Inspection on 13/02/09 for Springfields Care Centre

This inspection was carried out on 13th February 2009.

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

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

Springfields Care Centre 15/12/08

Springfields Care Centre 07/02/07

Springfields Care Centre 09/11/05

Springfields Care Centre 06/07/05

Springfields Care Centre 03/02/05

Springfields Care Centre 01/09/04

Springfields Care Centre 25/02/04

Similar services:

The Vicarage

Fairfields Country Rest Home

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5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Springfields Care Centre Springfields Care Centre 33 Springfield Road Elburton Plymouth Devon PL9 8EJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Springfields Care Centre 33 Springfield Road Springfields Care Centre Elburton Plymouth Devon PL9 8EJ 01752482662 01752482210 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Name of registered manager (if applicable) Mrs Nicola Marie Kelly Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: There will be no more than the maximum of eighty five (85) service users in the home at any time. Date of last inspection Brief description of the care home Springfield Care Centre is an 85 bedded purpose built home that provides nursing and personal care to adults who suffer from physical or mental health problems in separate Care Homes for Older People Page 4 of 36 20 20 0 10 Over 65 20 20 25 65 care home 85 Brief description of the care home units. There are presently 20 registered nursing beds on the dementia care unit that can be used for adults or the elderly. The remaining beds are to be found in two other distinct units, one providing general nursing care, and one that provides residential (personal) care. The residential care unit is undergoing refurbishment to provide separate facilities for older people and older people who suffer from early signs of dementia. The home has a Registered Manager who has overall responsibility for the running of the home. In addition to this each unit is separately staffed and has its own unit manager. Each of the two nursing units are managed by a registered nurse, and have a registered nurse on duty 24 hours a day. The residential care unit is managed by an experienced Senior Carer who may call on the District Nurses for any nursing needs the clients might have that do not warrant placement in a nursing home bed. The units are arranged over two floors with shaft lifts between each floor. There is an enclosed garden at the rear of the home lying between the ground floor accommodation wings of the home. The homes fee structure begins at 357 Pounds rising to 560 Pounds plus the funded nursing care contribution. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. Prior to this inspection we performed a random inspection in December 2009 following a complaint. This random inspection found no evidence to support these allegations and found that no regulations had been breached. Prior to this inspection we also received completed surveys from people who use the service, their relatives and staff who work at the home. We also received an AQAA. An AQAA is a document we ask for once a year which Care Homes for Older People Page 6 of 36 contains factual information about improvements within the home, information about events occurring at the home as well as numerical information about the home. This document was well completed and given to us within the timescales set. This key unannounced inspection consisted of a visit to the home on Friday 13th February 2009. One inspector and an expert by experience performed this inspection. The Commission for Social Care Inspection consider an expert by experience as a person who either has a shared experience of using services or understands how people in this service communicate. They visited the service with us to help us get a picture of what it is like to live in or use the service. During this time we spoke to the registered manager who is the person with day to day responsibility for the service, the administrator, two deputy managers and a registered nurse, the chef and three care staff. We spoke to 11 people who live in the home and 6 visitors. We case tracked six people who use the service. Case tracking means we looked in detail at the care six people receive. We spoke to staff about their care, looked at records that related to them and spoke to their relatives or made observations if they were unable to speak to us. We looked at six staff recruitment records, induction and training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Springfields Home. What the care home does well: People who use the service and their relatives have the information they need to decide whether Springfields is the right home for them to move into. The admission procedure shows that staff make sure they can meet the persons needs but also means that they are assessed to ensure they would fit in with other people in the home. People tell us that Springfields was the best home they had visited and that the admission process is good. People receive an excellent standard of personal and nursing care. One person wrote This home is well run and comes highly recommended Communication with health care professionals in the community is good. The care people receive is good and provided in a safe and respectful way. The way care is provided to those with dementia type illnesses is based on best practice guidelines and staff are continuing to look at ways of improving the care that is provided. Medicines are also well managed at the home by the nursing staff. Staff at the home ensure people see the doctor or other health care professionals when they need to. The care planning systems and documentation at the home are good and mean that staff know how to care for some one in a safe and consistent way that meets their individual needs and preferences. Care planning is made from the persons view point to show that it is person centred rather than institutionalised. People have access to an excellent and varied programme of activities and are able to maintain contact with their family and friends. People enjoy the activities at the home particularly the 1:1 sessions and opportunities to chat with staff. The staff continue to look at good practice guidelines for caring for people with dementia type illnesses and have adopted new and varied activities to provide meaningful stimulation. People tell us that the food is excellent at the home and any issues regarding dietary requirements, preferences or weight issues are sensitively managed. The home has been proactive at looking at ways of ensuring people get a balanced diet without the need for supplementary drinks. This means that people sleep longer and do not wake up hungry. