Inspection on 06/07/05 for Springfields Care Centre

This inspection was carried out on 6th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Springfields Care Centre 13/02/09

Springfields Care Centre 15/12/08

Springfields Care Centre 07/02/07

Springfields Care Centre 09/11/05

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

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Springfields Care Centre 33 Springfield Road Elburton Plymouth PL9 8EJ Lead Inspector Douglas Endean Announced 6 July 2005 th 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 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. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Springfields Care Centre Address Springfields Care Centre, 33 Springfield Road, Elburton, Plymouth, Devon, PL9 8EJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01752 482662 01752 482210 BetterCare Group Limited Vacant Care Home 85 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20), Mental disorder, excluding learning of places disability or dementia (20), Mental Disorder, excluding learning disability or dementia - over 65 years of age (20), Old age, not falling within any other category (25), Physical disability (10), Physical disability over 65 years of age (65), Terminally ill (4) Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: There will be no more than the maximum of eighty five (85) service users in the home at any time. Date of last inspection 03/02/05 Brief Description of the Service: 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, predominently dementia. It has recently been aquired by Four Seasons Health Care, one of the counrties largest providers of care home beds. There are presently 20 registered nursing beds on the dementia care unit that can be used for adults or the elderly. The remaining beds can be used for people who suffer from a physical disability and need help with personal care or nursing care or are in the category of old age. Up to ten people may be admitted to this part of the home who are under retirement age. There are three seperately staffed units in all, Sycamore, Maple and Willow. The units are arranged over two floors with two shaft lifts between them. There is also an enclosed garden at the rear of the home lying between the wings of the home. Each of the two nursing units are have a registered nurse on duty 24 hours a day. The residential care unit is managed by a Senior carer who is experienced in managing care and staff. The home does have a full time management position that is presently covered by a temporary manager whilst a full time manager is being recruited. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over a five and a half hour period and was attended by the manager and the Area Manager/Risk Manager. The Manager provided the inspector with a completed pre-inspection form with supporting information attached. The inspector made a tour of the entire home, spoke to six staff members and seven clients. A total of seven client records were studied and the staff explained the contents and structure of the notes to the inspector. The inspector looked at a random selection of four staff files. Comment cards were received from three relatives and two clients prior to this announced inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 7 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 standard(s) 1, 3 &4. Standard 6 is not applicable. The literature provided about the home is clear and informative about the service a client can expect should they choose to live there. The pre-admission assessment format is comprehensive and should help to avoid any inappropriate placements. EVIDENCE: The home has a professionally prepared Statement of Purpose that provides the reader with all the information they will need to make a decision about moving to the home. The manager or another registered nurse completes a full pre-admission assessment of prospective clients. The inspector saw completed copies of these assessments in each of the seven files that were reviewed during the tour of each unit of the home. The care plans seen were drawn up initially from these assessments and from the additional information that the home had received on each client such as care manager’s assessment and hospital discharge information. All these documents form part of the client’s records. The home employs nurses with expertise in general and mental health nursing to meet the specialist needs of those clients who need nursing care. The staff Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 8 rotas provide evidence that the two nursing units always have a nurse in charge of them. The pre-inspection information has provided evidence that the nurses employed all have a current registration with the Nursing and Midwifery Council. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8, 9 & 10 The homes arrangements for meeting the care needs are in the main satisfactory, however, the basic assessment skills of some care staff needs to be improved. EVIDENCE: The assessment of clients is reviewed at least every three months to keep information on clients current. Evidence of reviews having taken place was in the sample of notes seen by the inspector. Assessments include Waterlow scale, mobility, nutrition, general risk from falls, or injury from bed guards. The care plans are developed from this information and these were satisfactory in the way they are constructed. Review dates were evident in the sample of records looked at by the inspector. The activity coordinator has her own care plans for each client that were seen during the inspection. The care staff must read the care plans and sign that they agree with the content and delivery of care. The care staff were observed providing care such as grooming and feeding or supervising a meal in a respectful way. The home has specialist equipment to provide for individual clients assessed needs such as pressure relief mattresses, hoists and stand aids and disabled bathing facilities. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 10 The home has a Doctor who attends twice a week who is employed by the Primary Care Trust. He acts on behalf of the general practitioner that the clients are registered with and keeps them informed of the changing care needs. Registered Nurses are employed 24 hours a day in the two nursing units. The residents are referred to a District Nurse for any nursing needs to be met. There is evidence of the involvement of District Nurses in the care of residents. The assessment skill of some of the care staff has been found to be questionable and was the subject of concern. This is to be addressed by the manager and the registered person. The inspection of the arrangements for the ordering, storage, administration and return of medication showed they are now satisfactory throughout the home. The service users spoken to were complimentary about the care they receive. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12, 13, 14 & 15 The home provides many services to meet the individual social and recreational needs of the clients that they are made aware of through assessment. EVIDENCE: The clients ability to meet their own routines of daily living and activities are assessed and their care plans developed around where they need help and supervision. They are able to exercise choice such as who they see, the choice of cloths they wear and how they wish to have themselves groomed such as the style of their hair. The initial assessments and discussion with the clients and their relatives and friend help the staff to understand (and record) likes and dislikes in such things as food. The home employs an activities coordinator who offers practical activities and entertainment, some from external sources. The coordinator arranged a show for the clients recently called “The Good Old Days”. She also has a designated activities room for the clients to come to on a regular basis. The clients have enjoyed a 3-month computer training and awareness course at the home that was run by Help the Aged and Microsoft. The home does have its own mini bus that is used occasionally to take clients to church, the shops or to a local venue for a coffee morning. The garden has been improved recently and is now able to be used by all the clients in the home. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 12 Visiting is unrestricted except at the request of the clients or for medical and psychological reasons. Clients were seen to have visitors in the communal areas and also in the privacy of their own rooms during the inspection. Rooms are personalised by the clients who were seen to have brought a variety of items with them to decorate their rooms such as pieces of furniture, pictures and ornaments. The home does not manage the financial affairs of the clients. The home has a large well-run kitchen that produces all the meals and snacks for the entire home. The food that had been served for dinner looked appetising and in good quantities. The clients that were spoken to during dinner stated that they were happy with the quality of the meals they receive. All the clients have a nutritional assessment and their diets are planned around this. Assistance was provided to clients that needed it during the meal. A full set of rotating menu’s were supplied with the pre-inspection information that show the meals offered and alternative choices. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 & 18 The policies and procedures to protect clients from abuse are robust however some complaints have taken too much time to resolve. The departing manager did begin to change this situation. EVIDENCE: The home has a complaints procedure displayed that does inform the reader of the preferred process for dealing with complaints of any nature. The address of the Commission for Social Care Inspection in Ashburton is given so that they may be contacted in line with the wishes of the complainant. The home has its own copy of the local authorities “Alerters Guide”. The staff have all received training in “Protection of Vulnerable Adults” that was carried out at the home by an external trainer. There is also ongoing training on the same subject by the local authority and staff have been booked onto this training also. The staff who are employed by the home are fully vetted in line with the company procedure so as to avoid employing unsuitable individuals. A POVA First and a Criminal Records Bureau check is part of this procedure. The internal/company disciplinary procedure is robust enough to deal with some acts of poor practice and abuse. The whistle blowing policy is there as protection of staff who may report episodes of abuse. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 20, 21, 23, 24, 25 & 26 The environment provides ample space to meet the social, domestic and nursing needs of the clients. The décor in some areas is poor and unsuitable for those with visual problems. Bathing equipment in the dementia care unit is not suitable for this group of clients. EVIDENCE: The décor of the home is damaged in some areas and showing signs of age with wallpaper being torn and of old design making some areas dark. This may have an effect on those clients who have a visual impairment. There is a full time maintenance man at the home who does carry out his duties on a routine basis or when he is informed that there is a problem. He is supported by outside contractors for specialist equipment such as the hoists and hot water boilers. Evidence of servicing and maintenance was see during the inspection with particular emphasis shown to the hot water boilers that were causing problems by failing on a regular basis. The inspector was informed that the problem has now been resolved. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 15 The enclosed garden area at the rear of the home has recently received attention and can now be used by all the clients at the home. There are several designated communal areas in the home that are used by the clients. The dementia unit has just acquired additional lounge space that has improved the service received by this group of clients. The clients were seen to be relaxing in this space, and also taking part in different activities. They appeared to be comfortable and relaxed at that time. Each unit has adequate numbers of toilets and bathing facilities. However the facilities in the dementia care unit are not in a good state of decoration and the actual type of bath provided is not suitable for this client group. The dining room in the dementia care unit was functional, unattractive and in need of redecoration. All the bedrooms have en-suite facilities. The home does appear clean and odour free. There is a total of 15 hours a day of domestic duties split between three staff who clean the whole home in this time. The clients do personalise their own bedrooms and the inspector saw a variety of levels of personalisation during the tour of the home. Rooms are of good size and shape to enable the care staff to perform tasks that are identified in the care plans. All the beds in the home are subject to a replacement program following the results of a review by the new owners of this home. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29. The home employs registered nursing staff in adequate numbers and with the skills to meet the nursing needs of the clients. The home employs care staff in adequate numbers but varying degrees of experience and skills who have training needs that need to be met. EVIDENCE: Duty rotas were looked at in each of the homes three units. The units are each staffed separately. The two nursing units are staffed 24 hours a day by a registered nurse who has a current pin number. The inspector checked this during the course of the inspection. The manager also supplied full details of all staff employed at the home with the pre-inspection information. The residential care unit is staffed by care staff who are not trained nurses. The Officer in Charge has NVQ qualifications and has recently taken charge of this area of the home. She has made positive changes to the care and management of this area the storage and administration of medication being just one of the more noticeable issues. The nursing staff are not responsible for the residential care unit and do not attend there on a regular basis to assess or treat clients, this is the role of the District Nursing Services. The Deputy Manager also is in charge of the general nursing unit and leads the team of nurses and cares well. The Dementia care unit also has its own manager who is an experienced nurse and manager and provided the inspector with information about how her team manages this challenging client group. The inspector looked at random selection of four staff files and the homes recruitment procedure. The files were complete with photographs, criminal Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 17 record bureau checks and references. There was also evidence in the files to show that staff have completed an induction course that includes fire and manual handling training. In addition to this there was evidence of three staff having been trained as Fire Wardens, all staff having had Adult Protection training in-house by an external trainer, medication training by a national pharmaceutical company for those who are involved in the administration of medication to clients and training to improve communication. There are several overseas staff at the home who have different levels of command of the English language. The company representative told the inspector that they are to provide training for these staff to improve their spoken English. Four of the five comment cards report that they are satisfied with the care provided to them or their relative. One said that there was not always enough staff whilst one other said the same thing but qualified it with the reason for this being staff not turning up for duty and the home being unable to replace them straight away. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33, 36. The management structure in the home does place the needs of the clients as the main priority. EVIDENCE: The Home Manager, at the time of the inspection, does run the home in the best interests of the clients by identifying gaps in the service, including the training needs of the staff, and filling them. He has also empowered the staff to take an active part in the care delivery and be responsible for their role in meeting the homes aims and objectives. The staff are now monitored/supervised in a way that provides positive outcomes for them and the care of the clients whichever unit they are in. The heads of each unit are involved with the staff during the training process and care delivery. The Deputy Manager and one other nurse have been on a supervision-training course and were able to show records that formal supervision has taken place. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 19 There is much internal and external audit taking place that looks at the performance of the home and individuals within it. The accident audit was seen, the managers reports to head office and the Commission for Social Care Inspection receives extensive reports on how complaints are investigated. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 2 x 3 3 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x 3 3 x x 3 x x Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 21 YES 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. Standard 8 Regulation 13(1)(b) Timescale for action The registered person shall make Review arrangements for the service 07/09/05 users to receive where necessary, treatment, advice and other servicesfrom health care professionals. Training of care staff in the recognotion of basic health needs and the recognotion of pointers to identify ill health is needed. 30/11/05 The registered person shall having regard to the number and needs of the service users ensure that all parts of the home are kept clean and reasonablydecorated. Dementia care dining room is in poor decorative state and some corridors with dark stripped wall paper may not be suitably decorated for those with visual deficities. The registered person shall 30/11/05 having regard to the number and needs of the service users ensure that suitable adaptations are made, and such support, equipment and facilities as may be required for service users who are old, infirmed or physically disabled. The bathing facilities in Version 1.40 Page 22 Requirement 2. 19 23(2)(d) 3. 21 23(2)(n) Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc 4. 27 18(1) the dementia care unit are not suitable and the bathrooms are poorly decorated. The registered person shall ensure that the persons employed by the registered persson to work at the care home receive training appropriate to the work they are to preform. Staff are trained to observe and report any changes in the service users presentation so that their health care needs can be continually met. 30/09/05 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 27 16 Good Practice Recommendations The practical aspects of effective communication between the carer and the client is addressed through improved use of spoken English. The investigation of complaints and the reporting of there conclusion needs to be done within acceptable time frames as in the complaints procedure. Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Springfields Care Centre D52-D04 S3605 Springfields V226206 060705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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