CARE HOMES FOR OLDER PEOPLE
Springhill House Nursing Home Fairfield Street Accrington Lancashire BB5 0LD Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 31st January 2006 10:10 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 Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 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. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Springhill House Nursing Home Address Fairfield Street Accrington Lancashire BB5 0LD 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) 01254 381719 01254 872685 Springhill House (Accrington) Limited Miss Catherine Dunn Care Home 75 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (17), Old age, not falling within any other category (75), Physical disability (4), Terminally ill (3) Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered for a maximum of 75 service users to include:Upto 3 service users in the category TI (Terminally Ill) Upto 4 service users in the category of PD( Physical Disability under 65 years of age) Upto 10 service users requiring nursing care in the category of DE(E) (Dementia over 65 years of age) or MD(E) Mental Disorder, excluding learning disability or dementia over 65 years of age) Upto 7 service users erquiring personal care in the category of DE(E) (Dementia over 65 years of age) or MD(E) (Mental disorder, excluding learning disability or dementia over 65 years of age) Upto 71 service users requiring nursing care in the category OP (old age, not falling within any other category) Upto 21 service users requiring personal care (old age, not falling within any other category) Only service users requiring nursing care may be admitted in the categories TI (terminally ill) and PD (Physical disability under 65 years of age) Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 8th March 2002. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 7th July 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Springhill Care Home is a large detached house, which has been extended to provide purpose built accommodation on two levels. It is situated in a residential area, on a hillside overlooking the small town of Oswaldtwistle. It is on a bus route and close to all local amenities. The home offers personal care, nursing care, palliative care and care to older people with dementia. The home has a contract with the local Primary Care Trust to provide orthopaedic intermediate care for 6 people. The home is registered to provide care to a maximum of 75 residents. Accommodation is provided in mostly en-suite bedrooms. Communal rooms include 5 lounge areas and 2 dining areas. A passenger lift facilitates access to all areas of the home. The grounds are spacious with ample parking for visitors and staff. The seating areas are easily accessible to residents. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over five hours by two inspectors. No additional visits have been made since the last announced inspection. A tour of the premises took place and staff files and care records were inspected. At the time of this inspection seventy residents were living at the home. Members of staff on duty, residents and visitors were spoken to. Discussions also took place with the registered person and the manager about issues raised during the inspection. What the service does well: What has improved since the last inspection?
Care planning for residents on the Lynwood Suite has improved. These identified and explained how all care needs, including behaviour, were met. To promote the dignity and independence of residents on the Lynwood Suite knifes and forks were included in the place settings for lunch. Condiments were offered to all residents. The information board on the Lynwood Suite displayed correct information including the date and which members of staff were on duty. Since the last inspection a smoke detector has been fitted to the linen room on the Lynwood Suite. This will help to protect residents in the event of a fire. All razors and toiletries in this unit were kept locked away for the safety of residents. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 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 Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 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): 6 Intermediate care was provided in a dedicated area of the home. EVIDENCE: The home has a contract with the Primary care trust to provide intermediate orthopaedic care for up to six residents. A dedicated area of the home was used for this service. Residents admitted for intermediate care usually stayed at the home for two or three weeks. Meetings involving the physiotherapist, occupational therapist, intermediate care co-ordinator, social worker, nursing and care staff at the home were held weekly to discuss progress and further treatment. Designated members of staff were responsible for caring for these residents. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Care was given in a manner, which promoted the privacy and dignity of all residents. Care plans were detailed but not always updated when the needs of the resident changed. The procedure used for the administration of medicines was unsafe putting residents at risk of receiving the wrong medication. EVIDENCE: The individual records of six residents on the general unit and two residents on the Lynwood Suite were inspected. All these care plans identified the needs of each resident and explained how these needs were met. The care plan for a resident on the Lynwood suite gave clear guidance to staff about how to deal with any behaviour problems. Information about the guardianship order for one resident was insufficient. Details about whom the guardian is, expiry date, a full explanation of the resident’s legal rights and the action to be taken if this resident leaves the building needs to be included in the care plan. Appropriate Risk assessments had been carried out. Information about how any identified risks were addressed was written in the care plan. Although the care plans inspected were reviewed monthly one had not been updated when the care needs of the resident had changed. Risk assessments relating to pressure sores had not been reviewed monthly for two residents. It
Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 10 was evident in some care plans that the resident or their relatives had been involved with care planning. Residents were registered with a GP and had access to other healthcare professionals. During the inspection a registered nurse was observed giving out medication without following correct procedures. Medication for four residents was put in separate pots on top of the medicine trolley before being taken to the individual residents. The nurse did not check the medication against the resident’s medicine administration record to make sure the correct medication and dose was given. The nurse returned to the trolley and repeated this process. This procedure carries a high risk of error and must cease. During the inspection members of staff were observed attending to residents in a patient and friendly manner. Personal care was carried out in the privacy of the resident’s own room. All the residents asked said the staff were very nice. To promote the dignity and independence of residents on the Lynwood Suite knifes and forks were included in the place settings for lunch. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15 Residents were encouraged to choices about their life at the home. Social activities were well managed. The meals were wholesome and menus offered variety and choice. EVIDENCE: The information board on the Lynwood Suite displayed correct information including the date and which members of staff were on duty. Leisure activities took place daily; these were advertised in the home. Records were kept of which residents had joined in which activities and the level of participation. The meal service at lunchtime was wholesome and appetising. Puréed meals were served with each item liquidised separately. Condiments were available to all residents. The mealtime was unhurried allowing residents time to chat and enjoy their meal. Members of staff were observed assisting residents in a sensitive manner. Resident’s said, “The food’s lovely, can’t complain about it.” The menus were varied and offered choice. A finger-food menu was available for residents on the Lynwood Suite. Alternatives to the menu were readily available on request. Chefs went round and asked the residents what they wanted to eat. A bowl of fresh fruit was placed on the trolley at teatime. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 12 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 and 18 Complaints were be taken seriously and investigated. Members of staff had a clear understanding of adult protection issues, which protects residents from abuse. EVIDENCE: A copy of the complaints procedure was displayed in the home. One complaint has been made to the home since the last inspection. Details of the complaint and the action taken were seen. Policies and procedures relating to the protection of vulnerable adults were in place. Training was provided for all members of staff. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 13 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 and 26 The home was clean, comfortable and well maintained. This meant that residents had a homely place to live. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. The decoration and furnishings were of a high standard. However, there was an unpleasant odour in the entrance to the Lynwood Suite and in the lounge. The base of a bed in one bedroom was badly stained. There was also a problem with condensation in between the double-glazing of the window in this room. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 14 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 and 29 Staffing levels were appropriate to meet the assessed needs of the residents. Care staff were encouraged to obtain NVQ qualifications. Recruitment procedures were not robust potentially putting residents at risk. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. The files of five members of staff appointed since the last inspection were examined. Only two of these files indicated that all the required preemployment checks had been completed prior to appointment. One of the files had evidence that a reference had been obtained following appointment. The other two files contained only one written reference. CRB checks had not been obtained before these employees had been allowed to start working at the home. Moreover, a CRB check had been applied for but not yet received for one these employees. Training was actively encouraged. Sixteen care assistants had achieved NVQ level 2 and five care assistants had achieved NVQ level 3. (61 ) Seven care assistants were working towards NVQ level 2. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 15 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 and 38 The home has an experienced and competent manager. Appropriate procedures were in place to safeguard the health, safety and welfare of residents. EVIDENCE: The registered manager is an experienced nurse she has an NVQ level 5 in operational management and is currently doing a certificate in education. This will support the training and education of staff that is considered by the management to be important in maintaining standards at the home. The manager also attends relevant study days and is a member of the East Lancashire wound care forum. Policies and procedures relating to safe working practices were in place. Members of staff regularly received training in fire safety, health and safety and moving and handling. A fire risk assessment had been carried out. Fire alarms and emergency lighting were tested weekly. Fire drills were held every three months and attendance records were kept. A member of staff qualified
Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 16 to administer first aid was on duty for all shifts. Records of the routine servicing of equipment were seen. Records maintained by the cook included fridge, freezer and food temperatures. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 17 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 X X X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 18 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15(1) Timescale for action Unless it is impracticable to carry 31/03/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Full details of a guardianship order must be included in a resident’s care plan. The resident or their relatives must, if possible, be involved with care planning. The registered person shall (b) 31/03/06 keep the service user’s care plan under review. The risk assessment relating to pressure sores must be reviewed monthly. The plan of care must be 31/03/06 updated when a residents care needs change. Timescale of 13/3/05 and 31/08/05 not met. The registered person shall make 31/01/06 arrangements for the recording, handling, safekeeping, safe
DS0000022487.V269767.R01.S.doc Version 5.0 Page 19 Requirement 2 7 15(2)(b) 3 OP8 15(2)(b) 4 9 13(2) Springhill House Nursing Home 5. 26 16(2)(k) 6 26 23(2)(d) 7 29 19(1)(b) Schedule 2 administration and disposal of medicines received into the care home. Medication must be checked against the medicines administration record and given individually to each resident. The registered person shall 31/03/06 having regard to the size of the care home and the number and needs of the service users – (k) keep the care home free from offensive odours and make suitable arrangement for the disposal of general and clinical waste. The odour problem in the entrance to the Lynwood Suite and the lounge must be addressed. The registered person shall 31/03/06 having regard to the number and needs of the service users ensure that- (d) all parts of the care home are kept clean and reasonably decorated. The badly stained bed must be cleaned or replaced. 31/01/06 The registered person shall not employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 Two written references and a satisfactory POVA/CRB check must be obtained before all new employees start work. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 20 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. Refer to Standard 19 Good Practice Recommendations The problem with condensation between the doubleglazing should be addressed. Springhill House Nursing Home DS0000022487.V269767.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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