Inspection on 29/11/05 for Springfield Nursing & Residential Home

This inspection was carried out on 29th November 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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 &... 24/04/06

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 Announced Inspection 09:00 29 and 30 November 2005 th 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.V270710.R01.S.doc Version 5.0 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.V270710.R01.S.doc Version 5.0 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) 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.V270710.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 70 service users to include:Up to 38 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 30 service users in the categories of DE(E) or MD(E) (over 65 years of age, Dementia or Mental disorder not including learning disability) requiring personal care. Up to 25 service uisers in the category of PD or PD(E) (Physical Disability) requiring nursing care. Up to 5 service users in the category of TI (Terminally Ill) requiring nursing care. 1 named service users in the category of DE (Dementia under 65 years of age) requiring personal care. 1 named service user in the category of DE (Dementia under 65 years of age) requiring nursing care. Should any of the service users under 65 years of age either leave the home or attain the age of 65 years, an appropriate variation must be made. The registered provider should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 27th July 2005 2. Date of last inspection Brief Description of the Service: Springfield Nursing and Residential Home is owned by Four Seasons Health Care (England) Limited. The home is registered to provide care to up to 70 adults who require 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. Each floor is regarded as a separate unit and accommodates a different resident group. At the time of the inspection Level 4 was closed following a full refurbishment. Each floor 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.V270710.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, which meant that the residents, staff and visitors were told beforehand when the inspectors would be arriving. Two regulation inspectors carried out the inspection, which took place over two full days. At the time of the inspection there was a total of 45 residents accommodated on Levels 1, 2 and 3. 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 also met with three visitors to the home. Three residents and eleven visitors had returned comment cards that were sent out before the inspection. Responses were mainly positive but there were two comments about lack of activities and eight relatives indicated that they were unaware of the complaints procedure for the home. Discussions were held with the temporary manager and five members of staff. A tour of the premises took place and a number of documents and records were viewed. Detailed notes were taken, which have been retained as evidence of the inspection findings. There were two additional visits made to the home since the last statutory inspection. The first, on 30th August 2005, was in response to a complaint. There were a total of 52 issues raised by the complainant about hygiene in the home, personal care provided to residents, food, conduct of staff and care practices. 24 areas of the complaint were upheld, 7 were not upheld and 21 were unresolved. The manager was required to take action to improve standards in the home. The second additional visit was made to the home in October 2005. This was to monitor progress towards meeting requirements following the complaint investigation. What the service does well: Residents were satisfied with their rooms. One said, “my bedroom’s very good, a good big one and it’s nice to have my things round me.” Bedrooms were nicely decorated and furnished and many of the residents had brought in ornaments, pictures and small items of furniture to make their rooms homely. Residents and staff got on well together. Staff were seen to speak to residents in a respectful and friendly manner. Residents’ comments about staff included; “I get on well with the nurses”, “not a wrong word about any of them”, “can have a laugh with them” and “they are all very nice.” Residents Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 6 who returned comment cards indicated that they felt staff treated them well. A visitor to the home said that staff were “lovely” with her relative. What has improved since the last inspection? What they could do better: There had been improvements in some of the care plans for residents on Level 2. However, not all care plans provided a full picture of the resident’s needs and how they were to be met. Staff must take action to address this. Residents’ healthcare needs were not always met at the home. Staff must make sure that residents’ needs are fully assessed and plans drawn up to reduce risks to health. There were concerns about the way that medication was handled in the home. There had been very little progress made to address the requirements made after the last inspection. The manager must make sure that medicines are handled safely and that good records are kept. Several residents and one visitor said that there were not enough activities in the home. One resident said that he was lonely and other residents said that the activities on offer did not suit them. Residents must be consulted about Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 7 what kind of activities they would prefer and the range and amount of activities must increase. Some residents were not always able to tell staff what they wanted and staff had to make choices and decisions for them. Staff made decisions by getting to know what residents liked or disliked and by talking to their relatives. Staff must write these details in the residents’ care plans to make sure that other staff have the right information to be able to help