have sufficient opportunities to make their views known and influence change. Some health and safety practices placed residents at risk. EVIDENCE: A new manager, a registered nurse, had been employed at the home since the last inspection. The manager had several years experience of running care homes and said she had started the relevant management training. Some staff had found the changes in the management structure unsettling and staff morale was low in some areas of the home. There were a group of staff who expressed concerns about the standard of care in the home but several said they felt unable to approach the manager. Two residents said they were aware of conflict within the home. One said it did not affect them, the other Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 23 felt unable to approach the manager. A relative, who returned a comment card, said that the home was “better since the new manager,” but another relative said that the nursing and care staff were “let down by management”. There was no formal quality monitoring system in place at the time of the inspection. Residents were not routinely consulted about the service they received. One resident said, “They don’t ask if we’re happy, they haven’t even got time to talk.” There was no evidence of recent resident surveys, resident meetings or staff meetings at the time of the visit. The manager had started to audit some care records and procedures. She was aware that the home fell short of the minimum standards in several areas and was working towards identifying priorities for improvement. Residents’ finances were generally managed by their families. Records were kept of any money handed over on behalf of a resident and receipts were obtained for any transactions. Large amounts were deposited into a residents’ bank account. A small amount of cash was kept on the premises, which meant that residents had access to funds at any time. Staff did not have formal supervision with their line managers. The home manager was conducting initial one to one interviews with staff. Not all relevant documents and records were in place. A previous recommendation to change the accident reports to comply with data protection had been done. However, not all accidents were recorded. The progress notes for a resident on Level 1 indicated 6 falls in March and April but there were only 3 accident reports available. Certificates were available to evidence maintenance of installations and equipment in the home. Fire systems and equipment were maintained and serviced but 2 extinguishers, condemned in February, had not been replaced. Not all new staff had received fire safety training and other staff were overdue for refresher courses. Three of the seven staff on night duty at the time of the visit were not clear about the fire procedure and said they had never been involved in a drill. A number of staff on day duty were in the same position. There were three different fire procedures observed during the course of the visit to the home, which meant staff did not have clear written guidance. Some environmental and working practice risk assessments were in place but there were no assessments to support the open storage of cleaning materials on Level 4. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 2 STAFFING Standard No Score 27 1 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X 3 1 2 1 Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 25 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 OP1 Regulation 4&5 Requirement The statement of purpose and service users guide must contain up to date and accurate information about the home. The service users guide must include the terms and conditions of accommodation and must be supplied to each resident. 2 OP3 14 Residents must not be admitted to the home unless their needs have been assessed. Residents must receive confirmation in writing that their assessed needs can be met at the home. Care plans must be drawn up to address residents’ personal, health and social care needs. (Timescale of 31/01/06 not met) Care plans must be revised and updated in accordance with any changes. (Timescale of 31/05/04 not met) 30/06/06 Timescale for action 23/06/06 3 OP3 14(1)(d) 30/06/06 4 OP7 15 31/10/06 5 OP7 14(2)(b) 30/06/06 Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 26 6 OP7 15(1) The plan of care must include details as to how and when oral care is to be provided. (Timescale of 30/09/05 not met) The plan of care must include details as to how the assessed continence needs are to be met. This would include Individual toileting routines (Timescale of 30/09/05 not met) Care plans must be drawn up and reviewed in consultation with residents or their relatives. (Timescale of 31/01/06 not met) 31/10/06 7 OP7 15(1) 31/10/06 8 OP7 15(1) 31/10/06 9 OP7 13(4)(b-c) The registered person must ensure that any potential risks to residents’ health are fully assessed and strategies to control the risk drawn up. (Timescale of 31/10/05 not met) 13(4) The standard care plans on Level 1 for maintaining a safe environment must be reviewed to ensure they do not conflict with the home’s fire procedure. Residents’ health must be monitored and recorded. This would include regular weight checks. The registered person must ensure that there