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. People are safe at the home. Staff have had training to recognise signs of abuse and know how to report any suspicions or poor practice. Springfields is generally a safe and pleasant place to live and work. The manager and her staff group have suitable qualifications and experience to care for people who require nursing and personal care. Pre employment checks are performed on staff to show they are suitable to work with vulnerable adults. The people living at the home are involved in this process. Once employed staff are supported to continue to learn new skills and methods which enrich and enhance peoples lives at the home. The home is well managed by the manager and Provider. Care Homes for Older People Page 8 of 36 What has improved since the last inspection? What they could do better: The home should continue to use their established quality assurance programmes as a Care Homes for Older People Page 9 of 36 way of improving services for people in the home. In addition to this the manager should introduce systems to ensure the outside area is free from debris in order to reflect the high standards of cleanliness within the home. Sheets should be monitored to ensure worn sheets are replaced when necessary. The manager should also ensure photographs of staff kept on staff files are of a satisfactory quality to show what the member of staff looks like If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information provided means that people and their relatives have accurate information to decide whether Springfields is the home for them to be in. The admission procedure is good and means that staff have enough information to decide whether they are able to meet the needs of the person. Evidence: The Statement of Purpose and Service User guide are found in the entrance hall of the home. Both documents include the information that is needed for people to decide whether the home is the right place for them to be. Each document reflects the services that are provided and includes information on fees, staff, room sizes, services that are provided and how to make a complaint. Relatives told us they were given sufficient information when moving to the home. One Care Homes for Older People Page 12 of 36 Evidence: relative told us she had looked at 7 other homes in Plymouth before deciding that Springfields was the place for them to be. Surveys informed us that people coming from hospital had less information. On person said We had a limited choice of homes because of the nature of his illness. Our choice needed to be made quickly Staff told us that the pre admission assessment has improved since the last inspection and that the assessment tool has expanded to ask more detailed questions. One member of staff said, initially this document was difficult to use but now acts as a prompt to ask relevant questions. Each person is admitted following an assessment performed by nursing or management staff at the home. This assessment is used alongside assessments made by other health care professionals. Together this information is used to make an initial plan of care. Evidence was also seen of involvement of the person and their family. Staff told us the unit managers perform the initial assessments not only to assess the persons needs but to assess suitability to fit with other people in each unit. Relatives told us that, because of their illness, their relative was not aware of their admission to the home but staff gave a great deal of reassurance to them both. Another relative said she was especially grateful for staff taking on board our request for him to look smart. They really make an effort to fulfil that for us. Each person is given a contract when they move to the home. The examples seen contained information needed to protect both parties and showed what payments were expected. Care Homes for Older People Page 13 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care people receive is provided in a respectful and person centred way. The care planning systems at the home are excellent and reflect how health and personal care needs are identified and met in a safe way. The management of medicines is good and helps protect people from risk. Evidence: During the inspection people looked cared with the finer details such as eye care, nail care and appropriate foot wear present. All the visitors we spoke with said that they were very pleased with the way their relatives were being cared for. One relative said when speaking to my mother who is virtually blind one carer always kneels down so they are on face to face level and she can see him People told us that they were pleased with the attention they received from the Care Homes for Older People Page 14 of 36 Evidence: majority of the staff. One person said I get on very well with the girls and boys, they are very nice, polite, kind and helpful. Other comments included they always explain it to me when my medication or treatment changes unlike when I was in hospital Surveys showed that people and their relatives were also pleased with the care. One person wrote The standard of care has improved over recent years and There are close links with the GPs and there are doctors on call when needed and we feel the staff and management are committed to provide the best care for our mother. People living at Springfields