Inspection on 29/04/08 for Springfield Nursing & Residential Home

This inspection was carried out on 29th April 2008.

CSCI found this care home to be providing an Adequate service.

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 &... 22/10/07

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 29th April 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing & Residential Home DS0000022482.V360047.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.V360047.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.V360047.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 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. 22nd October 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 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.V360047.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. The latest Commission for Social Care Inspection report is on display in the foyer and copies are available from the home manager on request. 29th April 2008 the weekly fees ranged from £341.00 to £601.00. Additional charges are made for toiletries, hairdressing and newspapers. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. A key unannounced inspection, which included a visit to the home, was conducted at Springfield Nursing and Residential Home on the 29th and 30th April 2008. There had been one additional visit since the last key inspection. This was carried out on 12th February 2008 and was to check on the progress towards meeting the requirements from the key inspection. We found that very little progress had been made at that time. At the time of this visit there were 33 people living at the home. The inspector met with some of them and asked about their views and experiences of living at Springfield. Some of their comments are included in this report. Three people living at the home were case tracked. This meant that the inspector 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, family carers and staff working at Springfield. There was a low return and only two surveys were received. During the visit discussions were held with the manager, members of the staff team and visitors to the home. The inspector 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. People living at the home and their relatives made very positive comments about the care. One person said, “I wasn’t very well last week and they looked after me well. The care was excellent.” Two relatives commented that staff seemed to understand the needs of their relatives and one said their father was, “more than looked after.” People who returned surveys indicated that they received the care they needed. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 7 There was an open visiting policy, which meant that people could see their friends and relatives at any time. Staff made visitors welcome and offered them drinks. Most people said they enjoyed the meals. There was a varied menu, with plenty of choice. Meals were cooked with fresh ingredients. Several people praised the new chef. One person who returned a survey wrote, “The new chef is excellent, food has much improved.” Some staff had received training in customer care. This should help to make sure that even small complaints are taken seriously and responded to appropriately. People who were asked said they knew who to speak to if they were not happy about their care. What has improved since the last inspection? Since the last inspection a new, permanent, manager has been appointed, which should give the home some stability. The manager had plans for improvements some of which she had started to put into place. One of the people who were spoken with at the time of the inspection said the manager was “grand.” Two relatives also made very positive comments about her. There were improvements to some of the care plans. They told staff exactly what support to give to meet each person’s individual needs in exactly the way they wanted. All staff with responsibility for handling medicines had received more training. The way medicines were managed had improved. Most of the practices were safe and made sure that people received their medicines correctly. Staff said they were working hard to improve the care for people living at the home. They gave an example of making sure that everyone had the right aids and equipment to help them move about safely. The programme of activities had become more established. In addition to the usual games, such as bingo and dominoes, people could go out shopping or they could choose to sit and have a chat. The activity co-ordinator had done some training in organising activities for people with dementia, which she said had given her some new ideas. Staff said there were more opportunities for training. Courses in health and safety topics were ongoing and some staff had attended training, which helped them to understand the needs of people with dementia. Staff who organised training said, “There is more commitment and support from the manager and the company.” Springfield Nursing & Residential Home DS0000022482.V360047.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.V360047.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.V360047.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People thinking of moving into the home received sufficient information to help them to make a decision and staff received sufficient information to help them to understand the person’s needs. EVIDENCE: People thinking of moving into the home were given written information about Springfield. However, the statement of purpose, which was under review at the last key inspection, was still not up to date. The service user’s guide was a corporate document with some information about the procedures and systems at Springfield. The manager was in the process of putting together a file with comments and views of families, which should help to make the information more individual to Springfield. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 11 One family carer said that talking to the manager had helped her to make up her mind about Springfield. 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 the skills and experience of the staff team were sufficient to meet the person’s needs. The quality of the assessments had improved since the last inspection. As well as information about the person’s health and personal care needs, the manager had recorded information about people’s likes, dislikes and preferences. This meant that staff had access to this information as soon as the person came into the home. Standard 6 was not applicable. Intermediate care is not provided at Springfield. Springfield Nursing & Residential Home DS0000022482.V360047.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: Four sets of care records were inspected as part of the case tracking process and others were viewed in less detail. Three of the four records contained an assessment that was started before admission and then built upon as staff became more familiar with the person. Care plans were usually drawn up if the assessment highlighted a need for care and support. There was a difference in the depth and quality of care plans between the two levels. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 13 One person on Level one did not have any current care plans. Risks to their safety were not addressed. For example, the daily notes for the person indicated that they tried to open the exit doors. There were no directions for staff to support the person, either to go out with staff or to make sure the person was safe should the doors be left open. The notes also indicated that the person could be verbally aggressive but was easily distracted. There was no plan to ensure that staff were all aware of the best ways to distract the person and therefore prevent any distress. Other plans seen on Level one were not person centred. For example, the assessment for one person highlighted several reasons why the person was not eating well. The care plan to address this directed staff to “prompt and encourage” rather than look at interventions to support specific needs. In this instance the person had put on weight. However, because the plan was so vague staff would not be able to evaluate whether that was due to any particular intervention. The assessment for another person indicated what clothes they liked to wear but the care plan did not include this information and just directed staff to “choose appropriate clothing.” In contrast, the small sample of care plans seen on Level 2 were highly individual and person centred. This meant that staff would all be able to provide care to the same standard and in a way that took into account the person’s preferences. For example, plans to help people to dress indicated to staff exactly what people liked to wear. Plans for nutrition took into account how people preferred to be helped and what food they liked. On both levels there were inconsistencies in the level of consultation with residents and relatives about care plans. One family carer, who visited regularly, said plans had not been discussed with them. Other plans contained information provided by relatives. Care plans were evaluated every month. Some gave a good summary and evaluated whether the support provided had been effective. Others just repeated the person’s needs, which did not help staff to make a decision as to whether the plan needed to be altered. There was evidence that new care plans were put into place when people’s needs changed. Three of the four people case tracked had a set of health care risk assessments, which were reviewed every month. However, one of the people on Level 1 did not have plans to minimise the level of risk that was identified. Weight loss was generally being monitored more effectively. The manager audited weight records every week to ensure that people were receiving the correct treatment. However, records showed that people were not being offered food supplements as often as they should. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 14 Despite the shortfalls, people who returned surveys and those spoken with during the visit indicated that they received the care, support and medical attention they needed. Family carers were also positive about the care. One said, “I am very pleased with the care, staff seem to understand.” Another said their mother, “seems to be getting every care.” Staff who had worked at the home for some time said they thought the care was better. One said, “we are really working hard to improve things, relatives have come in and told us they think the care has improved.” Information included on the Annual Quality Assurance Assessment showed that all staff with responsibility for handling medication had received refresher training. Medication audits were also being carried out every week. The way medication was managed had continued to improve since the last inspection. Most of the shortfalls seen during the visit were isolated events but there were some recurring themes that could impact on the health and safety of people living at the home. For example, several of the MAR charts on Level 1 had been altered but not always re-written which made them difficult to understand and increased the risk of errors. Not all medication had been signed in which meant there was not always a complete audit trail. The temperature of the medication room on Level 1 was consistently above the temperature that most medicines should be stored at, which could affect the integrity of the medicines. There was still no audit trail of food supplements on either level. Staff received training on core values during their induction and NVQ training. People received personal care in private and two of the care plans seen made references to respecting the person’s dignity. During the course of the visit staff were heard to address people respectfully and there were some elements of good practice seen. However, there were some examples of lack of respect. For example, staff were observed putting snacks directly onto the table without offering the person a plate. One of the senior staff said she recognised this was undignified and had been trying to make sure this practice stopped. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 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. 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. Some people’s social and recreational needs were met through activities and contact with family and friends. EVIDENCE: People’s interests and preferences for activities were recorded on a variety of documents on their care files. However, none the people who were case tracked had a plan to support their individual needs for activity and social contact. There was a programme of activities on display. It showed a mix of group activities such as film shows, coffee mornings, bingo and dominoes. There were also a number of sessions set aside for one to one activities. The activity co-ordinator said, “A lot of people don’t like or can’t join groups but they like a visit to chat.” A few people talked about enjoying the activities. One said they particularly liked the film nights and another said he enjoyed trips to the Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 16 garden centre and tending the garden. One resident said, “Things started to liven up when (the activity co-ordinator) took over.” The activity co-ordinator had attended some training in organising activities for people with dementia, which she said had given her some new ideas. The assessment documentation also allowed for information about cultural and religious needs to be recorded. Staff spoken with said there was no one with specific cultural needs living at the home at the time of the visit. A member of staff was trying to arrange for visitors from the local churches to see those people who would like it. Staff said they had not had any equality and diversity training but said they would ask family members for help. There was an open visiting policy, which meant that people could see their friends and relatives at any time. Visitors said they felt welcome in the home. There were opportunities for people to go out with the activity co-ordinator, for example on shopping trips. Staff still controlled some routines. For example, they chose what days people had a bath or shower. They also said things were getting better and they did not get residents up early any more to accommodate staff. One staff member said, “We are here for the residents not the staff routine.” People living at the home confirmed this. One said, “I don’t have to be in bed at any time and I can have a lie in.” Family carers confirmed that their relatives were given choices. One said, “He likes to be by himself and they don’t force him to mix.” Another said, “They accommodate her all the time; she stayed in bed late a few days ago but staff made sure she had her lunch.” There was a new chef. In addition to the usual cooking and food hygiene qualifications, the chef had done some courses in nutrition and older people. There were new menus. The chef sought residents’ suggestions by going round and talking to them and getting feedback from care staff about which meals people enjoyed. Records showed that people were offered a varied menu with choices at every mealtime. Most people made positive comments about the meals, including, “the food is very nice,” and “I like the new chef, he’s not a bad cook.” One person who returned a survey wrote, “food has much improved.” Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 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. 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 that people could expect formal complaints and allegations of abuse to be dealt with correctly. Less obvious incidents may go unrecognised. EVIDENCE: A summary of the complaints procedure was displayed throughout the home. The full procedure was in service user’s guide and given to everyone when they came into the home. One person who returned a survey confirmed this. Another person said he had no complaints but would feel able to speak to most of the staff if he did. A senior member of staff said the team took complaints seriously. Some staff had done customer care training. As recommended following the last inspection, there was a new process to ensure that even minor complaints were recorded. However, not all staff spoken with were aware of this. There had been four complaints since the last inspection either to CSCI or directly to the home. Records showed that the manager investigated and took action to resolve all formal complaints, bringing in other agencies where necessary. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 18 The company had a safeguarding policy and procedure. Although it gave appropriate directions to staff on what to do should an incident occur, it was a corporate document and did not include information about local procedures. The policy was due to be reviewed in March 2008. The Blackburn with Darwen procedure in the home may have been out of date. New staff received training in safeguarding adults during their induction training. The Annual Quality Assurance Assessment (AQAA) showed that the manager was planning to make sure that all staff received refresher training within the next year. All the staff spoken with during the visit were aware of their responsibility to report any allegation of abuse to the manager. They were also aware of the whistle blowing policy and how to report bad practice outside the home if necessary. As previously recommended staff made records of any unexplained injuries and bruising. However, these records were not audited and there was no procedure to guide staff as to what and when further action should be taken. Some people had non-specific assessments and care plans indicating that they did not have the capacity to consent. The plans did not indicate what it was the person was not able to consent to. They did not take into account that people might be able to make decision about some things but not others. They did not guide staff to try alternative strategies to help the person to understand. This could result in people not being given sufficient opportunities to make decisions. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 19 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. Not all areas of the home were clean safe and comfortable. EVIDENCE: There had been no progress on the refurbishment of the kitchen since the additional inspection in February 2008. Many of the kitchen appliances were still out of order and beyond repair. The floor in the office of the kitchen had dried out but was still unstable. The manager stated that the work would commence as soon as she received permission from the company. Kitchen cleaning records and temperature records were in place as recommended after the last environmental health inspection. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 20 There was a large area of damp on the stairwell between Levels 1 and 2. The floor had rotted in places because of the damp. The cause had been identified but work had not started to rectify the problem. The manager stated that the whole building was due to be refurbished this year but there was no firm date for this. Areas that were accessible to residents were generally well maintained. However, one of the bathrooms on Level 2 had been out of use for four months. Some bedrooms needed repainting and some were in need of new floor coverings. Everyone who was asked said they liked their bedrooms. One person said, “It’s great and comfortable.” Several were highly personalised and one person said that staff had given him some pictures to put up. There were mixed views about the cleanliness of the home. There had been a formal complaint and some of the issues were found to be correct. For example some days there was a shortage of cleaning staff and staff did not always have time to deep clean. Residents who completed surveys indicated that the home was usually clean and fresh. One person wrote that the cleanliness was getting better but they needed more domestics because it is a big home. During the inspection a resident and two family carers commented that the areas of the home they went in were spotlessly clean. During a tour of the building it was apparent that there were a few areas that needed deep cleaning. These included carpets on the corridors on Level 2 and in some bedrooms. There was also poor odour control in a small number of bedrooms. Most staff had received infection control training and other courses were planned. Staff had access to infection control procedures and protective clothing. There had been a recent outbreak of diarrhoea and vomiting in the home. A complaint had been made by an outside agency that procedures and guidance for for containing an outbreak had not been followed properly. This was being investigated at the time of the inspection. The laundry was adequately equipped for the size of the home and there were sufficient hours allocated to laundry staff. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although improving, people using the service were not always supported by a consistent and appropriately trained staff team. People using the service could not be confident that they were protected by recruitment practices. EVIDENCE: According to information contained in the AQAA, there had not been any improvement in the high usage of agency staff since the last inspection. However, there were no negative comments about staff turnover or inconsistencies during the visit. Staff spoken with said there were enough staff on duty to meet the needs of the people living at the home. One member of staff said that people on Level 2 who required nursing care were left without a registered nurse for a short time at night because the nurse had to give out medicines on Level 1. People living at the home, and their relatives, made some positive comments about their relationships with staff. One person said, “they are all lovely,” and another said, “Most are very good in their own way.” Family carers described staff as, “understanding” and “very good.” The files of three new staff were seen. All applicants completed an application form and attended for an interview. All three provided a complete employment history and two references. One person had a POVA first check Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 22 before starting work but the other two did not. All three had evidence of a CRB disclosure on their file. However, it was company policy to detach all information, except the person’s name, from the disclosure form. This meant there was no date of issue and therefore, there was no evidence that the CRB disclosure had been obtained before the other two people started work. On some staff files the manager had written the date of receipt of the CRB on another document but not in all cases. The manager and staff talked about an increase in formal supervision for staff. The manager said one of the improvements as a result of supervision was a reduction in staff absence. She said staff were “more responsible and committed” New staff had an initial induction which included an introduction to the organisation, orientation of the building and emergency procedures. Staff without qualifications then went through the Skills for Care twelve-week induction programme. Records were available to show what type of induction new starters had. From discussions with staff and looking at records it was apparent that the level of training had improved. The training co-ordinator said there was more commitment and support from the manager and company, and staff were more motivated. All staff had an individual training profile, the manager had started the records anew to ensure that they were accurate and up to date. Not all staff had received refresher training in all the health and safety topics but there was training planned to address this. The AQAA showed that only 27 of care staff were qualified to NVQ level 2. The training organiser said that more staff were enrolled on the course and they were working towards the recommended level of 50 . Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 23 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manager was working to improve the organisation and management of the home for the benefit of the people living and working there. EVIDENCE: A new, permanent, manager had been in post since November 2007. The manager was a first level nurse and held the registered manager’s award. She had many years experience of working with older people and several managing care services. From discussions with the manager and looking at information in the AQAA it was evident that she was committed to improving standards in the home. For example, she saw working towards more person centred care as a priority. At the time of the inspection the manager had not applied for registration with the Commission for Social Care Inspection. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 24 The service had not regained the Blackburn with Darwen quality assurance award. There were no other external quality monitoring systems in place. There were a number of internal audits of care practices and other systems, some of which were quite in-depth. The manager said it was up to her to action any shortfalls. The last resident and relative survey report was dated 2006 to 2007. The company head office arranged the surveys and the manager was not sure whether another one had been done. None of the audits seen at the time of the inspection took into account the views of people living at the home or their representatives. Following a major audit, new systems for handling residents’ finances had been introduced. There were more checks and audit measures, which safeguarded people’s money. There were electronic records of all transactions. Receipts were given when money was handed over for safekeeping and whenever money was spent on behalf of people living at the home. 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. Most of the medium risk areas on the fire risk assessment had been addressed. There were still a number of low risk controls to be put into place in the next four months. The AQAA showed that maintenance of installations and appliances was up to date. Certificates were available to evidence maintenance of electrical installations and gas appliances in the home. Portable electrical appliances were safety tested every year. Except for a visual check by the maintenance person, there were no systems in place to ensure that items brought into the home between annual tests were safe to use. As previously required all potentially hazardous substances, such as denture cleanser, were stored safely, which protected people living at the home. Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 25 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 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 26 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) Timescale for action 30/06/08 2. OP8 13(4)(b-c) In order to protect the health and safety of people living in the home, plans to control risks must be put into place wherever risks have been identified. (Timescale of 31/03/08 not met) 13(2) In order to protect the health and safety of people using the service and to provide a thorough audit trail, accurate records must be kept of medicines received into the home. This includes food supplements. In order to protect people living and working at the home, all areas must be kept in a good state of repair. 31/05/08 3. OP9 31/05/08 4. OP19 23(2)(b) 30/09/08 Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user’s guide should be revised so that people who are considering moving into the home have accurate and up to date information about the services and facilities provided All care plans should be person centred to ensure that staff have sufficient information about people’s individual needs and how they wish to be supported. Care plans should include guidance for staff on how to support people to meet their need for social activity and contact. In order to ensure that medication remains effective it should be stored in accordance with the manufacturers’ instructions. Care plans regarding capacity should be individualised to take into account the person’s individual abilities to make decisions about different issues. In order to fully safeguard people using the service, the safeguarding procedure should include guidance on what and when to take further action with regard to unexplained injuries and bruising. There should always be sufficient domestic staff on duty to ensure that all areas of the home are clean, tidy and there is adequate odour control. Records of pre-employment checks should be dated in order to show that they were obtained before the person started work at the home. Training should continue in accordance with the training plan to ensure that people using the service are supported DS0000022482.V360047.R01.S.doc Version 5.2 Page 28 2. OP7 3. OP7 4. OP9 5. OP18 6. OP18 7. OP26 8. OP29 9. OP30 Springfield Nursing & Residential Home by an appropriately qualified and skilled staff team. 10. OP33 People living at the home, or their representatives, should have formal opportunities to make their views about the service known and to make suggestions for improvements. In order to protect people living and working at the home, portable electrical appliances should be safety tested before being used in the home. 11. OP38 Springfield Nursing & Residential Home DS0000022482.V360047.R01.S.doc Version 5.2 Page 29 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. 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