CARE HOMES FOR OLDER PEOPLE
Springhill House Nursing Home Fairfield Street Accrington Lancashire BB5 0LD Lead Inspector
Susan Hargreaves Unannounced 07 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Springhill House Nursing Home Address Fairfield Street Accrington Lancashire BB5 0LD 01254 381719 01254 872685 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Springhill House (Accrington) Limited Miss Catherine Dunn Care Home with Nursing (N) 75 Category(ies) of Physical disability (PD) 4 registration, with number Terminally Ill (TI) 3 of places Mental disorder, excluding learning disability or dementia - over 65 years of age (MD)(E) 17 Dement - over 65 years of age (DE)(E) 17i Old age, not falling within any other category 75 Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 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 disabilty under 65 years 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 disablity or dementia over 65 years of age Upto 7 service users requiring 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 of OP (old age, not falling within any other category) Upto 21 service users requiring personal care (old age, not falling within any other category. 2 Only service users requiring nursing care may be admitted in the categories TI (terminallt Ill) and PD (Physical disability under 65 years of age) 3 Staffing for service users requiring nursing care will be in accordance with the Notice issued dated 8th March 2002. 4 The service should, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 15 December 2004 Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 5 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 F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over seven 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 71 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 regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
To provide a greater variety of activities creative dance and aromatherapy hand massage have been added to the programme. Since the last inspection an additional member of staff was on duty on each unit until 10.00pm. This enables residents to go to bed at a time of their choosing. Residents who needed assistance with feeding received prompt attention at lunchtime on the day of the inspection. This ensured the meal was eaten when it was hot. To maintain an efficient laundry service new washing machines have been installed. All the required information, for the protection of residents, had been obtained and included in the staff files. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 7 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 F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 6 Residents received a full assessment prior to moving into Springhill House with the result that their needs were known and met. Intermediate care was provided in a dedicated area of the home. EVIDENCE: Individual records of 9 resident’s were inspected. Each contained copies of assessments completed by health and social care professionals. In addition to this a senior member of staff visited and assessed prospective residents in hospital or their own home prior to admission. The pre-admission assessment provided useful information for the care plan. A contract had recently been agreed with the Primary Care Trust to provide 6 intermediate orthopaedic care beds. A dedicated area of the home was used for this service. Residents admitted for intermediate care usually stayed at Springhill for 2 or 3 weeks. Meetings involving the physiotherapist, occupational therapist, intermediate care co-ordinator, social worker nursing and care staff from the home were held weekly to discuss progress and further treatment. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 and 10 Care was given in a manner, which promoted the privacy and dignity of all residents. Detailed information relating to all aspects of health care was not included in some care plans. This meant that there was the potential for some health care needs not to be fully met. Medication practices needed to be improved so that medicines were given in line with the home’s own policies and procedures. EVIDENCE: The individual care plans of six residents on the general unit and three residents on the Lynwood Suite were inspected. The care plans on the general unit identified the needs of each resident and explained how these needs were met. Risk assessments relating to nutrition, moving and handling, falls and pressure sores had been carried out. Information about how any identified risks were addressed was written in the care plan. This included the use of pressure relieving equipment and appropriate moving and handling techniques. However, the care plans inspected on the Lynwood Suite did not address all aspects of healthcare. It was evident that a resident had been very aggressive recently. There were no details of this in the plan of care and therefore no written directions for staff to follow. For another resident there were no
Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 11 direction to staff about his particular type of dementia and how to address any problems that may occur from this. The care plans were reviewed monthly. However, one care plan had not been amended to state that the resident now used a hoist instead of a zimmer frame. None of the residents were able to administer their own medication and this was done by staff. Two pots containing tablets and liquid medication were found on the bedside drawers of one resident. As the door was open the medication was clearly visible to anyone passing, with the potential that another resident may have picked up and taken this medication. There were clear records to show medications ordered, received, administered and returned. Discussion took place on the current method of returning medication and the fact that this must now be done by a licensed waste carrier. The medication storage room was tidy and there were good stock control measures in place. Due to the hot weather the temperature of the room had risen over 25 degrees Celsius on some occasions. This had the potential to affect the integrity of the medications stored. There were policies and procedures for staff to refer to about the control of medications. There was a good relationship with the Community Pharmacist, who made regular visits to monitor the storage and management of medications at the home. During the inspection members of staff were observed attending to residents in a polite and friendly manner. Personal care was carried out in the privacy of the resident’s own room. There was evidence of good resident and staff relationships, which led to a good atmosphere in the home. Resident’s praised the staff for their kindness. Comments included, “the staff are very nice indeed” and “they do their best for you”. During the lunch served on the Lynwood Suite no one was offered a knife and fork, all residents were given a spoon to eat their meal with. This had the potential to affect their dignity and undermine their remaining ability in respect of assisting themselves with their food intake. