Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 27/07/07 for Springfields Residential Home

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

This inspection was carried out on 27th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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.

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

Residents benefit from staff who have their well being at heart and try to meet their needs where possible. Staff were seen to be courteous, polite and caring. Residents were well presented and looked appropriately dressed and cared for. The meals seen on the day looked wholesome and tasty and residents confirmed choices are now given.

What has improved since the last inspection?

The home has benefited from a change in manager who has changed the ethos of the home. A considerable amount of work has been undertaken in care planning and the general care of the residents. The menus have been overhauled and a choice has been introduced. Better arrangements are now in place for drinks and snacks and a supper is now offered to residents. The manager commented that residents now looked better nourished. This was confirmed by the residents. Several weight records evidenced that some residents had indeed gained weight.Better communication from other professionals has the potential to improve practise further. Changes in the staff group have resulted in a caring and dedicated team. Recruitment and selection of staff has been improved and staff training has started. Medication procedures have improved but staff would benefit from more in depth training and formal assessments to ensure competency.

What the care home could do better:

Major concerns remain over the environment and health and safety issues. Further reports have been requested from the Fire Safety Officer and the Infection Control Nurses at the Health Protection Agency. Several of the bedrooms were damp and sparse, blocked guttering did not help in this area. The majority of the beds were old, low divan types, which will need to be replaced at some time. Concerns were raised over locked fire doors and the general state of some of the fire doors and closures. Fire signage was confusing and often not in place. There was no evidence that regular fire drills are carried out. The Fire Safety Officer was asked to make an urgent visit and this was carried out the same day. Several requirements were made and these must be fully complied with. Infection control measures are poor and advise must be sought from the infection control nurse. The home does not have a sluice to deal with commodes etc and some practises in this area are poor. Although the care plans have improved, it is important to remember this is a residential home and not a nursing home. The care plans need to reflect this and not become too medically biased. The home still cares for some people with dementia and the provider is again reminded it is not registered for this type of specialist care. Staff are not trained in mental health issues and some residents fall into this category. The call system does not cover all of the rooms and requires updating. The hard wiring certificate for the home has expired and is now out of date. The chair lift is obsolete and needs replacing. Policies require reviewing and updating.Although the outside gardens have been cleared of debris they remain inaccessible for residents to access on their own due to the poor state of the pathways. Staff have to escort residents when they wish to use the gardens.

CARE HOMES FOR OLDER PEOPLE Springfields Residential Home Hengist Road Westgate On Sea Westgate Kent CT8 8LP Lead Inspector Sue McGrath Key Unannounced Inspection 27th and 30th July 2007 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.V345233.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.V345233.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 01843 831169 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 Home’s Limited Vacant 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.V345233.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 5th February 2007 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. The home is located within a short walk from the sea front and local amenities. Fees are £310 - £345 per week. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 27th and 30th July 2007 and was conducted by Sue McGrath and Marion Weller, Regulation Inspectors for the Commission for Social Care Inspection. The key inspections for care home services are part of the new methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and discussions with residents and where possible families and other professionals connected to the home. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Some judgements have been made through observation only. The requirements made at the last inspection had not been fully complied with. What the service does well: What has improved since the last inspection? The home has benefited from a change in manager who has changed the ethos of the home. A considerable amount of work has been undertaken in care planning and the general care of the residents. The menus have been overhauled and a choice has been introduced. Better arrangements are now in place for drinks and snacks and a supper is now offered to residents. The manager commented that residents now looked better nourished. This was confirmed by the residents. Several weight records evidenced that some residents had indeed gained weight. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 6 Better communication from other professionals has the potential to improve practise further. Changes in the staff group have resulted in a caring and dedicated team. Recruitment and selection of staff has been improved and staff training has started. Medication procedures have improved but staff would benefit from more in depth training and formal assessments to ensure competency. What they could do better: Major concerns remain over the environment and health and safety issues. Further reports have been requested from the Fire Safety Officer and the Infection Control Nurses at the Health Protection Agency. Several of the bedrooms were damp and sparse, blocked guttering did not help in this area. The majority of the beds were old, low divan types, which will need to be replaced at some time. Concerns were raised over locked fire doors and the general state of some of the fire doors and closures. Fire signage was confusing and often not in place. There was no evidence that regular fire drills are carried out. The Fire Safety Officer was asked to make an urgent visit and this was carried out the same day. Several requirements were made and these must be fully complied with. Infection control measures are poor and advise must be sought from the infection control nurse. The home does not have a sluice to deal with commodes etc and some practises in this area are poor. Although the care plans have improved, it is important to remember this is a residential home and not a nursing home. The care plans need to reflect this and not become too medically biased. The home still cares for some people with dementia and the provider is again reminded it is not registered for this type of specialist care. Staff are not trained in mental health issues and some residents fall into this category. The call system does not cover all of the rooms and requires updating. The hard wiring certificate for the home has expired and is now out of date. The chair lift is obsolete and needs replacing. Policies require reviewing and updating. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 7 Although the outside gardens have been cleared of debris they remain inaccessible for residents to access on their own due to the poor state of the pathways. Staff have to escort residents when they wish to use the gardens. 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. The summary of this inspection report can be made available in other formats on request. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3,4 and 5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home does not provide prospective service users with suitable information so as to enable them to make an informed choice Residents and relatives cannot be confident the home can met specialist needs. EVIDENCE: The home’s Statement of Purpose and Service User Guide are displayed in the foyer of the home and the manager confirmed that both had been recently been updated. However some areas of the Statement of Purpose still do not comply with Schedule One of the Care Home’s Regulations 2001. It will remain an ongoing requirement that this be reviewed. These documents must be in a format that the residents can understand and be a true reflection on the Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 10 categories of people living in the care home. A requirement has been in place since October 05, was repeated in October 06 and February 07. Enforcement action may now follow. The home’s assessment process has improved and the paperwork introduced by the new manager has improved the information gathered prior to admission. The prospective resident and/or their representatives are invited to view the home and to stay for a meal if they wish. Arrangements can be made for them to stay overnight. There is a four week settling in period to ensure both the home can met their needs and that the residents is happy to remain in the home. The manager states that any new resident is given a written contract that details the service offered and the costs. Residents who have been in the home for some time may not be protected by such documents and this needs to be addressed by the owner as soon as possible. As stated in the previous report the home has a number of residents with differing needs e.g. schizophrenia, depression, visual impairment, and dementia. The home’s staff have not received specialist training to help support residents with these complex needs, and whilst caring and sensitive, have little or no understanding of ways in which they could improve the quality of support and stimulation to specific residents. Residents and relatives cannot be confident the home can met these specialist needs. Due to problems with the fire system the owner has been requested not to admit any more residents until the necessary work has been completed. The provider is also required to make arrange for all residents to be assessed to ensure they remain within the home’s registered category. There are serious concerns that the home is continuing to have residents who have a diagnosis of dementia. Urgent action is required. The home is not registered for the care of people with dementia. Again, as in the last report, 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. Whist some service users have been reviewed by a clinical specialist there is no evidence that the home has sought information on understanding difficult behaviours, strategies for coping, or delivering a consistent approach or monitoring outcomes. Again this is an ongoing concern. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ care plans have improved but ongoing work is still required. Whilst residents’ specialist needs are not always met their health care needs are mainly met. Residents can be confident that they will be treated with respect. The quality of everyday living in the home has improved for residents since better routines have been introduced by the manager. Residents could be put at risk because staff require further training in medication administration. EVIDENCE: The new manager has introduced new care plans and these are more robust than the previous ones. Care should be taken not to introduce plans that are Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 12 too medically based. As a care home, staff are not expected to perform nursing tasks since they do not have the necessary skills. The plans are overcomplicated and could be difficult to read or understand. However, it is noted that these document are still in the developmental stage and adjustments can be made. They are currently fragmented with various pieces of information and notes stored in