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Inspection on 21/08/06 for Springfields Residential Home

Also see our care home review for Springfields Residential Home for more information

This inspection was carried out on 21st August 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a suitable environment for the more able service user.

What has improved since the last inspection?

Some rooms have been newly decorated and carpeted to a good standard.

What the care home could do better:

The provider and manager must comply with the timescales of requirements made. Non-compliance may lead to enforcement by the Commission. The provider and manager must ensure that they accept only people within the registered category of the home to live there. A firm diagnosis must be sought for those people outside the registered category. Variations of registration must be sought and the home must provide evidence that it understands, and can meet these people`s holistic needs. Plans of care need to be improved to more clearly reflect service users needs. They must clearly instruct carers how to meet service users needs.Involvement and input must be sought from service users for their individual plans of care. The home does not have sufficient activities to meet the needs of service users. This must be addressed. Medication practices must be improved to ensure service user safety. Meals are small and unattractive. Service users must be offered adequate food at regular intervals. They must be offered a choice of menu and a choice of meals at each mealtime. They must not have an interval of more that 12hrs without food. Areas of the home need redecorating. Areas of the home are extremely dirty and require a deep cleanse. The home currently uses part of the kitchen as an extension to the office. This is inappropriate. The home has some staff that aren`t sufficiently trained to carry out some of the tasks they are performing. The home has insufficient staff, particularly of a night shift. The manager must ensure that staff have induction and foundation training. The manager must ensure that staff have supervision. The manager must ensure that recruitment practices ensure the safety of service users; all staff must have CRB checks prior to commencing work. All staff must have two suitable references. The home must have a more `open` culture. Staff, and service users must have the opportunity to affect the way in which the service is delivered. The home has no suitable quality monitoring process. This must be implemented. The home must improve many aspects regarding health and safety.

CARE HOMES FOR OLDER PEOPLE Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP Lead Inspector Tina Thomas Key Unannounced Inspection 21st August 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Springfields Residential Home DS0000064212.V303784.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. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springfields Residential Home Address Hengist Road Westgate On Sea Westgate Kent CT8 8LP 01227 362398 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) Macari Homes Limited Care Home 20 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (18) Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To admit one (1) Service User whose date of birth is 29.06.1932. Date of last inspection 12th September 2005 Brief Description of the Service: Springfield is a detached three storey property, which provides personal care and support for up to twenty older people. Accommodation is provided in both single and double bedrooms. There is a non smoking lounge and a smoking lounge and two dining rooms. Communal areas are large and furnished in a domestic nature. To the front, side and rear of property there are considerable gardens that provide residents with additional seating during summer months. The home is located within a short walk from the sea front and local amenities. Fees range from£320-£340 Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection. The Provider and the manager were both on vacation at the time of inspection. The carers that were left in charge, and who conducted the inspection, were courteous and helpful throughout. The manager was in contact with the staff during the inspection and did offer to make herself available to the inspector. Neither of the staff that were left in charge were NVQ qualified, although they were enrolled on NVQ courses, neither had management experience. At the last inspection 11 requirements were made. Six of these have not been actioned. Additional requirements have been made, as have good practice recommendations. Five immediate requirements were made. They were: No further service users are to be admitted out of category. Staff must not perform tasks if they are not suitably trained i.e. manual handling, medication administration and dressings. Service users must have adequate food at regular intervals. Toilets and bathrooms are to have a deep cleanse Doors are not to be pinned back unless they have an automatic closure. The step in the office is a trip hazard and must be made safe. What the service does well: What has improved since the last inspection? What they could do better: The provider and manager must comply with the timescales of requirements made. Non-compliance may lead to enforcement by the Commission. The provider and manager must ensure that they accept only people within the registered category of the home to live there. A firm diagnosis must be sought for those people outside the registered category. Variations of registration must be sought and the home must provide evidence that it understands, and can meet these people’s holistic needs. Plans of care need to be improved to more clearly reflect service users needs. They must clearly instruct carers how to meet service users needs. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 6 Involvement and input must be sought from service users for their individual plans of care. The home does not have sufficient activities to meet the needs of service users. This must be addressed. Medication practices must be improved to ensure service user safety. Meals are small and unattractive. Service users must be offered adequate food at regular intervals. They must be offered a choice of menu and a choice of meals at each mealtime. They must not have an interval of more that 12hrs without food. Areas of the home need redecorating. Areas of the home are extremely dirty and require a deep cleanse. The home currently uses part of the kitchen as an extension to the office. This is inappropriate. The home has some staff that aren’t sufficiently trained to carry out some of the tasks they are performing. The home has insufficient staff, particularly of a night shift. The manager must ensure that staff have induction and foundation training. The manager must ensure that staff have supervision. The manager must ensure that recruitment practices ensure the safety of service users; all staff must have CRB checks prior to commencing work. All staff must have two suitable references. The home must have a more ‘open’ culture. Staff, and service users must have the opportunity to affect the way in which the service is delivered. The home has no suitable quality monitoring process. This must be implemented. The home must improve many aspects regarding health and safety. 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 Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 7 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 Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 8 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): 1,3,4 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. Prospective service users do not have sufficient current information regarding the home so as to allow them to make an informed choice. Service users and their representatives cannot be sure that the home will meet their needs. The registered person is unable to demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. EVIDENCE: The statement of purpose did not correctly inform prospective service users as to the needs of the people already resident at the home. A requirement was made at the last inspection regarding providing a current statement of purpose. The provider and inspector agreed a timescale of 15th October 05 this has not been met. Preadmission assessments were in place, and generally well conducted. However the information gathered was not used to assess whether service users needs would be best met by the home. Pre admission assessments Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 9 frequently showed that service users had cognitive impairment. Some care manager assessments indicated that service users displayed dementia type symptoms and yet service users were admitted to the home. The home is not registered to care for service users with dementia. Specialist services offered to some service users (e.g. services for people with dementia or other cognitive impairments,) are not demonstrably based on current good practice, and do not reflect relevant specialist and clinical guidance. Staff individually and collectively do not have the skills and experience to deliver the services and care which the home offers to provide. An immediate requirement was made that no further service users with cognitive impairment or dementia be admitted to the home. A further requirement has been made that the Provider seeks a firm diagnosis for those people displaying cognitive impairment and requests a variation to its registration for those outside of its registered category. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. Each service user has a plan of care. Service users needs are not set out fully in their individual plan of care. Policies and procedures for the administration of medication do not protect service users. Service users are not always treated with dignity and respect. The home has policies and procedures regarding medication that protect service users. Service users are generally treated with privacy and dignity. EVIDENCE: Each service user has a plan of care. Evidence showed that information given in the care manager’s assessment of needs was frequently not transferred to the individual’s plan of care. The service user’s plan does not set out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the service user (see Standard 3) are met. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 11 Service users with cognitive impairment do not have their care or social needs significantly explored, explained or reviewed. Some service users have had cognitive assessments. Where these have shown ‘severe confusion’ this has not been actioned or addressed in their care plans. One service user with a history of physical aggression towards staff had no risk assessment regarding this. Staff were not given clear strategies of coping with this behaviour. Service users do not sign agreement of their care plans and there is no evidence that they are part of the decision making process. A requirement was made regarding this previously. The date of compliance has not been met. Service users files are stored inappropriately in the kitchen in an unlocked cupboard. One service user had not seen a GP since 21/07/05. There was no evidence that their medication had been reviewed during this time. One service user had skin lesions. Staff without training were applying dressings, which were not prescribed by a GP. A skin integrity chart was held in a file with communal daily records. This should be part of the service users care plan, and all records should be held individually. Daily records completed by staff are generally of good quality, but changes in behaviours, particularly of a night, that are well recorded by care staff are not investigated or actioned. Several service users were noted to be losing weight over a period of time but nothing in their plan of care referred to this. Policies and procedures regarding the administration of medication are poor. The medication policy shown to the inspector was not signed, dated and did not have a review date. It talks about crushing medication, which is covert administration and would not be acceptable as usual practice. The information regarding homely remedies was incorrect. The manager has since advised the Commission that this was not the current medication policy. However, staff left in charge were not aware that this was not a current policy. Medication that has been consistently refused by service users has not been revised. There is no method or means of taking the medication trolley upstairs. In an unlocked, cluttered and untidy cupboard in the dinning room/staff area the inspector found prescribed dressings, sprays, creams and ointments some of which were out of date. One of which was prescribed for a service users that had died some time ago and most that weren’t relevant to current prescriptions. District nurse notes labelled ‘private and confidential’ were also in this unlocked cupboard. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 12 Staff were observed to respect service users privacy and dignity. They spoke to service users in a kindly, courteous and caring manner. They were observed to knock on service users doors before entering. More able service users were able to articulate that their privacy and dignity was observed. Less able service users did not have their dignity observed at all times. The home has some institutional practices for example no choice in menu, being changed into night attire after tea at 5pm, being awoken and got up first in the morning, having to eat in a room, which is not a smoke free environment. One service user was seen to be asleep, doubled over in a chair. When asked if the service user was all right, staff replied that he was always like that. No effort was made to make this service user look dignified or comfortable. Springfields Residential Home DS0000064212.V303784.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): 12,13,14,15 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. Some people found that the lifestyle experienced in the home matched their needs. Service users maintain contact with family/friends as they choose. Some service users are not helped to exercise choice or control over their lives. Service users do not receive a wholesome appealing balanced diet. EVIDENCE: Outcomes for service users vary depending on their level of independence. The home clearly suited the needs of those service users who had autonomy and a degree of choice and independence. For those who were less able or who had cognitive impairment there was little choice regarding any matter in the home. Some of the practices around these people were institutional, for example no choice in menu, being changed into night attire after tea at 5pm, being awoken and got up first in the morning, having to eat in an environment that is not smoke free. There has only been on service user meeting in over a year. Service users’ interests are not recorded and they are not given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities, without they are able Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 14 to pursue them themselves. Particular consideration is not given to people with dementia and other cognitive impairments. There are insufficient staff to allow for dependant service users to be taken out of the home for leisure activities or for leisure activities to continue into the evenings. There are no reminiscence therapies for service users with cognitive impairment. The home has a visitor’s book and there are records of visits throughout the day. Visitors are free to visit the home without prior appointment. On the day of inspection service users were given no second choice of a cooked meal. The meal was bland, and was small even though it was served on a tea plate. The evening meal was at 5pm and service users were offered no food again until the morning. This is of particular concern as some service users are gradually losing weight. An immediate requirement was made that service users must have adequate food at regular intervals. The cook of another home owned by the Provider draws up the menu. Springfields Residential Home DS0000064212.V303784.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. The judgement has been made using available evidence including a service visit. The home has a suitable complaints policy. Staff are trained and understand what constitutes abuse. EVIDENCE: The home has a complaints procedure and a complaints book. The home uses an advisory service regarding employment law. Staff have training regarding the protection of venerable adults. Conversation with staff confirmed that they had a firm understanding of adult protection. Springfields Residential Home DS0000064212.V303784.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): 19.20,21,23,24 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. Service users do not live in a safe, well maintained environment. Service users have access to comfortable communal areas. Service users do not have sufficient and suitable lavatories and washing facilities. Service users own rooms met their needs and are comfortable. The home is not hygienic and clean. EVIDENCE: A tour of the home showed that some areas of the home were very nicely decorated and cosmetically pleasing, whilst other areas were not. Service users can use the outside areas but there are areas that are overgrown. The standards state ‘Where a timescale has been set for compliance with any standard relating to the physical environment of the home, a plan and programme for achieving compliance is produced and followed and records Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 17 kept.’ A previous requirement that the care home be kept clean and reasonably decorated was made with a compliance date of 01/01/06 has not been met. It is doubtful that the building complies with the requirements of the local fire service as fire doors are pinned back with various objects, and doors with notices ‘keep locked shut’ are left open and the environmental health department as the kitchen is very dirty and infection control procedures are poor. Some of the communal areas are inviting. One communal dinning room is decorated, and furnished to a very good standard, as is one of the communal sitting rooms. Conversely, in the dinning room that more needy service users use, although the furnishings are good the decoration is poor as is the furnishings and decoration in the area that smoking residents use. Although the home has sufficient numbers of bathrooms and lavatories they are not suitable. Toilets and baths were not only extremely dirty but had an unacceptable build up of limescale. Several toilets were soiled and did not have toilet paper. Staff said that this was because one service user kept taking them. One toilet did not have a light bulb, staff said that ‘no one used that toilet anyway’, however, this is an unsatisfactory response. The light bulb must be in place in case service users do choose to use it. One bathroom was being used as a storeroom; it was left unlocked and continued to have sign, which said ‘bathroom’ on the door. This could be confusing for service users with cognitive impairment. Service users rooms were personalised and many had bought pieces of their own belongings with them. Generally, bedrooms were very homely. Some bedrooms has been newly carpeted and decorated to a good standard. One service users room only had cold water coming from the sink taps. One service user has cigarette burns to their chair and rug although the staff stated that this service user does not smoke in his room. The registered provider must take steps to ensure these things are put right. The home has infection control issues. Foul linen should be contained in alginate bags; staff should not be separating it by hand prior to laundering. Bathrooms, toilets and the kitchen were extremely dirty. The kitchen sink was extremely dirty as was the rack for drying dishes, both had a build up of matter on them. The inside of drawers and cupboards were dirty. A previous requirement regarding cleanliness of the home with a compliance date of 01/11/05 has not been met. The cook has no catering certificates and no current food hygiene certificate. Fridge temperatures are not filled in. The rubbish bin in the kitchen had no lid. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 18 Part of the kitchen is used as an extension to the office. This is wholly inappropriate. Service users files are stored there inappropriately in a cupboard that is unlocked, in amongst other kitchen stores. Medication records are also inappropriately stored there. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. The numbers and skill mix of staff does not meet Service users needs. Service users are not always in safe hands. Service users are not protected by the homes recruitment policies and practices. Not all staff are trained and competent to do their jobs. EVIDENCE: Care staff demonstrated caring attitudes towards service users, they were collectively aware of the deficits of the home. Staff do not have suitable facilities, they do not have a staff room or anywhere lockable to keep their personal belongings. Care staff numbers are insufficient for the needs of current service users. Care staff numbers do not allow for staff to engage in social activities with service users. There is no opportunity for service users to participate in evening events. Night staff numbers are particularly low given the needs of some service users. There is only one waking night staff on duty. Practice within the home supports staff numbers as opposed to service users needs. A requirement has been made regarding this issue. Another requirement regarding staffing levels was made with the compliance date of 15/11/05. This has not been met. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 20 Less than 50 of staff have had NVQ Level 2 training. Trainees (including all staff under 18) are not registered on a SKILLS FOR CARE-certified training programme. Service users are not protected by the homes recruitment policies and practices. Staff files were not in line with Schedule 2 of the care homes regulations. Some did not have suitable references; some staff did not have CRB’s, one recently recruited staff member commenced employment without a CRB. A previous requirement was made regarding this issue with a compliance date of 15/11/05. This has not been met. Staff do not have a suitable induction or foundation training. Staff do have other specific training. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 21 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): 31,32,33,34,36,37,38 Quality in this outcome area is poor. The judgement has been made using available evidence including a service visit. The home is not well managed. The home does not have an ‘open’ culture. The home is not run in the best interests of the service users. Service users are not safeguarded by the accounting and financial procedures of the home. Staff are not appropriately supervised. Record keeping procedures in the home are poor. The health, safety and welfare of service users, staff and visitors are not promoted and protected. EVIDENCE: The Commission has registered the manager. The manager was not present at the home during inspection. The Provider and manager were both on vacation at the same time, leaving inadequately trained staff to manage the home. The manager was available to the staff by telephone and spoke to staff during the inspection and did offer to be available to the inspector. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 22 The staff also had access to the acting manager of another home owned by the Provider, in case of emergency. However, it remains that staff were left to manage that were not suitably qualified. There was no evidence that there had been any staff or service user meetings other than when Mr Macari first became the new owner. As previously mentioned some staff were performing manual handling tasks prior to manual handling, staff without medication training were administering medication. There are no apparent quality assurance procedures within the home. There is no annual development plan for the home, based on a systematic cycle of planning – action – review, reflecting aims and outcomes for service users. There is no continuous self-monitoring, using an objective, consistently obtained and reviewed and verifiable method (preferably a professionally recognised quality assurance system) and involving service users; and an internal audit takes place at least annually. The home has insurance cover. However, the Commission questions whether the insurance has been breached due to conditions at the home. The inspector was unable to view the accounts of service users money, as the carer in charge did not have access to this information. A previous requirement regarding service users own money has been left in place with an extended timescale. Staff do not have regular formal supervision. There is evidence that occasional supervision occurs. The manager must facilitate this. Record keeping practices within the home are poor. They are not in line with the Data Protection Act. Personal information is not kept in a secure manner. Records required by regulation for the protection of service users and for the effective and efficient running of the business are not maintained, up to date and accurate, for example statement of purpose, fire log, medication policy. The registered manager does not ensure so far as is reasonably practicable the health, safety and welfare of service users and staff or visitors. Staff perform tasks without sufficient training. One member of staff has been manual handling service users without suitable training. Other staff have been administering medication without any training. Fire doors were pinned back with a selection of objects, causing a risk in case of fire. There were no entries in the fire alarm logbook since 18/03/05. Staff working in the kitchen do not have current food hygiene certificates. There is little evidence that there is an understanding and practice of measures to prevent spread of infection and communicable diseases within the home, for example dirty bathrooms and kitchen. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 23 Cleaning cupboards containing hazardous substances were left unlocked. The first aid box was buried in a cluttered cupboard that contained boxes of dressings (some belonging to service users that were deceased) puzzles and other assorted items. Trip hazards have not been identified. The health and safety notice was not filled in with any details. Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 1 x 2 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 2 1 x 3 3 x 1 STAFFING Standard No Score 27 1 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 1 2 2 1 1 1 Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 25 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 OP1 Regulation 4 Requirement The registered person shall compile in relation to the care home a written statement which shall consist of a) a statement of aims and objectives of care home, b) a statement as to the facilities and services which are to be provided and c) a statement as to the matters in schedule 1. Previous compliance date of 15th October 05 Thorough and detailed preadmissions assessments must be conducted and recorded for all prospective service users. The registered person must be able to demonstrate the home’s capacity to meet the assessed needs (including specialist needs) of individuals admitted to the home. A firm diagnosis must be made for those service users demonstrating cognitive inability and an application made to vary the homes registration in regard of this. Timescale for action 21/10/06 2 OP3 14,15 21/10/06 3 OP4 12,14 21/10/06 Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 26 4 OP7 12 13 14 15 16 Care plans must be more detailed in some areas; for example, cognitive ability, and aggression and provide specific details about how to provide care, i.e. personal care, diet and nutrition, social care needs. Reviews must be conducted regularly and be a true review of assessed needs. The registered person shall ensure that all service users are involved in the review of their individual care plans and signatures are in place. A previous compliance date of 01/11/05 has not been met. 21/10/06 5 OP7 15 01/10/06 6 OP8 13 The manager must ensure that 01/10/06 the service user’s psychological health is monitored regularly and preventative and restorative care provided. The registered person shall make 01/10/06 suitable arrangements for the recording, handling. safekeeping, safe administration and disposal of medicines received into care home. A previous compliance date of 01/11/05 has not been met. Service users must have suitable 01/10/06 choices of meals. The registered person shall 01/01/07 having regard to the number and needs of the service users ensure that all parts of care home are kept clean and reasonably decorated. (replace soiled carpets and continue redecoration programme) A previous compliance date of 01/01/06 has not been met. The registered person shall DS0000064212.V303784.R01.S.doc 7 OP9 13 8 9 OP15 OP19 13 23 10 OP26 13 21/10/06 Version 5.2 Page 27 Springfields Residential Home ensure that suitable arrangements have been made to prevent infection, toxic conditions and the spread of infection. (provide paper hand towels and liquid hand soap in all bathrooms,w.cs and all areas receive a through clean.) A previous compliance date of 01/11/05 has not been met. 11 12 OP26 OP27 13 18 The kitchen must not be used as an extension to the office The registered person shall having regard to the size of the home, the statement of purpose and the number and needs of the service users ensure that at all times suitably qualified and experienced persons are working at the care home in such numbers as are appropriate for health and welfare of service users. A previous compliance date of 15/11/05 has not been met. The registered person must inform the Commission as to how night staff effectively manage with only one awake member of staff and one ‘sleep in’ member of staff 50 of care staff must be NVQ Level 2 trained or equivalent Trainees (including all staff under 18) are registered on a SKILLS FOR CARE-certified training programme. The registered person shall not employ a person to work at the acre home unless the person is fit to work at the care home and subject to paragraph (6), he has obtained in respect of that DS0000064212.V303784.R01.S.doc 01/10/06 01/10/06 13 OP27 18 01/10/06 14 15 OP28 OP28 18 16 31/12/06 01/10/06 16 OP29 19 01/10/06 Springfields Residential Home Version 5.2 Page 28 person the information and documents specified in paragraphs 1 to 7 of schedule 2. A previous compliance date of 15/11/05 has not been met. 17 OP31 10 Only staff that are appropriately qualified should be left to manager the home The registered manager must have strategies for enabling staff, service users and other stakeholders to affect the way in which the service is delivered. The Home must develop and implement an annual quality monitoring system, producing a report, a copy must be sent to the Commission. The registered person shall maintain in the care home records specified in schedule 4 Staff must have regular formal supervision The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety, avoidable risks and are wherever possible eliminated. (window restrictors, thermostats on radiators, and regulated water temperatures within bathrooms and bedroom sinks and baths. Staff must be suitably trained prior to undertaking to perform tasks such as medication administration, dressings, and manual handling DS0000064212.V303784.R01.S.doc 25/08/06 18 OP32 21 30/08/06 19 OP33 10, 12, 15,24 30/11/06 20 OP35 17 30/11/06 21 22 OP36 18 13 01/10/06 25/08/06 OP38 23 OP38 13 25/08/06 Springfields Residential Home Version 5.2 Page 29 24 OP38 13 Hazardous materials must be suitably stored 25/08/06 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 OP21 OP21 Good Practice Recommendations The bathroom without a bulb should have it replaced The bathroom that is being used as a store room should either be used as a bathroom or have the bathroom signs taken off. The home should use alginate bags for foul linen. 3 OP26 Springfields Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Residential Home DS0000064212.V303784.R01.S.doc Version 5.2 Page 31 - 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. 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