have access to a range of health care services both at the home and in the community. People have access to local and national NHS services and routine screening programmes. Each person has a GP who attends when staff request a visit. One person said it is good to have the same doctor all the time. People told us they were grateful for the nursing and personal care they received. One person said the nurses really know what they are doing and are quite informative. Whilst a relative said the staff always let me know when any thing changes. Health care needs are monitored in well written care plans. The care plans have been improved and are organised to show different areas of the plans. The plans are called care and health assessment profiles (CHAPS). Each CHAP sets out his or her specific needs. Each plan contains assessments for such issues as falls, nutrition, moving and handling and more general risks. Risk assessments included Waterlow, nutrition, falls and mental health assessment. There is also a risk assessment available when the use of bed guards (bed rails) has been considered. These assessments are reviewed each month or where a change occurs. Systems were in place to check reviews had occurred for all people in the home. Plans of care were well written and explain how care needs for each person will be met. Care Plans were written from the persons perspective to prevent staff making life at the home too clinical or institutional. Phrases such as I am no longer able to... and I would like... and If I get restless, this may be because... The use of skin maps were used for people who have sustained cuts and injuries. Unexplained bruising charts were in use to record where people had sustained bruising where no explanation could be found. These were then used to watch for patterns of injuries. Specialist health care professionals are sought for advice and guidance. Progress of the person is recorded in notes made by the staff and also by health care professionals such as chiropodist and Doctors. The home has its own activities staff who also have Care Homes for Older People Page 15 of 36 Evidence: their own sheet to record activities that each person has been involved in and their response to the activity. The management of medications is performed well at the home. We looked at the treatment rooms where medications are stored in either locked trolleys or locked cupboards. The Registered Nurses are responsible for management of the medication from receipt to disposal. Medicines are supplied mainly in a monitored dose system. The medication trolleys were clean, tidy and securely stored. A spot check of controlled drugs was performed and found to be correct and managed well. Fridge temperatures are recorded daily to ensure correct storage of medications. The records of administration were clear. To aid identification of the person to receive medication the records have photographs of each individual person living at the home who were in receipt of medication. Used medications that were to be disposed of were kept initially in a locked cupboard then placed in a returns container that securely held medication. All medications for disposal are recorded and signed for on collection as per the company and government policy. People who use the service are encouraged to join in with physical exercise programmes provided. The use of walking aids were encouraged and people had space to wander as they chose. Grab rails were present throughout the home and ramps were available to reduce risk. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and activities and addressed using their chosen term of address. The home cares for people with dementia type illnesses. Some staff have been trained in the specialist ways of caring for people with these specialist needs and care plans show how care is delivered in a person centred way. Appropriate use of diversionary tactics and orientation methods was also used throughout the inspection to calm anxiety and prevent escalation of some behaviours. We spent a portion of time watching staff interact with people in the lounge. As a team, staff displayed very positive interactions which caused positive experiences for people in the home. Interactions seen on the day of inspection were appropriately affectionate, kind and professional. The manager told us the home are enrolled on a project called PEARL, (Positively Enriching and Enhancing Residents Lives). Where training, looking at the environment, life stories and medication reviews eventually improve the life for people in the home. Care Homes for Older People Page 16 of 36 Evidence: Staff explained that there are awards that can be achieved as the outcomes improve for people in the home. Relatives told us they have attended dementia care training provided by the home. One relative told us It has really made us realise why staff are doing things the way they do. Relatives also told us they were being supported to set up a support group for other people who had relatives in the home. Staff told us they had attended dementia care training and were booked to attend the dementia care mapping training which senior staff have already attended. Dementia care mapping is a method used to evaluate the quality of care from the perspective of the person with dementia. Care of the dying is performed well at the home. Staff use the Liverpool Care Pathway where all health care professionals work together and record together the care that is planned and given to ensure care is continuous and effective. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The varied, well organised social and therapeutic activities provided for people is excellent. People also benefit from a wholesome balanced diet. Evidence: People we spoke with said they were very happy at the home. Surveys confirmed this. One relative wrote The home is a very happy place to be and another wrote My husband is very well looked after Relatives told us they were still able to take their relatives out for the day whenever they wanted. One relative said he takes his mum shopping because he knows that is what she loved to do. With one exception, people told us that they chose the time of rising and retiring, with or without assistance. The person with the exception said, I am awoken by a nurse singing loudly in my room adding it is 9.15 am by then so I am ready for breakfast, I am not complaining. Staff were seen and heard to knock and wait before entering bedrooms. Relatives said Care Homes for Older People Page 18 of 36 Evidence: staff allow privacy when visits take place. Another relative told us I am pleased that the staff encourage people to leave their rooms, socialise and join in the activities, my mother is always dressed in clean clothes which are her own and usually colour co-ordinated which was important to her before she became so ill Surveys told us that relatives were pleased with the activities. One relative wrote Mum has been encouraged to join in activities regularly and has enjoyed the sensory room and musical entertainments Some people told us that they chose to remain in their rooms as, I have everything I need here, pointing to their TV, music centre, books and magazines. Others said they joined in some of the activities. One person said, my wife visits and organises the Bingo which many others enjoy. I cant stand it myself. There is a designated activity room where people are able to perform arts and craft activities and use the homes computer to look at images and the internet. One relative was particularly grateful for staff who had supported her husband in making a valentines card for her. Staff explained that the programme of activities has changed over the last few months. Formal activities such as bingo, exercise sessions, films, musicians, animal visits and craft events continue. In addition to this staff have introduced more intense person focused activities on a 1 to 1 basis. One member of staff had bought in old pennies found at her mothers home. This member was spontaneously provoking response and interaction from people who had moderate and severe dementia type illnesses. Other staff were playing card games on a 1 to 1 basis and others were using a large ball for physical activity. A relative told us this happened each day and was not one because of the inspection Staff also told us they have realised the importance of swapping photographs and posters around in the dining rooms to provoke responses. Throughout the unit where people have dementia type illnesses there were scarves and bags available for people to touch, remove and play with. Staff told us they are in the process of getting rummage boxes full of things which are familiar to hold and look at. Staff at the home also use doll therapy where dolls are used to provide stimulation for some people in the home. This therapy is seen as good practice. The home have a well equipped sensory room which is used by people in the home. Lights, music and soft seating is provided to relax or stimulate people with dementia type illnesses. One relative said I feel we are fortunate to have this in our home. It really is fantastic. Care Homes for Older People Page 19 of 36 Evidence: A notice board in the entrance hall shows photographs some events that have occurred in the home. Staff told us of a new programme called Connecting with you community where staff encourage people to maintain their links with the community and start new links. An example given was where a relative took their relative to a local cafe and shared the positive experience with other people in the home. The manager explained that this scheme was in the early stages. One person is collected by members of her Church each Sunday morning and a group of people from another Church visit on a regular basis, as do singers and entertainers. A regular Communion service is provided at the home. There is a full-time Activities Organiser who was seen to be in full flow encouraging a person to play golf on the Nintendo Wii (a computer type game using bats and rackets which is displayed interactively on a very large TV screen watched by others) Visitors said they were always made welcome and given the freedom of the home and offered refreshments. A daily visitor arrived with a handful of new DVDs he had purchased to be used for the weekly film show. Staff explained that one lounge has large flat TV screen with surround sound audio system which was used for the cinema club. People said that in the summer they make use of the enclosed garden and staff will bring them tea and coffee there. Opinion on the food was that generally it was good and in sufficient quantity although one relative thought that the food budget had gone down since four seasons had taken over. Discussions with the chef confirmed extra money would always be welcome but there was adequate. The manager confirmed that the budget has actually increased in recent months. One person said the food is lovely and whatever I say I want they give it to me. Another mentioned the availability of fresh fruit for breakfast and bacon and egg twice a week. One person said, since coming here a year ago I have put on 2 stone due to the soups and other food and especially the care from one particular named nurse. (Enquiries revealed that on admission this person was critically ill and was now much better). Surveys confirmed that people and their relatives thought the food was good. Comments included Kitchen staff work hard to provide choices to accommodate their tastes and requirements staff surveys said Balanced client meals and vegetarian Care Homes for Older People Page 20 of 36 Evidence: options and full range is always well presented One relative wrote Kitchen staff go out of their way to see that he gets everything he wants. Our family member has a poor diet and does not like eating but we think the food is good. Following discussion with people who use the service,their relatives and staff, a trial of 4 weeks has been introduced where the main meal is now served at 5pm with a lighter meal at lunchtime. The explanations for this were that food intake is more evenly spread throughout the day. So far, staff told us that this has been a