CARE HOMES FOR OLDER PEOPLE
Springfield Residential Home Oaken Drive Codsall Wolverhampton Staffordshire WV8 2EE Lead Inspector
Mrs Wendy Grainger Key Unannounced Inspection 2 August 2006 8:30 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 Residential Home DS0000005000.V306275.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 Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Springfield Residential Home Address Oaken Drive Codsall Wolverhampton Staffordshire WV8 2EE 01902 844143 01902 845093 springfield.house@fshc.co.uk 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) Springfield House (Oaken) 2001 Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Mrs Lynda Warden Care Home 35 Category(ies) of Dementia - over 65 years of age (6), Old age, registration, with number not falling within any other category (35) of places Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Springfield House is located on the periphery of the village of Codsall. Standing in its own grounds the home is accessed via a long drive. The home was registered some years ago to offer accommodation to older people; the home has been extended sometime ago, but retained the majority of its original features. Within the grounds and screened by trees there is a large lake. Bedrooms were located on the first and ground floor; the first floor can be accessed via the stairs or one of the two shaft lifts. Some of the bedrooms had an en-suite facility, the bathing and separate toilet facilities were located throughout the home; the provisions of service users toilets were located near to the communal area. The dining room is central to the home and while not extensive provided sufficient space for the service users that chose to use it. Lounges were spacious providing exception space for the service users to wander freely. The lounge near to the dining room tends to be used by the frailer service user. At the rear of the home there was a large conservatory, the home was generally well furnished and maintained. From the information provided verbally and in the Pre Inspection Questionnaire the current fees for the home were £430 -£700 per week; this high fee was paid for a shared bedroom used for single occupancy. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was completed with the senior care assistant, she demonstrated her knowledge of the residents and awareness of the requirements to assist in the completion of this report. The pre inspection questionnaire had been returned to the Commission and information will be included, as will comments from the relatives and residents. A tour of the home was completed; a number of concerns were identified and will be reflected in the report and requirements. Reports and records where available were provided by the senior care assistant. What the service does well: What has improved since the last inspection?
According to the pre inspection questionnaire several bedrooms have been decorated. New stainless steel shelving fitted in the kitchen.
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 6 What they could do better:
The bedroom Maple remains in the same poor condition with curtains that are now in holes, the carpet and en-suite were poor. This bedroom according to the last inspection completed in July 2005 was to be refurbished. The inspector was told at a later date following this inspection that the curtains had been ordered. During the inspection it was identified that the two night staff spoken with did not have a first aid qualification/current training. Of the three staff on duty during the inspection no member of the team had the required first aid training. This report makes it a requirement to address these concerns. There were a number of concerns in respect of the environment and the fire doors that would be ineffective in the event of a fire. The monthly audit should have identified these areas. This area will be one of the requirements. A number of light bulbs were not working, some were replaced during the inspection but not all, because it was outside the remit of the maintenance person and required an electrician. This report makes it a requirement to ensure that residents had sufficient lighting. The inspector was outside the home for a period of time before a resident summoned a member of staff on the nurse call system. The front door bell was out of order. It is important that this bell is working. A requirement has been made. Staff training records identified that the staff had no training for COSHH, Vulnerable Adults and current training for dementia (two staff completed a one day course in 2000) The night staffing levels had been reduced to two, the Commission had not been informed about the reduction in staffing levels due to the resident occupancy. A number of the relative comment cards refer to the lack of staff on duty. The inspector was concerned that in the registered care managers absence, records were not available in respect of the staff and recruitment. These should be available for inspection and this will be a requirement. The Statement of Purpose could not be located, the document found for relatives contained out of date and inaccurate information. Following discussions with the residents it was identified that one of the ministers (Church of England) was no longer in post. The summary report of the home was dated 2004 and contained in the information within the service users guide. The management needs to ensure that the telephone number for the Commission was available in this document; if in the event a person wished to raise a complaint.
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 7 There was no evidence in the sample of the care plans or elsewhere that and social activity/stimulation was provided for residents who had diverse needs, with the exception of families calling and taking them out. This will be part of the requirements. 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 Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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 Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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): 1,3,5 Quality in this outcome area is poor. This judgement was made using the available evidence. Including trying to locate the Statement of Purpose and the accuracy of the information provided. The home on the day of the inspection could not provided accurate information to any person making an enquiry. Pre assessments continued, no person was admitted to the home without an assessment of their health and personal needs. EVIDENCE: The Statement of Purpose usually kept in the front lounge was unavailable. The service users guide contained information about the clergy in the area that from information gathered from residents were not longer in post. This document contained a summary of an inspection completed in 2004. The previous inspection report was located in the lounge area. One of the residents
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 10 offered assistance and informed the inspector that the papers she was looking for were usually kept by her in the lounge. From the evidence observed in the sample of care assessments continued prior to an admission to the home. An invitation to visit the home prior to admission was the practice of the management. Springfield Residential Home DS0000005000.V306275.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): 7,8,9,10 Quality in this outcome area was adequate. This judgement was made using available evidence including a sample of three care plans, reports, observations and discussions with the residents. The home continued to provide detailed daily reports evidencing the care provided. There were some areas in the care plans that did not comply with the National Minimum Standards. Staff were observed to be aware of individuals needs and addressed them to the satisfaction of the residents. The medication process was observed and found to be satisfactory. EVIDENCE: Of the three care plans seen each one was for a resident with different dependency levels. One did not have a photograph of the resident; this resident was admitted in May 2006.
