Inspection on 05/10/06 for Springfield Nursing & Residential Home

This inspection was carried out on 5th October 2006.

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

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

Other inspections for this house

Springfield Nursing &... 29/04/08

Springfield Nursing &... 22/10/07

Springfield Nursing &... 10/05/07

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 5th October 2006 07:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfield Nursing & Residential Home DS0000022482.V312992.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.V312992.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) 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.V312992.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 70 service users to include:Up to 38 service users in the category of OP (over 65 years of age, not falling into any other category) requiring personal care. Up to 30 service users in the categories of DE(E) or MD(E) (over 65 years of age, Dementia or Mental disorder not including learning disability) requiring personal care. Up to 25 service uisers in the category of PD or PD(E) (Physical Disability) requiring nursing care. Up to 5 service users in the category of TI (Terminally Ill) requiring nursing care. 1 named service users in the category of DE (Dementia under 65 years of age) requiring personal care. 1 named service user in the category of DE (Dementia under 65 years of age) requiring nursing care. Should any of the service users under 65 years of age either leave the home or attain the age of 65 years, an appropriate variation must be made. The registered provider should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 24th April 2006 2. Date of last inspection Brief Description of the Service: Springfield Nursing and Residential Home is registered to provide care to up to 70 adults who need help with personal care or who have nursing needs. Springfield is a detached building standing in its own grounds. Accommodation is provided on four floors, referred to as Levels. Each Level is regarded as a separate unit and accommodates a different resident group. Each Level has its own communal facilities, including lounges, dining areas, snack kitchens and bathrooms. 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.V312992.R01.S.doc Version 5.2 Page 5 Information about the home is sent out to anyone making enquiries about admission. Copies of Commission for Social Care Inspection reports are available from the home manager on request. On 5th October 2006 the manager stated that there was only one weekly fee of £321.50. Additional charges are made for toiletries, hairdressing and newspapers. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Springfield on the 5th and 6th of October 2006. Two regulation inspectors and a pharmacist inspector carried out the visit. There were 45 residents accommodated in the home. The inspectors met with residents from each level and spent time observing interactions between staff and residents. Wherever possible residents were asked about their views and experiences of living in the home and some comments are quoted in this report. The inspectors met with 5 visitors to the home. Discussions were held with the manager and several members of day and night staff. A tour of the premises took place and a number of documents and records were viewed. None of the comment cards sent out to residents and relatives prior to the inspection visit had been returned. What the service does well: What has improved since the last inspection? The manager assessed all prospective residents before they were offered a place at the home. This meant that staff had a better understanding of what care the person might need and whether it could be provided at the home. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 7 Records of complaints were much more detailed and showed that complaints were investigated thoroughly. Letters were sent to the complainant to keep them informed about what was happening. More areas of the home had been decorated and some new furnishings were on order. The home was cleaner and smelled better, which meant the residents lived in a more comfortable and homely environment. There were improvements in the way new staff were employed. All staff had thorough background checks before they started work at the home, which helped to protect residents. The manager had sent out some surveys to find out what residents and their relatives thought about the home. She planned to use this information to make improvements for residents. What they could do better: Care plans did not always tell staff enough about the residents’ needs and the care they should be receiving. This was especially true for residents with dementia. Plans were not always kept up to date. This meant that staff did not always have the right directions, which may result in residents’ needs not being met. Risks to residents’ health were not always monitored thoroughly enough to highlight problems. There were concerns that the residents’ medication was not managed safely. There had been very little progress made in this area since the last inspection and outcomes for residents remain poor. Staff understood about residents’ needs for privacy and dignity but there were times when they were not met. There were not enough suitable activities organised for residents who were not able to occupy themselves. Results of resident and relative surveys indicated there was room for improvement in this area. The lack of written information on care plans meant that staff did not know enough about residents’ likes, dislikes and preferences when they needed to help them make choices. Low numbers of staff and high dependencies of residents at mealtimes meant that some residents had to wait to be assisted to eat their meals and the food was not at its best. Some areas of the home were very busy and the staffing levels should be planned to take into consideration how much care the residents need. The manager must make sure that staff have more opportunities for training. All staff must be trained in adult protection and health and safety topics in order to protect residents and themselves. It is also important that staff working with residents with dementia have the appropriate training to understand and meet their needs. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 8 Some of the procedures to protect residents’ health and safety were not being followed properly. The manager must make sure that all staff understand what to do in the event of a fire. Items that could be harmful to residents must be stored correctly. 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.V312992.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.V312992.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process was thorough and ensured that residents had information to help them to make a decision about moving in and staff had enough information to understand the resident’s care needs. EVIDENCE: The statement of purpose and service user’s guide was on display. The documents had been reviewed by the manager but still included some inaccurate and out of date information. The terms and conditions of residency were included but the information about fees was out of date. Residents or their representatives were asked to sign their acceptance of the terms and conditions. Most residents were assessed by health or social service professionals before being referred to the home. Senior staff also assessed all prospective residents before offering them a place. Staff said they received enough information to understand the resident’s needs before they were admitted. There was evidence that residents were sent letters confirming that their assessed needs could be met at the home. Intermediate care was not provided at the home. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs were not always met and some staff practices ignored residents’ privacy and dignity. The overall standard of medicines management was poor and placed residents at serious risk of harm. EVIDENCE: The quality of care records varied between the levels in the home. Some plans were not detailed enough to ensure that residents received consistent care and others were standardised and not specific to the resident. Residents’ needs were not always addressed on their care plans, for example, the daily notes for one resident reported frequent anxiety and agitation but there was no plan in place on how staff should help with this. Residents who were admitted for specialist dementia care had no relevant care plans and staff were not fully aware of their mental health needs. Residents or their relatives were not routinely involved in drawing up or reviewing plans. However, relatives said they were kept informed of any changes in the resident’s health. Not all care plans were reviewed monthly which meant that specific areas of need or concern were not always monitored Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 12 often enough, for example, the care plan of a resident who had multiple falls had not been reviewed since July. Health care assessments were on most files but they had not been completed for two new residents on Level1. Others had not been reviewed or changed when necessary. There was evidence that residents were referred to appropriate professionals for health care. Relatives said that residents were well looked after. One visitor said they had seen a complete change in their relative since she was admitted. Residents’ weights were being recorded but several residents on Level 2 had significant weight loss. Not all had corresponding care plans or interventions. On Levels 1 and 3 weight loss was picked up very quickly and addressed. Staff on Level 2 said that more often than not residents were bathed as planned but not every day because of lack of staff time. There were no records of recent baths for a number of residents, two since August. Information about residents’ wishes with regard to death and dying was included on some assessments but not always carried forward onto care plans. During the course of the inspection staff were heard to speak respectfully to residents. Personal care was provided discreetly and in private. However, there were some practices that infringed residents’ rights to privacy and dignity. Personal care plans did not specify what residents were able to do to make sure that staff helped them to maintain their independence. Some residents were subject to intrusive behaviour from other residents because they were not able to keep them out of their bedrooms. Comprehensive policies and procedures for the safe handling and administration of medication were available, but were not reflected by current practice. One resident said that staff supported her to administer her own medication. Whilst she and other residents had signed a disclaimer, risk assessments had not been completed. Failure to assess the ability of residents to manage their medication safely, places them at risk of harm. It was not always possible to see exactly what medication residents had received and when. The recording of external products and nutritional supplements was particularly poor. Not all medication received into and leaving the home had been recorded. When medication was not given, the reason was rarely recorded. Verbal dose changes had not been accurately recorded. Handwritten entries on Medication Administration Record charts (MARs) had not been checked, dated and cross-referenced to the care notes. There was no guidance available for the administration of when required medication. This meant that staff did not have enough information to be able to give medication effectively and safely. Poor record keeping