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Residents were able to make choices about their life at the home so that their lifestyle met their preferences. Resident’s social, cultural and recreational needs were met through links with their family and friends being maintained and opportunities to undertake activities within the home. EVIDENCE: Social activities were advertised in the home. These included board games, skittles, crafts, gardening, reminiscence, painting, aromatherapy hand massage and creative dance. The physiotherapist also did movement to music on a Monday afternoon. Records were kept of which residents had joined in which activities and the level of participation. A resident said, “I’ve done some lovely paintings here.” The daily routine was flexible in order to meet the needs and preferences of residents. One resident said, “ I can go to bed when I want.” Visitors were welcome at the home. The residents could choose whether to see them in the lounge or in their bedroom. The meal served at lunchtime looked wholesome and appetising. A choice of meal was offered. Members of staff were observed encouraging and assisting residents to eat their meal. However, none of the residents on the Lynwood Suite were offered the choice of using salt and pepper. The whiteboard in the Lynwood Suite displayed the wrong day and date. The week’s menu on display
Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 13 was not for the correct week. This had the potential to increase the confusion of the residents. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Complaints would 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. No complaints have been made to the home or the Commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with three members of staff. They were aware of the procedure and said they would report any concerns immediately. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Residents were happy with their accommodation at the home and lived in a safe, clean, well-maintained environment. EVIDENCE: The home was clean and well maintained. The decoration and furnishings were of a high standard. There was access to gardens that were attractive and well kept. There was a linen store on Lynwood unit that did not have a smoke detector fitted. This may be a potential fire hazard. There was a Handyman and a decorator employed. This meant that repairs and items of decoration could be done in a short time scale. The staff recorded items for repair in a record book that was ‘signed’ off when the repair was completed. As well as this the Handyman did a weekly maintenance check and recorded any repairs needed and completed. The home was clean and odour free at the time of the inspection. The systems for maintaining hygiene included procedures for infection control. Plastic aprons and gloves were available to staff when undertaking care duties. There was a separate laundry room, which had sufficient and appropriate equipment
Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 16 to meet the laundry needs of the number of residents accommodated. A resident spoken to said, “They take good care of my clothes”. In one of the bathrooms on Lynwood there were 3 safety razors seen. As well as a potential safety issue this compromises infection control if razors are used between residents. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 17 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were thorough. Training for all members of staff was actively encouraged. 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. Most residents chose to go to bed between 8.00pm and 10.00pm. In order to make this possible an additional member of staff was on duty on both units until 10.00pm. The files of three members of staff appointed recently were inspected. These indicated that all the required pre-employment checks to ensure protection of the residents had been completed. It was evident from discussions with the manager and three members of staff that training was actively encouraged. This included, induction training for new members of staff, moving and handling, fire safety, first aid, health and safety, record keeping, dementia care, abuse, nutrition, palliative care, continence, wound care and NVQ levels 2 and 3. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 38 The health, safety and welfare of residents and staff was promoted and protected. EVIDENCE: Records of financial transactions involving resident’s money were seen to be well maintained and up to date. Records of fire drills were kept. Fire alarms and emergency lighting were checked regularly. Water temperatures were checked quarterly. There was a current electrical installation certificate. There were records to show that Portable Appliance Testing was done. The servicing of the gas boilers and appliances had been done in January 2005. The hoists and the passenger lift were serviced regularly. There were very good risk assessments with directions for staff to follow to manage any risk identified. The health and safety procedures were well written, being clear and precise in the information they contained. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 19 Staff had received training in health and safety. Some staff had received training in First Aid and the Manager said there was always a person with this training on duty. Fire safety training had been done in December 2004. Moving and handling training had been done. A member of staff recently employed said that she had yet to do this but was not allowed to use any equipment e.g. the hoist, in the meantime. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x 3 x x 3 Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 15(1) Requirement The plan of care must include all aspects of the residents health needs and how these are to be met. The plan of care must be updated when a residents care needs change. Timescale of 13 March 2005 not met. The administration of medications must be in a safe manner and in line with the homes own policies and procedures. Appropriate arrangements must be made for the disposal of medications. The Lancashire Fire and Rescue Service must be consulted about the provision of a fire detection method in the linen cupboard on Lynwood. Timescale for action 31 Aug 2005 2. 8 15(2)(b) 31 Aug 2005 3. 9 13(2) 8 July 2005 4. 9 13(2) 31 Aug 2005 31 Aug 2005 5. 19 24©(i) Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 22 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. 3. 4. 5. Refer to Standard 9 10 12 14 26 Good Practice Recommendations That action to cool the medication storage roomis taken should the temperature be recorded as being above 25 degrees Celsius. That residents are offered the use of a knife and fork to eat their meals if this is within their assessed capabilities. That the information on display for residents is correct. That residents are offered the choice of condiments at meal times. That razors are kept out of sight and are not used communally. Springhill House Nursing Home F57 F07 S22487 Springhill V231361 070705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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