different places. All information on each resident should be maintained in an individual file. This was discussed with the manager who agreed to simplify the plans. Care must be taken by staff to keep all written information regarding the residents in a private and confidential manner. The manager stated that where possible residents are involved in the drawing up and reviewing of these plans. Where capacity is an issue, the reviews should be agreed with families or other professionals. Evidence was seen that the residents have the opportunity for chiropody, dental examinations and optical tests. Weights are mainly recorded and advice was given over the format for nutritional screening. It is recognised that a considerable amount of work has been undertaken with regards to the home’s care plans and that the work is ongoing. Records were seen of GP and DN visits and the manager confirmed that a good relationship has developed between the staff and the District Nurses. As stated earlier in the report some of the complex needs of some of the residents have not been assessed or guidance requested from other professionals and staff would benefit from some training in challenging behaviour training and in behaviour management. The staff were seen to be very supportive and caring on the day of the inspection and several residents stated they now felt more at ease in the home. One comment from a resident seen on a written survey was ‘ I feel less intimidated than before’. The daily notes continue to need to be improved and this was discussed with the manager. Storage space for confidential files remains a problem. All of the residents presented as being clean and tidy, clothing was clean and appropriate for the weather. The home uses the Monitored Drug System of medication administration and this provides an audit trail, which indicated that the residents were given their medications in an appropriate manner. Records are complete, signed and dated. However the home is strongly recommended to make use of one of the several empty rooms as a medical room. The drugs are currently stored in a corridor, in a locked cupboard attached to the wall. The storage of further supplies of medication and of dressings is compromised because of a lack of secure storage. The district nurse’s sharps container is currently stored in the Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 13 laundry room for example. Further supplies of drugs are in the manager’s office and dressings are in a wardrobe. This is not ideal. The home also lacks a dedicated medicines fridge and records are not kept of the temperature of the area where the drugs are stored as recommended in the guidelines issued by the Royal Pharmaceutical Society of Great Britain. Staff training is also an issue and a requirement will be made to ensure that all staff who administer medication are suitably and competently trained. Guidelines are now in place for the administration of PRN medications. The controlled drugs registered was assessed and found to be accurate. GP visits are now conducted in the privacy of the resident’s bedrooms. Some new locks had been fitted to resident’s doors to ensure privacy, however some had movement sensors on the doors to alert staff if the door had been opened. There was no evidence that any multi disciplinary agreement had been reached over the use of such restrictive items. The home had taken it upon themselves to install them. It is strongly advised that reviews are carried out to ensure these particular residents are suitably placed at Springfields. Some of the resident’s rooms remain odorous and the home has not supported these residents to maintain their dignity by introducing improved cleaning schedules or replacing soiled carpets. The cleaning schedule in place is unrealistic given the hours worked by the one domestic. Several carpets need to be replaced and are highlighted in the environmental section of the report. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to maintain contact with family and friends as they wish. Residents receive a wholesome, appealing, balanced diet in pleasing surroundings. EVIDENCE: The home has very recently employed an activities co-ordinator who is currently developing new ideas and is involving residents in deciding what activities they would like. There is a range of ideas coming forward and as this position is very new, it is too early to make any judgements on outcomes for residents. The residents are looking forward to the forthcoming garden party that is being held in the grounds over the coming weekend. Residents, relatives and staff have been invited. The gardener was busy preparing the tables and chairs and gazebos have been erected. Several plans for entertainment and activities were discussed and it is hoped that the next inspection will report favourably on the activities that have been undertaken. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 15 Families and friends are made welcomed at any times and comments in the new visitors book confirm the recent improvement in the home and in the care of the residents. The manager is advised to inform relatives that the visitor’s book is not the appropriate place to pass on confidential matters. There are concerns that this may indicate there are insufficient staff to pass such messages onto. Staff and some residents confirm that the routine is now more flexible and that residents can retire when they want and get up at what time they want. However, the majority tend to follow a similar daily routine but staff confirm this is their choice. The manager is very keen to instil the regime of choice within the home. Where choices had been made on behalf of service users there was no evidence of the thought process behind those decisions or agreement from care managers or relatives. With the Capacity Act coming into force in October this year the management must implement the required actions. It is strongly recommended that training be provided both to staff and management. Residents are allowed to bring personal possessions with them to the home. Some of