puts the health and wellbeing of residents at risk of harm. Medication was not always given correctly. An audit of current stock showed that some MARs had been signed when items had not been given. Others Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 13 showed that medicines had not been signed for, but could not be accounted for. The administration and recording of Controlled Drugs was particularly poor. Two residents were prescribed patches for pain relief. In both cases, only 7 of the last 15 patches had been applied at the correct time. Entries in the Controlled Drug register did not match those on the MARs. The failure to record and administer Controlled Drugs correctly places residents at serious risk of harm. Not all medication was stored correctly. Oxygen cylinders were not chained or on trolleys. Eye drops and insulin vials had not been dated on opening. This placed residents at risk of being given out of date medication. Insulin in current use was kept in the fridge, against guidance issued by the manufacturers. The medication fridges were not maintained within the recommended temperature range and one medication room was particularly hot (34°C). Medication must be stored at the correct temperature in order to maintain its effectiveness and safety. The service did not fully assess the quality of handling, recording and administering medication. This failure meant that shortfalls and errors were not spotted and no action taken to improve. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. A significant number of residents had little choice and control over their lives and many were under stimulated. Residents were offered a nutritious and healthy diet but mealtimes were not pleasant and social occasions for all residents. EVIDENCE: Only a small number of residents were able to make choices about their daily lives known. Staff had to make decisions on behalf of most others. Some assessments included information about residents preferred routines and activities but most were not detailed enough. The information was not generally transferred to care plans to ensure it became common knowledge to all staff. There were a high number of residents up and dressed at 07.00am on the first day of the site visit. The majority of those residents were not able to tell inspectors whether this was by choice or to fit in with staff routines. Staff on Level 1 said that most residents were up because they were restless and wandering. However, none of the night reports made mention of this and at 07.30am seven of the eight residents in the lounge were asleep. Other staff said they felt under pressure to get residents up in order to help day staff because they were so busy. The care plan format gave staff the ability to record cultural and religious needs on assessments, for example one Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 15 assessment made reference to the resident attending regular Holy Communion but this was not carried forward to the care plan. There was some brief information recorded about residents’ interests and hobbies. This was not updated or added to as staff became more familiar with residents or as residents abilities changed. There were no social care plans to direct staff what residents enjoyed or were capable of. There were very few activities for frailer more dependent residents. Records showed that residents were not regularly occupied. For example, the records for a resident on Level 1 showed they were only offered activities approximately once a month. The manager stated that there should be more frequent and suitable activities in the new year because of a planned increase in resources. There was an open visiting policy. Visitors said they were made welcome and could stay for a meal if they wished. One relative said, “You can visit anytime you want which I think is a good sign – it means they are not tidying up before visitors.” Residents had a choice at every mealtime. The cook spoke to new residents and their relatives to find out their likes and dislikes. Two residents had a separate menu. Meals at time of the inspection looked appetising and records showed that residents were offered a varied and nutritious diet. Several residents said the meals were very good. One said, “I have a good breakfast, it sets me up for the day.” Mealtimes on Level 1 were much more relaxed than at the last inspection. However, there were still concerns about Level 2. A high number of residents needed maximum help. Therefore staff were too busy supervise residents who just needed encouragement or minimal assistance. Sometimes residents’ were left struggling with the wrong cutlery, or their meal was cold by the time staff were available to prompt them to eat it. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The procedures for safeguarding residents were understood by staff but a lack of training may result in allegations of abuse being mishandled. Systems for handling formal complaints had improved but residents could not be confident that minor concerns would be addressed appropriately. EVIDENCE: There was an appropriate complaints procedure displayed around the home. There had been seven complaints made either directly to the home or to the Commission for Social Care Inspection since the last inspection. The manager had investigated the complaints and found them to be partially substantiated. The way complaints were recorded had improved since the last inspection. Staff were still not recording and passing on minor complaints to the manager. Two relatives and a resident said they had complained to staff about the laundry but because the manager was unaware of the problem she could not address the cause. The manager said she was trying to access a customer care course for staff. Staff had access to written guidance on the protection of vulnerable adults. Some had received training but this was not up to date for all staff. The staff spoken with during the inspection were aware of their roles and responsibilities in reporting any allegations to their line manager and outside the home if necessary. Not all incidents of restraint were recorded. Chairs that restricted the movement of residents were in use without assessments or care plans. An Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 17 armchair was being used instead of bed rails to prevent a resident from rolling out of bed. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the environment continued and the manager was working towards residents having a clean, safe and comfortable place to live. EVIDENCE: The redecoration and renewal plan was on target and improvements to the environment continued. There were regular maintenance checks and with one or two exceptions the building seemed to be in a good state of repair. Level 2 was being decorated and there were new furnishings and carpets on order. Level 1 was next on the schedule. Residents and relatives were satisfied with the environment. One resident said, “it’s comfortable in here, just what you want,” and a relative said it was a “gorgeous place, beautiful.” Residents were happy with their rooms. Some were highly personalised with ornaments and pictures. The manager said that some residents had been asked about a bedroom door lock because other residents were going into their rooms uninvited but new residents were not routinely asked whether they wanted a lock on their door. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 19 Not all radiators were guarded but there was a planned date for completion of this work. There were general improvements in the cleanliness of the home but a few items of bedroom furniture were stained and dirty. Although some areas were slightly malodorous, overall the home smelled fresher. A number of staff were undertaking infection control training and written guidance was available. Care staff were seen to wear protective clothing and handle clinical waste appropriately but some ancillary staff did not have a full understanding of infection control procedures. Residents and relatives still had some concerns about clothing going missing and clean clothes not being looked after properly. In a few rooms items were seen stuffed into drawers resulting in creased and unkempt clothing. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels and insufficient training may contribute to some of the shortfalls in standards of care. Improvements in recruitment practices help to safeguard residents. EVIDENCE: Staff views about the staffing levels in the home varied. Some said that staffing numbers were “sufficient” and “on a par with other areas” others said that there were not always enough staff to carry out care. Residents and relatives commented that there were shortages in some areas. One resident said, “You can tell that they’re short staffed, they’re so busy all the time,” and another said that staff did not have enough time to spend talking. There were high numbers of agency staff on Level 2. A member of staff said this sometimes caused problems because they did not have time to tell them what to do. Another member of staff said that they did not have time to write and update care plans and had to stay behind to do it. Residents and relatives made positive comments about the staff team. These included, “they’re nice when they come to you,” “pleasant,” and “the staff are great.” Recruitment practices had improved. All the required documents and information had been obtained and were seen on staff files. Pre- employment checks were conducted. However, staff were not always appropriately supervised whilst waiting for their CRB disclosure to be returned. For example a nurse was left in charge of the home before she had a CRB check. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 21 There was evidence that new staff had first day induction training and they completed the old style induction standards. Inspectors were shown a programme that met the skills for care standards that would be given to all new starters. Less than 50 of care staff were trained to NVQ level 2. The manager said that several staff were enrolling on the course. Staff had received training in moving and handling and fire safety since the last inspection but training in other safe working practice topics was not up to date. Two staff had attended courses on dementia awareness but two of the three staff working on Level 1 during the inspection did not have training in dementia care. The manager stated that she is meeting with the training co-ordinator for the organisation to develop a training plan for the home. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The commitment of the manager has contributed to some improvements in the management and administration of the home. EVIDENCE: The manager is a registered nurse with several years experience of managing a care home. She was aware of the need to apply to register with the Commission for Social Care Inspection but had not done so at the time of the inspection visit. The manager kept her practice up to date by attending short training courses. From discussions it was apparent that she was keen to improve the standards in the home. Since the last inspection the manager had put into place some quality monitoring systems, including resident/relative surveys. The organisation was in the process of introducing a new system for monitoring and improving the Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 23 quality of the service, which the manager said will be fully implemented later this month. There were no changes in the way residents’ finances were handled. Records were kept of all transactions and residents or their relatives were able to see the balance of money held on their behalf at any time. Most staff had had at least one