success with less food wasted midday and more people being able to sleep through the night without waking up feeling hungry. The chef told us more food is available at lunch times. On the day of the inspection the lunch was vegetable soup, omelette and dessert. One diner was suitably assisted by a carer sat alongside. Evening and night snacks are said to be available. Those requiring a soft pureed diet experience a positive experience. The pureed meal was sampled and shown to have good flavour, aroma, texture and taste. The AQAA told us A large blackboard has been created in each dining area so that residents can be reminded each day what is on the menu. The dining room in the dementia unit has been improved and tables are set with tablecloths, place settings and condiments at each mealtime Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service and their relatives can be confident that their complaints and concerns will be listened to and acted on. The knowledge, procedures and training in place for the Protection of Vulnerable Adults help to protect people. Evidence: Relatives told us they felt able to complain to staff and the manager in the home. One relative said they even felt able to complain for other people in the home. Surveys also told us that people were able to complain. Comments included Yes I do know how to complain but have not needed to do so. and We have never needed to complain The complaints procedure is displayed in the home for the benefit of people who use the service, staff and visitors to the home and includes how to contact the Commission for Social Care Inspection. The procedure is also displayed in the Statement of Purpose and Service Users Guide. The home has a record which is organised and clearly shows any complaints in along with the outcomes following an investigation. In the last year the home have received eight complaints. Four were substantiated, two are on going and two were unsubstantiated. The CSCI received an anonymous complaint late last year. It was alleged that people were got out of bed before they Care Homes for Older People Page 22 of 36 Evidence: chose, people did not have enough bedding to keep the warm and people were placed in recliner chairs to stop them wandering around. A random early morning inspection was performed where no evidence could be found to support these allegations. Since this time the CSCI received another complaint which was handed to the provider for investigation. The investigation is still ongoing. We did not see anyone who was unnecessarily restrained in the home. One person was in a reclining chair, the reasons for this were recorded in their care plan. A risk assessment is available when the use of bed guards (bed rails) has been considered. However, staff told us that each time a risk assessment is performed alternative methods of keeping a person safe is found. We saw examples of bed wedges which are used. These wedges enabled people to get out of bed if they chose but prevented people rolling out of bed. Beds for people who were more mobile could be lowered to the floor and spare mattresses were also used to protect people from falls whilst allowing freedom of movement. Because of the mental illness, people who use the service express their dissatisfaction with issues verbally and sometimes physically. Staff were ale to explain which people showed different ways of distress and how they spotted them. During the inspection we saw staff anticipate behaviours and triggers for people to prevent discomfort and distress. Interactions seen on the day of inspection were appropriately affectionate, kind and professional. Relatives told us they are in the process of setting up a relatives support group to enable relatives and friends to express their views and support one another. Relatives told us this group would be useful to feedback ideas and concerns with the manager. Relatives told us they had never seen staff act inappropriately with any person in the home. Everyone we spoke with, without hesitation said they felt safe living at the home. Staff we spoke to said they felt able to talk to the manager about any worries or concerns. The home also operates a supervision and appraisal system in which staff raised concerns that are discussed, recorded and acted upon. Staff told us they would have no hesitation to complain if the situation arose and would certainly report poor practice. Staff said they had attended Protection of vulnerable adult (POVA) training and had been informed of the different types of abuse and how to report them. All staff were Care Homes for Older People Page 23 of 36 Evidence: aware they could speak with the CSCI if they were concerned about abuse. The manager confirmed that she would remind staff of how to report allegations of abuse if it was done by staff in a senior position to them. The manager told us senior staff had also attended mental capacity act and deprivation of liberty training which was going to be passed to care staff. All staff have a criminal records bureau police check and a POVA register check performed before they are able to work. Care Homes for Older People Page 24 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Springfields is a safe, hygienic and pleasant place to live and work. Minor improvements to the outside of the home could improve appearance of the home. Evidence: Springfields is a purpose built home arranged over two levels. Each room is for single occupancy and has an ensuite bathroom. There are a very small number of large rooms which could be used for double occupancy for people who chose to share. There are three units within the home. A residential unit is on the right of the building and is arranged over two floors. There is a shaft lift for access between floors and stair cases for people who wanted to use the stairs. There is a nursing unit on the ground floor on the left hand side of the building which has access to well maintained secure garden. The garden has covered areas, gazebo, scented walkways and seating area which relatives said was popular in warm weather. On the upper floor on