are sufficient staff to help residents to meet their personal care needs. This would include bathing. Risk assessments must be completed before selfmedication. They should be reviewed on a regular basis. (Timescale of 31/05/04 not met) 31/10/06 10 OP7 30/04/06 11 OP8 13(4) 31/05/06 12 OP8 12(1) 18(1)(a) 30/06/06 13 OP9 13(2) 24/04/06 14 OP9 13(2) The criteria for the 31/10/06 administration of PRN medication DS0000022482.V287465.R01.S.doc Version 5.1 Page 27 Springfield Nursing & Residential Home must be identified in the plan of care. (Timescale of 30/09/05 not met) 15 OP9 13(2) Accurate records must be kept of all medication administered to residents. (Timescale of 14/10/05 not met) Accurate records must be kept of all medication entering the home. (Timescale of 31/12/05 not met) Records must be kept of all creams and other topical medicines administered. (Timescale of 31/07/05 not met) Medication no longer in use must be disposed of correctly. Medication, including cream, must only be administered to the resident it is prescribed for. The registered person must ensure that residents’ privacy and dignity are respected. 26/04/06 16 OP9 13(2) 30/09/06 17 OP9 13(2) 30/09/06 18 19 OP9 OP9 13(2) 13(2) 30/09/06 26/04/06 20 OP10 12(4)(a) 30/04/06 21 OP12 16(2) (m-n) Following consultation with 30/09/06 residents the current programme of activities must be revised. There must be sufficient appropriate activities to meet the needs of the residents (Timescale of 31/10/05 not met) Routines in the home must be established in the best interests of residents and not staff. Care plans must include details of residents’ preferences, including preferred times of rising and retiring. (Timescale of 25/11/05 not met) The registered person must DS0000022482.V287465.R01.S.doc 22 OP14 12(2)(3) 30/09/06 23 OP14 12(3) 31/10/06 24 OP15 16(2)(i) 30/06/06 Page 28 Springfield Nursing & Residential Home Version 5.1 18(1)(a) 25 OP16 22 ensure that there are sufficient numbers of staff to provide appropriate assistance and supervision at mealtimes. All complaints received must be recorded, investigated and the complainant informed of the outcome. (Timescale of 31/12/05 not met) The manager must continue with the programme of redecoration and refurbishment. The registered person must continue with the programme to fit radiator guards in accordance with the risk assessment. Staff commencing work before a full CRB disclosure is returned must be supervised by an experienced member of staff. (Timescale of 01/12/05 not met) The registered person must ensure that all documents and information required to be held about staff are obtained and retained. Staff must receive training appropriate to the work they perform. This would include: Induction training Protection of vulnerable adults Dementia care Continence management Fire safety First Aid Safe working practice topics. (Timescale of 31/03/06 not met) A system for reviewing and improving the quality of care, based on seeking residents’ views, must be established and maintained. (Timescale of DS0000022482.V287465.R01.S.doc 30/04/06 26 OP19 23(2)(bd) 13(4) (a-c) 31/10/06 27 OP25 31/08/06 28 OP29 19(4) Schedule 2 30/04/06 29 OP29 19(4) Schedule 2 30/07/06 30 OP30 18(1) 31/10/06 31 OP33 24 31/08/06 Springfield Nursing & Residential Home Version 5.1 Page 29 31/03/06 not met) 32 OP36 18(2) All staff working at the home must be appropriately supervised. Timescale of 31/03/06 not met) All records indicated in Schedules 3 and 4 must be kept. This includes o A photograph of each resident o A report of any accident or incident affecting a resident All staff must receive fire safety training. A clear fire procedure must be displayed in key areas of the home. All fire equipment must be in good working order. 35 OP38 13(4)(a) Potentially hazardous items must be risk assessed and stored safely. 30/04/06 30/06/06 33 OP37 17(1)(2) 31/07/06 34 OP38 23(4) 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP7 OP9 OP9 Good Practice Recommendations Care plans should contain interventions to meet the residents social and psychological needs. All handwritten amendments on MAR sheets should be signed and witnessed. Temperatures of medication storage rooms should be monitored and maintained below 250c Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 30 4 5 6 7 8 9 10 11 12 OP11 OP12 OP16 OP24 OP26 OP30 OP36 OP28 OP29 A record should be kept of residents wishes regarding terminal illness and after death. Staff should have access to training on providing occupation for residents with dementia. Staff should receive training on how to deal with complaints. Residents wishes regarding locks on their bedroom doors should be sought and actioned. The manager should act upon the concerns raised about the laundry. The induction training should meet the specifications of the national training organisation. All staff should receive formal supervision at least six times per year. A minimum of 50 of staff should be qualified to NVQ level 2. A record of supervision should be kept on the files of staff who start work before a full CRB disclosure is returned. Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield Nursing & Residential Home DS0000022482.V287465.R01.S.doc Version 5.1 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!