supervision session with a senior member of staff and the manager was working towards appropriate supervision for all staff. The records showed that the content of the sessions was appropriate and focused on the member of staff’s strengths and training needs. Some staff had been appraised. Following a previous requirement accident reports were being completed but were not always accurate. New residents still did not have photos on file. Some health and safety practices gave cause for concern. Two residents were seen to be moved in wheelchairs without foot plates. The care plan for one stated that foot rests must be used. Caustic denture cleaner was seen in some unlocked bedrooms. There were no risk assessments to support open storage of potentially hazardous items. Certificates were available to evidence maintenance of electrical installations and gas equipment in the home. Some electrical portable appliances had not been tested when they were brought into the home. Despite fire safety training not all staff were completely clear as to how they should proceed in the event of a fire. The fire procedure on display was not clear and referred the reader to another procedure. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 2 STAFFING Standard No Score 27 2 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 2 2 2 Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4&5 Requirement The statement of purpose and service users guide must contain up to date and accurate information about the home. (Timescale of 23/06/06 not met) Following consultation with the service user or their representatives, the registered person must prepare a written plan as to how the service user’s needs in respect of his/her health and welfare are to be met. (Timescale of 31/01/06 not met) The registered person must • Make the plan available to the service user • Keep the plan under review • Following consultation with the service user or their representative revise the plan • Notify the service user of any such revision. (Timescale of 31/05/04 not met) 3. OP7 13(4)(b-c) The registered person must ensure that any potential risks to residents’ health are fully DS0000022482.V312992.R01.S.doc Timescale for action 31/12/06 2. OP7 15(1)(2) 31/10/06 31/10/06 Springfield Nursing & Residential Home Version 5.2 Page 26 assessed and strategies to control the risk drawn up. (Timescale of 31/10/05 not met) This would include regular weight checks and appropriate and timely action taken to monitor and resolve weight loss 4. OP8 18(1)(a) The registered person must ensure that there are sufficient staff to meet the needs and dependencies of the residents. This would include: • Assisting residents to bathe. • Appropriate assistance and supervision at mealtimes. (Timescale of 30/06/06 not met) 31/10/06 5. OP9 13(2) The registered person shall make 05/11/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Previous timescales ranging between 31/05/04 and 30/09/06 not met) The registered person must ensure that residents’ privacy and dignity are respected. (Timescale of 30/04/06 not met) 31/10/06 6. OP10 12(4)(a) 7. OP12 16(2) (m-n) Following consultation with 31/01/07 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) The registered person shall so far as practicable enable service users to make decisions with respect to the care they are to receive and their health and welfare. DS0000022482.V312992.R01.S.doc 8. OP14 12(2)(3) 30/11/06 Springfield Nursing & Residential Home Version 5.2 Page 27 So far as practicable ascertain and take into account the service users’ wishes and feelings. (Timescales of 25/11/05 and 30/09/06 not met) 9. OP29 19(4) Schedule 2 Staff commencing work before a full CRB disclosure is returned must be supervised by an experienced member of staff. (Timescale of 01/12/05 not met) Staff must receive training appropriate to the work they perform. This would include: Induction training Protection of vulnerable adults Dementia care Continence management First Aid Safe working practice topics. (Timescale of 31/03/06 not met) A system for reviewing and improving the quality of care, based on seeking residents’ views, must be established and maintained. (Timescale of 31/03/06 not met) All records indicated in Schedules 3 and 4 must be kept. This includes A photograph of each resident An accurate report of any accident or incident affecting a resident (Timescale of 31/07/06 not met) A clear fire procedure must be displayed in key areas of the home. (Timescale of 31/05/06 not met) Potentially hazardous items must be risk assessed and stored safely. (Timescale of 30/04/06 not met) DS0000022482.V312992.R01.S.doc 31/10/06 10. OP30 18(1) 31/10/06 11. OP33 24 30/11/06 12. OP37 17(1)(2) 31/10/06 13. OP38 23(4) 31/10/06 14. OP38 13(4)(a) 31/10/06 Springfield Nursing & Residential Home Version 5.2 Page 28 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 OP9 Good Practice Recommendations Temperatures of medication storage rooms should be monitored and maintained below 250c All handwritten amendments on MAR sheets should be signed and witnessed. 2. 3. 4. 5. 6. 7. 8. OP11 OP12 OP16 OP19 OP24 OP26 OP28 A record should be kept of residents wishes regarding terminal illness and after death. Staff should have access to training on providing occupation for residents with dementia. Staff should receive training on how to deal with complaints. The manager should continue with the programme of redecoration and refurbishment. Residents wishes regarding locks on their bedroom doors should be sought and actioned. The manager should act upon the concerns raised about the laundry. A minimum of 50 of staff should be qualified to NVQ level 2. Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Springfield Nursing & Residential Home DS0000022482.V312992.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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