residents. The complaints procedure was not complete and staff did not always report or record complaints received from relatives. The procedure must be altered so that residents and relatives know how their complaint should be dealt with. Staff should receive training to help them to know what to do. Staff must receive training in the protection of vulnerable adults to ensure that they would be able to recognise any abusive behaviour and know how and where to report it. The manager must consider the risk of injury to residents from hot radiators that are not guarded. Where a risk is identified, for example, in areas where residents are not supervised all of the time, guards must be fitted. The induction training for new staff was not thorough enough to help new staff to understand the needs of the residents. Health and safety training was not up to date. The manager must make sure that training opportunities for staff improve. Springfield no longer held the award for quality given out by the local council. There were some ways that the home monitored the service they provided but these were not thorough enough and must be improved. All care staff must receive regular supervision. This is needed to make sure that they are aware of their roles and responsibilities and have opportunities to discuss their work with residents. 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.V270710.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Written information about the home assisted prospective residents to make a decision as to whether the services and facilities offered at Springfield were suitable to meet their needs. EVIDENCE: The service users guide was under review at the time of the inspection and the draft had been sent out for consultation. The revised document contained specific information about Springfield but did not include information about the qualifications and experience of the staff. The description of the accommodation would also benefit from further development. Terms and conditions of admission and residency had been drawn up since the previous inspection. There were separate statements for self funding residents and those who were funded by the local authority. The documents met the standard in full. There was evidence that all residents had been issued with the appropriate statement. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 10 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 Not all care plans set out how residents’ personal, health and social care needs were to be met. Risks to residents’ health were not always identified or addressed. The way medications were managed at the home may place residents at risk of harm. Personal care was provided in such a way as to maintain residents’ privacy and dignity. EVIDENCE: Care files for a selection of residents from each of the three levels were inspected. Plans varied greatly in detail and clarity. There were some improvements in the standard of plans on Level 2 since the last inspection. There was evidence on three plans that residents or their relatives had been consulted and 10 out of the 11 relatives who returned comment cards indicated that they were kept informed of important matters. Most plans contained sufficient detail to direct staff on how to meet residents’ needs. Plans were reviewed every month and two had been re-written to take into account changing needs of the residents. There were shortfalls in the plans seen on Level 1. Plans did not always address residents’ assessed needs. One resident was on a smoking cessation programme but did not have a plan of care to support this. Care plans to address psychological and social care needs were generally inadequate. Psychological needs associated with dementia, for Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 11 example, depression and anxiety, were not addressed. Continence care plans were not always in accord with assessments. Plans were reviewed every month but were not always updated when the resident’s needs changed. Two of the plans did not include evidence of consultation with the resident or their relatives. None of the care plans seen fully addressed residents’ health care needs. Residents’ nutritional risks were assessed monthly. However, records for two residents on Level 2 showed a significant weight loss over a period of months. Their risk assessments did not reflect this and there were no plans of care to address their needs. Risk of developing pressure sores was assessed but plans to reduce risks were not always adequate. Use of pressure relieving equipment and other strategies to reduce risk were not recorded. All residents at risk of falling had care plan strategies. However, on Level 1 these were preprinted and did not take into account individual risk factors. Not all residents had plans for the provision of oral care. Those seen were pre-printed and in some cases provided incorrect directions for staff. Individual risk assessments and management strategies, for example, for alcohol intake or aggression, were inadequate. Those residents on Level 2 whose continence needs had been reassessed had detailed plans in place but these did not always include routines for toileting. Risk assessments were in place for the use of bed rails. One resident had sustained an injury following a fall. Although there was a care plan in place, important information was missing from the plan, which may have an affect on the resident’s future health and safety. Records of medication entering the home were incomplete and there were no records of medicines leaving the home. There were some “gaps” on Medication Administration Record (MAR) charts. Creams and other external preparations were not signed for. Handwritten amendments on MAR charts were not always witnessed. Residents who were self medicating had not been assessed as to their ability to do so safely, although one resident had a signed agreement from their GP. There was no evidence that compliance for these residents was