the left hand side of the building is a frail elderly nursing unit. There are many communal areas throughout the home which were being used. Large lounges were divided into smaller seating areas which people were seen rearranging freely. Some lounges had TV whilst others had a radio. Some people chose to sit in their own rooms. There is a large dining area close to the kitchen which is used by people throughout the home. Relatives and people who use the service told us they Care Homes for Older People Page 25 of 36 Evidence: are able to have their meals where they chose. There are many toilet and bathing facilities within the home. Specialist baths are availaible for people wishing to have a bath. Each person has their own room which are decorated with personal items. Each room has a brass name plaque. Whilst performing a tour it was noted that some sheets were worn and in need of replacement. The manager gave assurances that these would be ordered. The home was clean and tidy with a total absence of unpleasant odours. People told us the home was always clean. Surveys said Domestic staff work hard to keep rooms and corridors clean and provide fresh laundry on a daily basis. However one survey said The smell on the EMI unit is often disgusting, armchairs are stained. Our inspection found all areas of the home were clean and free from odour. One visitor commented on the amount of litter in the car park saying that it detracted from the otherwise good appearance of the home. We were told that all communal areas and the majority of rooms had been redecorated and refurbished since the last inspection. Many carpets have been replaced and lights changed. Staff told us there is a very good maintenance man who attends to routine and ad hoc repairs where necessary. The AQAA informed us that contracts were in place for maintenance of equipment and services at the home. The manager also informed us that since the last inspection the fire control panel had been replaced following a fault. The chef told us the recent EHO (Environmental health Office) inspection was very good and had resulted in less frequent inspections. The kitchen was clean, well organised and tidy. Cleaning and maintenance checks were in place in addition to the safer food better business food standard agency checks. Staff had access to gloves, aprons and hand soap. Hand gel was available throughout the home. The laundry was clean, tidy and well organised. People told us there were not any major issues with laundry. One person said nothing gets lost because clothes are labelled with either a room number or name. Washing machines suitable for washing foul laundry were present and industrial dryers were present. The laundry has washable walls and impermeable floors. There are dedicated staff who operate the service who explained that the route for bringing laundry to be washed was done without access through dining or kitchen areas. Care Homes for Older People Page 26 of 36 Care Homes for Older People Page 27 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are cared for by a stable well trained staff group who have had sufficient pre employment checks carried out. Minor improvements to the recruitment records would improve the quality of information held. Evidence: The home is managed by a Registered Nurse who has been educated to degree level. She has several years experience in the management of this care home that provide nursing to older people who have a mental health problem. She is supported by other registered nurses and senior care staff who are also experienced in this field of care. Between them provide registered nurse cover over the 24 hour day. Without exception, comments regarding staff were very positive. People and relatives used descriptions such as wonderful, you cant ask for better the staff are so thoughtful and the nurses are always laughing, full of smiles and giggles Off duty records are maintained and show that staffing levels are stable and supplied in sufficient numbers to meet the complex needs of people who use the service. In addition to the nursing and care staff, additional ancillary staff to clean, cook and attend to the laundry. The manager told us that staff at the home continue to cover shortages themselves to provide continuity of care, so agency use is kept to a minimum. Staff surveys confirmed this. One comment read Lately we have had a lot Care Homes for Older People Page 28 of 36 Evidence: of sickness but with the good team spirit we have coped with the situation When asked whether people and their relatives thought there were enough staff, the responses varied from yes to there always seems to be not enough staff at the weekends and holiday time. One person suggested that certain staff failed to report for duty following drinking sessions at the end of the week. The manager explained that the staffing numbers were the same at weekends and at weekdays but that organisation was not as formal. Relatives comments supported these findings in that staffing levels were generally good apart from when staff were off sick. Comments on call bell response times were, quick, within 5 minutes, 5 to 10 minutes, and exceptionally has been up to 30 minutes particularly at the weekends, but they apologise when they do arrive. An investigation was made into this particular statement which showed that call bell times averaged between 3 and 6 minutes and this person had indeed had to wait for 30 minutes for a low priority task whilst staff dealt with another person who needed immediate assistance. Some staff at the home have come from overseas and subsequently English is not their first language. In these cases people said there were no problems in people and staff understanding one another. The care staff have received training in both general care duties such as manual handling, food hygiene, fire safety, health and safety and infection control. Some care staff have had additional training to understand the more complex needs of mental health problems including dementia. Staff told us that many care staff have an NVQ in care at level 2 or