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 12 There was no evidence of any social activity/stimulation for residents with diverse needs. The inspector was doubtful about one risk assessment for a resident with dementia about their ability to ask for assistance regarding “falls” records evidenced that the last contact this resident had with a dentist was 2003 and she had some remaining teeth. The inspector was impressed with the detailed assessment contents completed by the senior care assistant for the emergency admission resident for respite. The staffs in general continue to produce detailed reports on individuals’ daily life style. Staff on duty were observed to address the needs of the residents, they served breakfast and assisted where necessary. The staff were polite and respectful to each person. Residents spoken with were complimentary about the staff on duty; they assisted when necessary, aware of their needs and enabled individuals to continue with their life style. The morning medication procedure was observed, the senior care assistant dealt with the administration of medicines with awareness of each persons needs, coaxing where necessary. Records were current with all areas being signed. Arrangements for the continued health care from other agencies was displayed in the care plans. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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): 12,13 15. Quality in this outcome area was good. This judgement has been made using available evidence including speaking to residents, viewing the records and observing menus. Monthly entertainment was provided events were displayed in the hall for any person to partake. The staff were aware of the needs of individuals and provided the appropriate care. Residents confirmed the inspector’s observations. A balanced diet was available to the residents; the cooks were aware of individual’s dietary needs , responded to requests when preparing meals. EVIDENCE: The monthly programme of activities was displayed in the hall for the year. Each month the same person visits to entertain the residents. While this was no problem the residents did express that sometimes they would like some other entertainment. The management had arranged a day out in August, plus barge trips and Walsall lights. There was no specific entertainment or
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 14 stimulation for the residents with dementia. This needs to be built into the activity programme and recorded. Visiting was at any time to suit the relative/friends. Contact was maintained for the majority of families. The breakfast was observed, residents had a selection of cereals, grapefruit, porridge and toast. One resident requested poached egg on toast, which the cook prepared. Residents were served liver and onions for lunch some commented that it was all right but they did not really enjoy it. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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): 16,18 Quality in this outcome area is good. This judgement was made using available evidence including speaking with the staff and from the information displayed. The homes complaint process was available to any person wishing to raise a complaint. Information observed was not complete. Staff on duty confirmed that they were aware of the need to protect residents from abuse. EVIDENCE: Springfield residential and the Commission had received no complaints in respect of the care/home /food provided. The complaints process displayed in the front hall was without the telephone number of the Commission and should be included. The senior care assistant told the inspector that she had received training to care for vulnerable adults. Staff on duty confirmed that they knew the procedure for reporting any concerns. Records available indicated that not all the staff had received vulnerable adult awareness training and this would be a requirement for all the staff including catering and housekeeping. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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): 19,20,2122,23,24,25,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a tour of the home. There were a number of concerns that if not addressed could put residents at risk. The exceptional size of the communal areas allowed residents to relax in a spacious environment. EVIDENCE: Located at the end of a long drive where the potholes were increasing. The home stands in its own grounds. The inspector continued to ring the door bell which was identified to be out of order. A resident in the lounge rang the nurse call system to alert the staff to the visit. It is important that the door bell is operational due to the fact the front door was secured.
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 17 From the sample tour of the home the inspector observed and identified a number of concerns that a monthly audit of the home would have identified. A quantity of bedroom doors would have been ineffectual in the event of a fire; door handles were not working correctly. A quantity of the light bulbs were not working, some were changed at the time of the inspection; others required an electrician. Working thermometers were required in all the bathrooms one was found without its mercury centre, failure to check the water when bathing could put residents at risk. The large shared bedroom (maple) and referred to in other reports remained in the same poor condition with the curtains now in holes. The management had planned to refurbish this room previously. Two bedrooms had a mal odour of urine. Bathroom 5 was identified to have toiletries left loose on the bath putting residents at risk. The dining room floor was stained and aged there was a need to have the floor commercially cleaned to bring it back to an acceptable standard. The curtains and roof in the conservatory would benefit from cleaning/washing. There was a need to ensure that the equipment used by residents was in working order, it was observed that at least two of the residents were mobilising with frames that had unsafe ferrules putting residents at risk while having the tendency to damage carpets and other flooring. The furnishings in the lounges were comfortable and suitable for the needs of the residents. Bedrooms were observed to contain personal possessions. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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): 27,28,29,30 Quality in this outcome area was poor. This judgement was made using the available evidence including speaking to staff and the administrator. The inspector was unable to check staff records to ensure that the recruitment process protected the residents. Staff training was not up to date and could put residents at risk. EVIDENCE: From the records and rotas provided the inspector identified that there had been a reduction of one in the staffing levels night, which now totalled two. This had not been agreed by the Commission who had not been made aware of the changes made due to the reduced number of residents. On duty at the time of the inspection were three care staff including one senior care. This remained the same ratio for the afternoon shift. Three housekeeping and two catering staff supported the care staff. The training records provided by the administrator identified that staff in the residential home were, with the exception of one person without first aid training. This had been confirmed to the inspector by the night and day staff on duty.
Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 19 Moving & Handling continued, which was completed by the Deputy Care Manager. There was no evidence for COSHH, and Vulnerable Adult/abuse awareness training. There were four certificates displayed from 2000, two of the staff were no longer in employment. This training was for the care of people with dementia. From the information provided in the pre inspection questionnaire it stated that six people had NVQ in Care, from the record it appears that seven staff had NVQ including Level III. The registered care manager was not on the complex; the required records were locked in her office. No other person on the complex had access to the office. The inspector was unable to check the recruitment records to ensure that residents were protected. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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 38 Quality in this outcome is adequate. This judgement was made using the available evidence, including observation of records, speaking with the staff and residents. The home operated to provide care to elderly vulnerable people. Resident’s finances were protected by the safe system for the handling. Records with the exception of the annual fire risk assessment were current, practices and procedures with the exception of the ineffective doors should protect the residents in the event of a fire. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 21 EVIDENCE: The required weekly testing of the fire system was current, on going involvement of the staff in fire drills continued. The annual fire risk assessment was not current the last review document was dated 2004. The finances of the residents agreeing for the home to hold their personal allowances were accurate from the sample of records seen. There was no evidence of any quality assurance provided on this visit, the inspector was aware that this feed back is sought on an annual basis. Staff spoke well of the senior management and felt supported by them. Staff confirmed that supervision continued. During the inspection it was noted that the home had a relaxed atmosphere. Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 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 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 3 2 2 2 2 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 3 3 2 Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last 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. 1. 2. Standard OP1 OP7 Regulation 4 (c) 15 Requirement To provide at all times current information in respect of the home and the facilities offered To ensure that all the details required in Schedule 3 were available including reviewing the risk assessments for the residents that had a disability/dementia The registered person shall ensure that the front door bell is in working order at all times The registered person shall ensure that the lighting suitable for service users is provided in all parts of the home used by service users. Outstanding from the previous report 18/05/05 The registered person shall take adequate precautions against the risk of fire by ensuring that the bedroom doors and other doors were effective in the event of a fire The registered person shall having regard to the size of the home occupied by residents furnishings including curtains
DS0000005000.V306275.R01.S.doc Timescale for action 25/08/06 25/08/06 3. 4. OP38 OP38 23 (c) 23 (p) 25/08/06 25/08/06 5 OP24 4 (a) 25/08/06 6 OP24 16 (c) 25/08/06 Springfield Residential Home Version 5.2 Page 24 7 OP22 13 (c) 8 OP22 23 (c) 9 OP21 13 (a) 10 OP29 17 (3) (b) 11 OP30 18 (c) 12 OP33 24 13 OP38 23 (4) suitable to residents needs, this was a recommendation in the previous report. The registered person shall ensure that the equipment used by the residents was safe and satisfactory condition. A monthly check on the walking frames and sticks would ensure that ferrules were not worn The registered person shall ensure for the safety of individual residents by ensuring there is a working thermometer in each bathroom The registered person shall at all times ensure the safety of residents by removing the toiletries from the bathrooms The registered person shall ensure that records are at all times available for inspection, including recruitment and relevant checks required prior to employment The registered person shall having regard to the size of the home and Statement of Purpose ensure that persons employed receive training appropriate to the work they are to perform this includes First Aid, COSHH, Dementia and any other relevant mandatory training. The registered person shall supply for the commission the survey/review of the consultation with the residents. This evidence was not available The registered person shall ensure that the review of the fire prevention and paperwork was current, including the annual fire risk assessment 25/08/06 25/08/06 25/08/06 25/08/06 01/09/06 01/09/06 01/09/06 Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 25 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 Refer to Standard OP12 OP20 Good Practice Recommendations To ensure that the residents with a dementia receive the appropriate stimulation to ensure that they were involved in activities suitable to their needs. To have the dining room flooring deep cleaned to return it to an acceptable standard Springfield Residential Home DS0000005000.V306275.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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