rooms, particularly of residents who have been at the home for some time, appear spartan and the home has not been proactive in supporting and helping those individuals to personalise their rooms. The food that is offered has improved and residents now have a choice at meal times. Supper has also been introduced, as have regular hot drinks and biscuits. The manager stated the when she took charge of the home, she felt some residents looked undernourished but they now all looked better. Weight records confirm some resident have gained weight. No formal nutritional assessments had been undertaken and advise was given in this area. Residents confirm the food has improved. Bowls of fresh fruit were seen in the home. The home currently is trying to employ another cook to cover the hours the current cook does not work. It is recommended that records indicating food intake are completed by the care staff and are more in depth. It is also recommended that kitchen staff receive guidance on diabetic and other specialist diets. The kitchen remains in a poor state of repair with gaps behind the sink where mould has grown. Some of the units under the worktop were falling apart with doors missing and drawers collapsing. The work surfaces and edges were showing signs of wear and tear. The hand-washing sink highlighted in the last report has not been replaced. This kitchen is in urgent needs of refurbishment. A requirement will be made. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 16 Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are protected by a robust complaints system and service users and relatives feel their views are listened to and acted upon. Poor record keeping and some poor practices with regard to the managing of challenging behaviour have the potential to put residents at risk. EVIDENCE: The home is currently updating it complaints procedure and the system for handling complaints has been revised. The manager has received one complaint since her arrival and has dealt with the issue promptly and effectively. Records of the complaint were well maintained. The manager stated she encourages both staff and relatives to discuss any issues they may have with her as soon as possible. Residents are at risk of abuse through poor practice in respect of gaps in existing staff records including current CRBs and health and safety issues. Residents are also at risk due to staffs’ lack of training, understanding and competency regarding the specialist service user group. Staff have little understanding of how to monitor and manage challenging behaviour, and to seek interventions in these areas. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 18 There is evidence that some physical interventions and some environmental additions (door locks and sensors) may be used but staff are not trained to do so. Some staff demonstrated an awareness of adult protection issues and the need to raise concerns outside the home if they felt matters were not being dealt with within the home. Staff now feel confident the manager would deal with any issue. Policies and procedures within the home are currently reviewed and assistance is being sought from an outside company. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is or poor. This judgement has been made using available evidence including a visit to this service. Failure by the management to recognise and prioritise serious health and safety issues within the home leaves service users at risk. Little consideration has been given to improving people’s lives or meeting their needs of their conditions through aids and adaptations. EVIDENCE: The main lounge and dining room are well maintained and nicely decorated and have a large television and DVD player and video for the residents to enjoy. A music centre was also seen in the lounge. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 20 Other areas of the home are poor and unsafe. As stated in the last report the remaining décor is in need of upgrading in some areas with wallpaper is still peeling off in some rooms where there appeared to be problems with dampness. Crumbling of plasterwork was again noted in several bedrooms where this was a problem. Carpets in some rooms were stained and odorous, despite the home having a cleaning machine. One hall area had pipes from a radiator that had been removed not capped off securely, no other forms of heating had been installed to replaced the radiator. One shared room (14) felt very damp, with one of the beds being pushed against a wall that had wallpaper hanging off and evidence of black mould on the walls. Some of the light bulbs are missing in the wall lights and the privacy curtains around the sink have been fitted in such a way as to make them unusable. The beds are very low and very old and stained. The sheets on the beds are paper thin. Extension leads trailed across the floor between the bed and the sink. This is a trip hazard. If more electric sockets are needed they should be professionally fitted. The room has venetian blinds but no curtains. The lampshades are very dusty. This was not a pleasant room to sleep in. Several other bedrooms felt damp and all had the same low beds, which were very old. These could be considered a health and safety risk for staff. The bedrooms generally are not comfortable or homely. However it is recognised that a few have been updated and some bedrooms were comfortable with personal possessions reflecting individual residents tastes and interests. Other rooms remain bland with no personal possessions, residents had not been supported to personalise their rooms to their own tastes. The outside space has been cleared of overgrown foliage and grass but this has exposed pathways that are in a poor state and need major repairs. The manager stated that the owner has obtained quotes for this work to be done but now action must be taken. Currently the paths are too dangerous for residents to go into the gardens unescorted. Some of the windows look reasonably new but others are in a poor state. There is some concern over the window restrainers on the upper floors. Some were adequate but some were merely lengths of flimsy chains attached by a small screw. It would be easy for someone who really wanted to remove them to do so. Consideration must be given to installing safer and more secure window restrainers on all upstairs windows. The guttering on the outside of the building has fully grown weeds and bushes growing in them, therefore restricting the safe draining of rainwater. This could be one of the causes of the dampness in the home. These gutters must cleared of debris. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 21 The home has sufficient toilets and bathrooms. One of the bathrooms has recently had a new shower built in it, this will allow service users choice, but is not accessible to those with mobility problems. On the day of the inspection it was not very clean. One of the bath hoists was in a poor state of repair and no evidence could be found that it had been maintained. An immediate requirement was made that it should not be used until made safe by a qualified engineer or replaced. The other bath hoist had holes in the plastic cover exposing rusty metal tubing; this is an infection control issue. Several areas of concern were raised over infection control and the home was advised to contact the Health Protection Agency for advice. A visit was arranged for later in the month. The home does not have sluicing facilities and the method used for cleaning commodes was not appropriate. Advice must be sought from the Infection Control Nurse and any recommendations made must be adhered to. Some pressure relieving mattresses were seen during the inspection and the manager stated that they work with the district nurses for the treatment of pressure areas. The home had purchased two new wheelchairs since the last inspection. Footplates are now in use. The owner has attempted to guard the majority of the radiators, however the workmanship is poor and the edges and tops are not guarded. It looks as if MDF boarding has just been attached to the front of the radiators by metal clips. They do not present in a homely or professional way. The owner did say thermostatic mixer valves were on all sink outlets, some were exposed and some were in cavities. No record of water temperatures had been maintained and no TMV could be seen. Bath temperatures were not recorded. No evidence could be found of any water thermometers for staff to use. A requirement will be made regarding the control and management of water temperatures. There are insufficient domestic hours provided by the home. The manager is currently trying to recruit further staff for this role. The call system does not cover the entire home as is required by standard 22.8. The main board is on the lower floor. This means that if staff are on either the first or second floor they need to come to the kitchen to see who is requiring help and them go to assist. This could result in staff having to go back upstairs and could cause a delay if an emergency had occurred. The provider must ensure that either a panel is fitted on each floor or that staff are provided with hand held pagers. The system needs to be reviewed and updated. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 22 Carpets in rooms 18,13 and 10 urgently need replacing. Others should be assessed to ensure they are clean. Room 9 has a sink that is very loose and hanging off the wall. There is also some plastic truncking that is covering some wiring, but it is hanging off the wall exposing the wiring again. The television aerial does not have a connector attached, so cannot be used. Several of the rooms did not have bedside lamps or lockable drawers as required by the National Minimum Standards. Not all held the required furniture. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are at risk from insufficient night staff and a lack of domestic and kitchen staff reduce residents’ quality of life. The care of residents is compromised because some staff require mandatory and service specific training. The safety and well being of residents has been improved because of the home’s improved recruitment procedures. EVIDENCE: There have been some recent changes to the staffing group and several new staff have been appointed. The manager is currently trying to recruit an extra cook and domestic staff that should relieve care staff to concentrate on delivering the care required by the residents. The number of night staff is insufficient to meet the needs of the residents when taking the layout of the building and current needs into account. An immediate requirement was left to increase night staff to two. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 24 Staff training has been an issue in the past but the manager is in the process of drawing up staff training matrixes and staff development plans, which will include training profiles. Some mandatory training has already been undertaken and an ongoing programme is in place. The home is reminded that if it intends to offer care for people with specialist needs the appropriate specialist training must be given to staff to ensure they can met the complex needs of some of the residents. Training needs to be ongoing. Five staff have completed NVQ to level two or above and four are currently working towards their award. Recruitment procedures have improved recently and the home now conducts both POVA first and full CRB checks. Two references are required and all employment gaps are investigated. However some of the existing staff do not hold current CRB checks and these need to be arranged urgently. The manager is currently carrying out an audit of the staff files to ensure compliance. The requirement made at previous inspection regarding staff files will remain in place until all files comply with regulation but it is recognised that the manager is aware of the shortfalls. The home is currently using an induction programme that is in line with ‘Skills for Care’. This has been a recent improvement. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is not run in the best interests of the residents. Whilst the manager has the skills and experience to manage the service she is not supported by the provider and there are outstanding health and safety issues at the home which the provider has failed to address. EVIDENCE: The current manager has been in post for approximately three months and has not as yet registered with the Commission, although she hopes to do so soon. She has bought with her some fresh ideas and management skills which have improved the care within the home. She has worked diligently to raise standards and staff morale. Other staff stated they now feel well supported Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 26 and very positive. A senior care has been promoted to the position of deputy manager and the lines of responsibility have improved. The manager has displayed clear leadership and has dealt with several challenging staffing issues. However, the manager is not being supported by the provider who continues not to address the serious health and safety issues and environmental concerns within the home. These have been highlighted in several of the last reports. This reflects the low scoring in the quality judgements above. Issues over the fire system, lifts and hoists are putting residents at risk. The environment generally is very poor and requires a lot of financial investment to ensure full compliance. The provider will be required to evidence that there is sufficient capital in the business for these improvements to be made. A requirement will be made to this effect. Quality Assurance was discussed with the manager who has started a basic assessment but is aware that this to be improved upon and given time she is confident she can achieve this. Meetings are starting with both residents and families, which is a positive move. Staff meetings are also starting. Residents personal monies were audited at this inspection and were found to balance with basic records kept. Supervision is starting to happen but currently in a haphazard way. The manager is aware that this is an area that requires improvement and is advised to ensure that all senior staff who offer supervision are fully trained in this practise. Staff do day they now feel well supported and the manager and her deputy are available for them at most times. The health, safety and welfare of residents and staff are compromised by poor standards of maintenance and non-adherence to fire risk assessments. The home does have a copy of a fire risk assessment but it is basic and appears to be written for another home. The document is not dated or signed. Concerns were raised over the stated of the fire precautions and condition of fire doors and fire signage within the home. There is no evidence that staff are aware of or have practised any fire drills in the last year. The Fire Safety Officer from Kent’s Fire and Rescue Service was asked to conduct an urgent visit of concern. This visit was conducted the same day. Following the Fire Officers visit extensive requirements were made regarding doors, door closures and signage. Emergency lighting, fire drills and staff knowledge were also highlighted. A compliance date of September 21st 2007 has been issued. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 27 The emergency lighting is tested by the owner, but no one else is aware of how he does it. Details of how these are tested need to be supplied to the Commission. The electrical wiring certificate is over a year out of date and urgently needs attention. The stair lift is considered, by the last lift engineer who visited, to be obsolete so arrangements need to be put in place now to replace it. The landlord’s gas certificate is several years out of date. The call system does not cover all rooms and requires either a master board on each floor or handheld monitors to alert staff where they are needed. Water temperatures are not monitored. There is no evidence that a comprehensive risk based approach to Legionella is in place. This approach should consist of a Legionella risk assessment, a scheme for prevention, evidence of managing and monitoring control measures and an appointed and competent person to be responsible Urgent action is required on all of the above issues. The home’s accident book was viewed and evidence was seen that the manager monitors accidents and that appropriate action is taken to prevent further accidents where possible. Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 28 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 2 2 1 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 1 2 1 1 X 1 1 1 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 1 3 2 X 1 Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s 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. Compliance dates of 15/10/05, 21/10/06 and 14/03/07 NOT MET 2. OP7 15 The registered person shall ensure that all service users are involved in the review of their individual care plans and signatures are in place. Previous compliance dates of 01/11/05, 01/10/06and 13/03/07 NOT MET 3. OP9 13 The registered person shall make 30/09/07 DS0000064212.V345233.R01.S.doc Version 5.2 Page 30 Timescale for action 31/08/07 31/08/07 Springfields Residential Home suitable arrangements for the recording, handling. safekeeping, safe administration and disposal of medicines received into care home. Previous compliance dates of 01/11/05 ,01/10/06 and 13/03/07 NOT MET 4. OP19 23 The registered person shall 30/09/07 having regard to the number and needs of the service users ensure that all parts of the care home are kept clean and reasonably decorated. (replace soiled carpets and continue redecoration programme) Previous compliance dates of 01/01/06, 01/01/07 and 13/03/07 NOT MET 5. OP26 13 The registered person shall ensure that suitable arrangements have been made to prevent infection, toxic conditions and the spread of infection. There must be a programme of cleaning, and the home must be suitably clean. bins in the kitchen must have lids, carpets, furnishings and equipment must be clean. Previous compliance dates of 13/03/07 NOT MET 6. OP27 18 The registered person shall having