above. Surveys read We are fully encouraged to take NVQ training. We have had more recent training in person centred care and dementia Recruitment is well managed at the home. The administrator processes the actual application and chases CRB and references, whilst the manager and senior staff interview potential staff. People living in the home are also included in recruitment. One person told our expert 8 applicants were interviewed over two days using a preset list of questions and conversation. This person said some would be ideal for the post of carer but I am waiting the management decision. Staff recruitment folders showed that the recruitment process is consistent with all staff being interviewed following completion of an application form. Applicants are asked to complete a criminal declaration and health questionnaire. Staff files also contained CRB and POVA recording information two written references and proof of identity including photograph from the driving licence or passport. All registered nurse files contained up to date Nursing and Midwifery Council and work permit checks Care Homes for Older People Page 29 of 36 Evidence: where appropriate. All staff files showed evidence that staff had completed an induction programme and had had a recent supervision session. Care Homes for Older People Page 30 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The competent Manager and staff at the home manage the home in an effective and efficient way. Evidence: One comment we received within a survey read One person wrote This home is well run and comes highly recommended. The Registered Manager is an experienced Registered Nurse with experience of managing care homes. The Registered Manager is educated to degree level and continues to update her knowledge by attending courses and other continued professional development courses. Staff surveys read I have worked at Springfields for several years and feel this is the best it has ever been with a supportive and approachable manager. Another staff member wrote My manager has been a great support to me and has always encouraged me and believed in me, even when I wasnt believing in me Whilst another wrote Our manager is very much involved in staff Care Homes for Older People Page 31 of 36 Evidence: needs and she always seems to ask me if Im OK and offers me support if I need it. The home is owned by a corporate organisation who provide the manager and staff with support and guidance. There are many company policies and procedures i place which are tailor made to ensure they are suitable for Springfields. The manager is supported by a skilled staff group who collectively manage the home. The manager told us she sees herself facilitating the three unit managers and other senior department staff at the home who all report to her. There is an administrator at the home who has a background in banking and finance. His role is to support the manager in an administration role. Part of this role is the management of peoples personal accounts. These systems were inspected and show that the process of managing other peoples money is safe, appropriate and auditable. Records and receipts kept were clear and well organised. Records also showed that whilst the monies of people are stored within one bank account, unpaid bills are not supported by other people or the home. Relatives or representatives are sent the unpaid invoices and asked to settle. Other records were well maintained at the home. Confidential information is appropriately stored and records are safely stored. Financial systems were not closely inspected on this visits. However, Insurance certificates were displayed in the home and show sufficient cover. Staff told us there are clear lines of management at the home and contact details of how to contact different staff within the organisation are within the office areas. Staff said they felt the home was well organised and appreciated the open door policy of the manager and unit managers at the home.Staff said the manager is very approachable, supportive and maintained confidentiality when personal issues are shared. Staff said they could come and discuss issues at any time. Staff told us there are staff meetings where new information is shared and is also an opportunity for staff to share ideas and concerns. Staff also told us mandatory training was always up to date because there are weekly training events for staff to attend. All staff we spoke with told us they had receive mandatory training within the last year. Relatives also told us they appreciated the open door approach of the manager but found the communication with each unit manager was also effective. Relatives also told us that there are meetings held on regular basis and sometimes they are asked to fill in questionnaires. Care Homes for Older People Page 32 of 36 Evidence: Quality assurance processes are robust at the home. We were told of the monthly quality and clinical governance meetings held each third month. This meeting was where heads of departments gather to talk about accidents, incidents, infections, pressure areas, weight monitoring and use of restraint. The manager told us she also performs random spot checks on staff. There are also team audit processes which include calibration of equipment. These audits are cross checked and audited by staff outside of the home. Quality assurance is also maintained by performing customer surveys, health and safety meetings, food standard meetings, supervision and staff meetings, Regulation 26 (Provider inspections), home reviews, and resident and relative meetings. Care Homes for Older People Page 33 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 34 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 19 24 29 The manager should introduce systems to make sure the car park area is well maintained The manager should introduce systems to make sure sheets and bedding are of a good quality The manager should improve the quality of staff photograph on staff file Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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