monitored. A number of residents were prescribed medication to be taken only ‘when required’. Staff on Level 2 had drawn up very clear criteria for when medication should be given. This was not the case on Levels 1 and 3. Temperature records for the storage rooms on Levels 1 and 2 showed that temperatures regularly rose above 25oc. This may affect the integrity of the medication. There were no hand washing facilities in the treatment room on Level 2. There were excess stocks of medication for two residents on Level 1. One of the medicines was no longer prescribed. Medication was administered to residents on Level 2 by a registered nurse. Not all care staff who were responsible for medication on Level 1 had received accredited training. Staff spoken with were aware of the importance of respecting residents’ privacy, dignity and independence. They gave various examples of how this Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 12 was achieved including, ensuring personal care was conducted in private and knocking on bedroom doors before entering. These practices were observed during the inspection. Staff were also observed speaking to residents in a polite and respectful manner. Residents who completed comment cards confirmed that their privacy was respected and visitors said they were able to visit their relatives in private. One resident said that staff always closed his door and curtains. Another said that staff were “polite and nice”. There were several bedrooms on Levels 2 and 3 that had obtrusive notices aimed at staff. This was thought to infringe residents’ privacy and should cease. Staff should ensure that residents on Level 1 have the option to wear socks or tights in order to preserve their dignity. An ongoing recommendation to seek and record residents’ wishes regarding terminal illness and after death had not been met. Only two of the care plans seen contained this information. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 13 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, 14 and 15 Residents who were able were encouraged to make their own choices and decisions. However, lack of written information may result in wrong decisions and choices made on behalf of less able residents. The lack of suitable recreational activities meant that some residents’ social interests and needs were not being met. Residents were provided with a varied and balanced diet but the meals were not to everyone’s taste. EVIDENCE: Residents, who were able, confirmed that they made choices about their daily routines. One resident said he got up and went to bed at times that suited him. Another said she chose to stay in her room most of the time and sometimes had her meals there. Throughout the course of the inspection staff were seen to consult with residents about what they wanted. Following a previous requirement, staff on Level 2 said they always asked residents whether they were ready to go to bed or get up. Staff on Level 1 said they sometimes had to make choices on behalf of residents who had cognitive impairment. They said they did this by getting to know residents preferences and by consulting relatives. Information about rising and retiring times were recorded on night profiles for residents on Level 1 but there was little information about any other preferences. One of the plans on Level 3 provided detailed information about the resident’s likes and dislikes. Information to help Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 14 staff understand residents’ preferred routines was not always recorded on plans for residents on Level 2. Some residents’ families had completed social assessments, which gave detailed information about past interests and activities. This information was rarely transferred to care plans and plans for occupation and activity were inadequate. Two of the plans seen stated that residents were at risk of social isolation but there were no clear directions for staff on how to address this. Some residents were able to occupy themselves. One said she had her own television and DVD player and personally did not want additional activities. Another resident said he preferred to spend his time reading. He said that his keyworker sometimes took him to the library on his day off because he did not have time when he was working. One resident said they were happy with the activities in the home and said the regular concerts were very good. Other residents who did not pursue independent activities said there was not enough to do. There were two activity co-ordinators employed in the home. Records showed that the programme of activities was very limited and only a small core of residents regularly joined in. One resident said “singalongs and bingo are not for me”. Another resident said “there is nothing to do; eating, sleeping and watching TV is not living.” A third resident, who was very clear about his interests, said there was not enough for him to do and he was often lonely. One relative indicated on their comment card that their relative “needs to be involved in some form of activity.” There was little communication between the activity co-ordinators and care staff. Therefore, resident’s individual social and recreational needs were not discussed or planned for. None of the staff had received any training in providing occupation for residents with dementia and the activities provided on Level 1 did not cater for special needs. Comments regarding the food were mixed. Two of the three residents who returned comment cards indicated that they did not like the food and the third indicated they only liked it sometimes. However, comments on the day of the inspection were generally positive. Residents said the meals were “always lovely,” “very nice” and “I like the food I get it’s very good.” One resident said some meals were better than others and another said their meals could be hotter. Food was transported to the separate Levels in heated cabinets and the manager planned to provide staff with temperature probes to check food before it was served. Records of meals showed that residents received a nutritiously balanced diet with plenty of variety. Menus were displayed on each Level and residents said they had choices. A resident on Level 2 said that staff came round with 2 or 3 choices and residents on Level 1 were asked which of the meals they wanted. On the day of the inspection there was insufficient supervision at lunchtime for residents on Level 1. At least seven residents required physical assistance and by the time staff helped the last residents, their meals were cold. Staff were too busy to notice that some residents were attempting to eat from other plates or putting unwanted food on their neighbour’s plates. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 15 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 The complaints procedure was not complete and the lack of adequate records may result in residents’ or relatives’ complaints not being acted upon. The lack of staff training in the protection of vulnerable adults may result in abusive practices being unrecognised and unreported. EVIDENCE: There were two complaints procedures. A full procedure was available in the service users guide and a summary was displayed on Level 1. The procedures did not include contact details for the Commission for Social Care Inspection. Eight relatives who returned comment cards indicated that they were not aware of the complaints procedure. Residents said they would speak to staff if they had any complaints. Two residents named staff they would see. There was only one complaint recorded since the previous inspection. Records showed that this had been dealt with appropriately and correspondence sent to the complainant. The Commission for Social Care Inspection had received two complaints directly. Both of which were partially upheld. Three relatives indicated on their comment cards that they had made complaints to the home. There were no records of these. Not all of the staff spoken with were fully aware of the difference between a concern and a complaint or how each should be recorded and dealt with. There were procedures for staff to follow should they suspect that an incident of abuse had taken place. All staff spoken to said they had read the guidance and policy but they had not had further training. Staff were aware of reporting procedures inside the company but not all were aware of the role of the adult protection team or how to report issues outside of the home. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 16 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 Improvements in the overall standard of decoration and cleanliness enhanced the comfort of the residents. Not all residents were given a choice about locks on their bedroom doors which may result in a lack of privacy. The absence of radiator guards may present a risk of injury to residents. EVIDENCE: There had been improvements in the standard of the environment since the last inspection. The backlog of repairs and maintenance was being attended to and several areas had been redecorated. A tour of the premises showed that there was still outstanding work to be carried out. For example, most of the bedroom doors were scuffed and unsightly. The lounge carpet on Level 2 was shabby and should be replaced. The shower room was still out of order awaiting repairs to the ceiling. Work on the ceiling of bedroom 18 was not complete. It was pointed out to the manager that the decoration in one of the bedrooms on Level 1 was unacceptable and redecoration was started before the end of the inspection. Some other areas needing attention were discussed with the manager. Several were already on the programme of work to be carried out. Two requirements were made following a recent environmental Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 17 health inspection. One had been implemented and a request had been made for funding to replace the floor covering. Residents on Level 1 had locks on their doors but none of the residents held their own keys. One resident said she would like to be able to lock her door when she left her room to prevent other residents from wandering in and disturbing her belongings. Staff were not aware of any reasons why she had not been given a key. Two of the care plans on Level 2 included evidence that residents had been asked whether they wanted a lock on their bedroom door but not all residents had been consulted. Most of the bedrooms seen were decorated and furnished to a good standard. Many were highly personalised with items of furniture, ornaments and mementoes. Those residents spoken with were happy with their rooms. One said “my bedroom’s very good, a good big one and it’s nice to have my things round me.” Not all radiators on Levels 2 and 3 were guarded. At the time of the inspection radiators were noted to be very hot in some bedrooms, corridors, bathrooms and toilets. Residents could be injured if they fell against a hot radiator and remained unobserved for any length of time. One resident on Level 2 had been assessed as being at risk of falls but the radiator in his room was not covered. A risk assessment identified radiators on corridors and lounges as being low risk and therefore did not require covers. However, not all communal areas were continually supervised, therefore a resident may fall without staff being aware. The risk assessment indicated that guards should be fitted to all high risk areas but this work had not been carried out. There was an improvement in the standard of cleanliness and hygiene within the home. At the time of the inspection the home was clean and tidy although there were still some bedrooms and corridors that were malodorous. 13 staff had received training from the community infection control nurse. Staff spoken with showed an awareness of infection control procedures and how to deal with clinical waste. Staff were seen to wear appropriate personal protective clothing and the previous practice of carrying uncovered continence waste through the home had ceased. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 There were enough staff to meet the needs of the residents accommodated at the time of the inspection. Recruitment practices safeguarded residents but the lack of appropriate supervision of new staff may place residents at risk of harm. Staff were not provided with enough training to competently undertake activities expected of them, which may result in residents being placed at risk or their needs remaining unmet. EVIDENCE: At the time of the inspection there was an appropriate ratio of staff to residents on all levels of the home. This included ancillary staff. Nursing and care staff spoken with said there were sufficient numbers to meet the needs of the residents currently accommodated, although there was no formal way of measuring residents’ needs and dependency levels to calculate staffing numbers. Eight of the eleven relatives who returned comment cards indicated there were always sufficient staff on duty. Residents said they thought there were enough staff. The residents who returned comment cards indicated that they felt well cared for and staff treated them well. On the day of the inspection comments about staff included; “I get on well with the nurses”, “not a wrong word about any of them”, “can have a laugh with them” and “they are all very nice.” One resident said, “it’s not home but they do their best.” The files of three recent employees were inspected. All contained evidence of appropriate pre-employment checks and the required information and documents were in the files. One employee had commenced work following a satisfactory POVAfirst check. There were no records to show that an Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 19 experienced member of staff was supervising this employee until their full CRB disclosure was obtained. The duty roster showed that they sometimes worked alongside an agency carer. The induction training programme for new staff was based on the outcomes of the former induction standards of the national training organisation. However, there were no records to evidence the content of the training or how it was delivered. There was no assessment of competencies at the end of the induction period. The trainees’ mentor had not signed one of the completed forms and there was no indication of how long the programme took to complete. There was no evidence of initial induction/orientation to the home, which should include issues such as the fire procedure, company policies and information about residents. Agency staff confirmed that they had an orientation to the home, which included fire procedures. A training matrix showed that there had been some improvement in training in safe working practice topics but, with the exception of moving and handling, these were not all up to date. There were no records to indicate how many care staff had achieved NVQ to level 2 but the manager confirmed that this was well below the 50 target. Planned training included dementia awareness and continence management. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 20 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, 37 and 38 Appropriate arrangements had been made to cover the absence of the registered manager. Residents’ finances were managed in a way that safeguarded their interests. Quality monitoring systems must be improved upon to ensure that the home is run in the best interests of the residents and that the quality of care is appropriate for them. Staff were not being appropriately supervised with the potential that they might not fully understand their roles and responsibilities. Inappropriate moving and handling techniques may cause risk of harm to residents and staff. EVIDENCE: The registered manager had been absent from the home for several weeks before the inspection. A temporary manager, who had the relevant qualifications and experience, had taken over for an unspecified period. One member of staff described the manager as supportive and helpful. There had Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 21 also been changes in the higher management within the company and the area manager was to be based at Springfield in the future. The Blackburn with Darwen Quality Assurance Award had been withdrawn from the home. Staff from Springfield sent surveys out to residents or their families every six months but the results were not analysed and used to develop the service. There were procedures for auditing care plans, medication and the environment. Results from the audits were used to plan improvements. However, this system had not identified some of the shortfalls noted during the inspection (see standards 7 and 9). The manager advised that a new procedure for monitoring the quality of the service was due to be introduced throughout the company. The programme of staff supervision implemented before the last inspection had not been kept up. Four of the staff members spoken with had never received formal supervision. Another said they had an appraisal some time ago but nothing since. There were details of fees charged and paid. Staff only handled finances for one resident, who had a personal bank account. Their pension benefits were paid directly into a company account with personal allowances being transferred every month. Residents, who were able, continued to look after their own finances but the majority were managed by 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 but staff did not have access to this out of office hours, which limited residents’ access. The manager advised that there were plans to rectify this. Following the additional inspection a requirement was made to record and investigate all reports of unexplained injuries to residents. Separate records were being kept but not all were investigated to establish a cause and prevent reoccurrences. The book used to record and report injuries did not comply with data protection legislation. All residents had a moving and handling assessment and all staff had received training. In general the moving and handling practices had improved throughout the home and new equipment had been purchased. However, one member of staff and one visitor on Level 2 described inappropriate techniques that had been used recently. Records provided by the manager showed that maintenance and servicing of equipment and appliances were up to date. Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 22 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 2 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 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 1 2 2 Yes Version 5.0 Page 23 Are there any outstanding requirements from the last Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc inspection? 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. Standard Regulation Requirement Timescale for action 1 OP7 14(2)(b) Care plans must be revised and 31/01/06 updated in accordance with any changes. (Timescale of 31/05/04 not met) 2 OP7 15(1) The plan of care must include 31/01/06 details as to how and when oral care is to be provided. (Timescale of 30/09/05 not met) 3 OP7 15(1) The plan of care must include 31/01/06 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) 4 OP7 13(4)(b-c) The registered person must 31/01/06 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) 5 OP7 15(1) Care plans must be drawn up 31/01/06 and reviewed in consultation with residents or their relatives. 6 OP7 15 Care plans must be drawn up to 31/01/06 address residents assessed needs. 7 OP8 13(4)(c) The cause of unexplained 31/12/05 injuries must be investigated and, so far as possible, eliminated. (Timescale of 01/09/05 not met) 8 OP9 13(2) Risk assessments must be 01/12/05 completed before selfmedication. They should be reviewed on a regular basis. (Timescale of 31/05/04 not met) Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 24 9 OP9 13(2) 10 OP9 13(2) 11 OP9 13(2) 12 13 OP9 OP9 13(2) 13(2) 14 15 OP9 OP12 13(2) 16(2) (m-n) 16 OP14 12(3) 17 OP16 22 18 OP16 22 19 OP19 23(2) (b-d) Records must be kept of all creams and other topical medicines administered. (Timescale of 31/07/05 not met) The criteria for the administration of PRN medication must be identified in the plan of care. (Timescale of 30/09/05 not met) 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 and leaving the home. Medication must be stored at the correct temperature in accordance with manufacturers instructions. All staff responsible for administering medication must receive appropriate training. Following consultation with 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) Care plans must include details of residents’ preferences, including preferred times of rising and retiring. (Timescale of 25/11/05 not met) The complaints procedure must include contact details for the Commission for Social Care Inspection. All complaints received must be recorded, investigated and the complainant informed of the outcome. All parts of the home must be kept in a good state of repair and reasonably decorated. (Timescale of 27/07/05 not met) DS0000022482.V270710.R01.S.doc 01/12/05 31/12/05 01/12/05 31/12/05 31/01/06 31/03/06 28/02/06 31/01/05 31/12/05 31/12/05 31/03/06 Springfield Nursing & Residential Home Version 5.0 Page 25 20 OP25 13(4) (a-c) 21 22 OP26 OP29 16(2)(k) 19(4) Schedule 2 18(1) 23 OP30 24 OP33 24 25 26 OP36 OP38 18(2) 13(5) The registered person must conduct risk assessments in respect of the unguarded radiators in the home. Guards must be fitted where a risk is identified. The home must be kept free from offensive odours. Staff commencing work before a full CRB disclosure is returned must be supervised by an experienced member of staff. Staff must receive training appropriate to the work they perform. This would include: Induction training Protection of vulnerable adults Dementia care Training Continence management Fire safety First Aid Safe working practice topics. A system for reviewing and improving the quality of care, based on seeking residents’ views, must be established and maintained. All staff working at the home must be appropriately supervised. The registered person must suitable arrangements to provide a safe system for moving and handling residents. (Timescale of 31/07/05 not met) 31/12/05 31/12/05 01/12/05 31/03/06 31/03/06 31/03/06 01/12/05 Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 26 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 4 5 6 Refer to Standard OP1 OP7 OP9 OP9 OP9 OP10 Good Practice Recommendations The service users guide should include all the information specified in this standard. Care plans should contain interventions to meet the residents social and psychological needs. All handwritten amendments on MAR sheets should be signed and witnessed. Medication no longer prescribed should be disposed of. Hand washing facilities should be available in the treatment room on Level 2. The practice of displaying staff notices in residents’ bedrooms should cease. Residents on Level 1 should have the option to wear socks or tights in order to preserve their dignity. 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. The lunchtime routine on Level 1 should be reviewed to ensure adequate supervision over the mealtime. Staff should receive training on how to deal with complaints. Residents wishes regarding locks on their bedroom doors should be sought and actioned. 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. The induction training should meet the specifications of the national training organisation. All staff should receive formal supervision at least six times per year. Accident records should comply with data protection legislation. 7 8 9 10 11 12 13 14 15 16 OP11 OP12 OP15 OP16 OP24 OP28 OP29 OP30 OP36 OP37 Springfield Nursing & Residential Home DS0000022482.V270710.R01.S.doc Version 5.0 Page 27 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. 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