regard to the size of the home, the statement of purpose DS0000064212.V345233.R01.S.doc 31/08/07 31/08/07 Springfields Residential Home Version 5.2 Page 31 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. Previous compliance dates of 15/11/05, 01/10/06 and 31/03/07 NOT MET IMMEDIATE REUIREMENT WAS ISSUED FOR THE EMPLOYMENT OF TWO NIGHT STAFF The registered person shall not employ a person to work at the care home unless the person is fit to work at the care home and subject to paragraph (6), he has obtained in respect of that person the information and documents specified in paragraphs 1 to 7 of schedule 2. Previous compliance dates of 15/11/05, 01/10/06 and 31/03/07 NOT MET 8. OP38 13 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. Compliance date of 25/08/06 Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 32 7. OP29 19 31/08/07 30/09/07 and 31/03/07 NOT FULLY MET 9. OP4 12,14 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 home’s registration in regard of this. Compliance date of 21/10/06 and 31/03/07 NOT MET 10. 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. It is recognised that work is currently being undertaken and care plan have improved and that work is ongoing. Previous compliance date of 21/10/06and 31/03/07 NOT FULLY MET 12. OP18 12,13,17, 21 The registered person shall make 30/09/07 arrangements, by training staff or by other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Previous compliance dates of DS0000064212.V345233.R01.S.doc Version 5.2 Page 33 30/09/07 31/10/07 Springfields Residential Home 31/03/07 NOT MET 13. OP20 23 Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users must safely be able to access the outdoor space. There must be a timely programme of redecoration and improvement. Previous compliance dates of 31/03/07 NOT MET 14. OP21 23 The registered person must ensure that toilets and sinks are clean, and must provide evidence to the Commission that water temperatures have been adjusted to safe levels. Previous compliance dates of 13/03/07 NOT MET 15. OP22 23 Facilities, including communication aids (e.g. a loop system), and signs are provided to assist the needs of all service users, taking account of the needs, for example, of those with hearing impairment, visual impairment, dual sensory impairments, learning disabilities or dementia or other cognitive impairment, where necessary. Previous compliance dates of 31/03/07 NOT MET 16. OP24 16 The home provides private accommodation for each service user which is DS0000064212.V345233.R01.S.doc 31/10/07 31/08/07 31/10/07 31/10/07 Springfields Residential Home Version 5.2 Page 34 furnished and equipped to assure comfort and privacy, and meets the assessed needs of the service user. The home must take into consideration the needs of those service users that have dementia needs, for those that are short of sight. Previous compliance dates of 13/03/07 NOT MET 17. OP28 18 50 of care staff must be NVQ Level 2 trained or equivalent Previous compliance date of 31/12/06 and 31/03/07 NOT MET 18. OP30 18 The registered person ensures 30/09/07 that there is a staff training and development programme which meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. Previous compliance dates of 13/03/07 NOT MET The registered manager must have strategies for enabling staff, service users and other stakeholders to affect the way in which the service is delivered. Previous compliance date of 30/08/06 and 31/03/07 NOT MET 20. OP33 10, 12, 15,24 The provider must develop and implement an annual quality DS0000064212.V345233.R01.S.doc 31/12/07 19. OP32 21 31/10/07 31/10/07 Springfields Residential Home Version 5.2 Page 35 monitoring system, producing a report, a copy must be sent to the Commission. Previous compliance date of 30/11/06 and 31/03/07 NOT MET 21. OP36 18 The provider must ensure that all staff must have regular formal supervision Previous compliance date of 01/10/06 and 31/03/07 NOT FULLY MET 22 23 24 OP22 OP21 OP38 16(1)(2) (c)(d) 23 16 The provider must ensure that carpets in rooms 18, 13 and 10 be replaced. The provider must ensure that the sink in room 9 must be made safe and fixed firmly to the wall The provider must ensure that evidence be provided that water temperatures are regularly monitored. The provider must ensure that evidence be provided that the provider has a risk based approach to Legionella. The provider must ensure that an environmental risk assessment of the premises and facilities is carried out by a suitably qualified person or persons as stated in NMS 22.1 The provider must ensure that financial accounts be forwarded to the Commission that demonstrate financial viability of the home. The provider must ensure that the call system meets the needs of the residents and are provided in every room the residents use regularly. DS0000064212.V345233.R01.S.doc 31/10/07 30/09/07 31/08/07 31/08/07 25 OP38 16 31/08/07 26 OP22 16 and 23 31/10/07 27 OP34 Schedule 3 and regulation 25 23 31/08/07 28 OP22 31/10/07 Springfields Residential Home Version 5.2 Page 36 29 OP38 23 The provider must ensure that all hoists are safe and maintained. IMMEDIATE REQUIREMENT ISSUED OVER ONE BATH HOIST The provider must ensure that the electrical system is safe and maintained. The provider must ensure that infection control procedures are in place. The provider must ensure that the chair lift is replaced, as it is obsolete and can no longer be repaired. The provider must ensure that all staff carry out regular fire drills. The provider must ensure that a suitably qualified person undertakes a fire risk assessment. The provider must ensure that all of the requirements issued by the Fire Safety Officer are complied within the required timescale set by the Fire Officer. 31/08/07 30 31 32 OP38 OP38 OP22 16 23 16 30/09/07 31/08/07 31/10/07 33 34 OP38 OP38 23 23 31/08/07 31/08/07 35 OP38 23 21/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Springfields Residential Home DS0000064212.V345233.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V345233.R01.S.doc Version 5.2 Page 38 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!