Inspection on 10/04/07 for Springview

This inspection was carried out on 10th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Springview 01/08/06

Springview 07/02/06

Springview 25/07/05

Springview 17/01/05

Springview 07/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Springview 10 Crescent Road Enfield Middlesex EN2 7BL Lead Inspector Mr David Hastings Unannounced Inspection 10th April 2007 09:30 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 Springview DS0000010649.V333148.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. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springview Address 10 Crescent Road Enfield Middlesex EN2 7BL 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) 020 8367 9966 020 8366 0900 jeremybalcombe@btconnect.com Springdene Nursing and Care Homes Limited Mr Soobash Koomar Jhurry Care Home 58 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (58) of places Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home must not accept older people with a diagnoses of dementia who are in need of nursing care. The home must have a designated staff team at all times on the second floor who are trained, competent and in sufficient numbers to care for people with a diagnoses of dementia. 1st August 2006 Date of last inspection Brief Description of the Service: Springview is a purpose built care home registered to provide personal care for a maximum of fifty-eight older people. There are seventeen beds located on the second floor that have been registered to provide a service to people who have a diagnosis of dementia. The home is privately owned and managed by Springdene Nursing and Care Homes Limited, which owns and operates three other care homes in North London. The aims of the home as set out in the statement of purpose are to ensure that all service users receive the highest possible standard of physical, mental, spiritual and social care within an environment, which upholds the core values of privacy, dignity, individuality, choice, rights and fulfilment. The home has fifty-eight single bedrooms with en-suite facilities located on all it’s four floors. The main communal facilities are located on the ground floor and consist of a large lounge, dining room, library and activities room. Also on this floor are the kitchen, laundry room, reception and the managers office. There are separate lounges on the first and second floors. Communal bathrooms are located on the first, second and third floors. There is a parking area at the front of the home for several cars and a garden at the back. The garden is partly paved and accessible to service users. The home is located in a quiet residential area of Enfield Town close to a variety of shops, restaurants and transport links. The fee charged by the home range from £630 - £750. The provider must make information about the service available (including reports) to service users and other stakeholders. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 5 Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on Tuesday 10th April 2007 and lasted eight hours. I met with the directors of the home and I was assisted throughout the inspection by the registered manager who was open and helpful. I spoke with seven staff and twelve residents of the home. I inspected the building and examined various care records as well as a number of policies and procedures. I also spoke with two visitors to the home. The majority of residents I spoke with said they were very happy with the care and support they received. One resident told me that the home was like a hotel and one of the directors that I met said this was the indeed the ethos of the home. I spent time on the second floor speaking with those residents with dementia and observing staff interactions. What the service does well: What has improved since the last inspection? Twelve requirements were issued at the last inspection and the home has complied with eleven of these. The assessment of potential residents has improved so that people know the home they come in will be able to meet their needs. The temperatures of the medication area and the freezers in the kitchen are being maintained at safe levels. The dietary needs and preferences of residents are reviewed by both staff and people who use the service. Staffing levels have been reviewed at residents’ meetings and there are satisfactory numbers of staff to support residents at the home. Individual staff training profiles have been developed to highlight any gaps in the required essential training needs of staff. Window restrictors are in place where required to ensure the safety of residents. Procedures in relation to residents’ finances have improved. The fire risk assessment of the home has been updated and night staff undertake fire drills as required. Accounts of the home have been sent to the CSCI. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Springview DS0000010649.V333148.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 Springview DS0000010649.V333148.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): 3 (6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager makes sure that all potential residents to the home have their needs assessed before they make a decision to move in. EVIDENCE: A requirement was issued at the last inspection that initial assessments of potential residents must be more detailed and comprehensive. It is important that the staff at the home know and understand the needs of an individual so they can be sure that the home will be able to meet all their assessed needs. I examined three assessments of people who had recently moved into the home. These assessments were detailed and clearly identified individual needs to ensure that people could be appropriately supported by staff. The registered manager told me that he is now more involved with the assessment process. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs are being met and procedures in relation to medication are being adhered to. Residents are being treated with respect and their right to privacy is generally being upheld. Care plans do not detail the social and emotional needs of residents on the second floor who have dementia care needs. Recent training in “Person Centred” care that staff have undertaken has not been put into practice. EVIDENCE: Seven residents’ care plans were examined. There was evidence from these plans that people’s physical care needs were recorded as well as the action needed to address these needs. Residents I spoke with confirmed that they were appropriately supported and had good access to health care professionals such as doctors, district nurses and chiropodists. There was evidence from some care plans that residents’ emotional, social and spiritual needs were Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 11 being met. However this was not always the case and care plans on the second floor did not address these issues in sufficient detail. The organisation has recently developed a new care planning format and the residents at the home, particularly those people with dementia would benefit from staff using this plan of care. People with dementia need to be treated as individuals. Records examined on the second floor suggested that this was not always the case. Records are being maintained of when residents are taken to the toilet. The times when residents are taken to the toilet are not based on individual needs and as such indicates that the staff are not using a “Person Centred” approach to care. A requirement relating to this issue has been made in the relevant section of this report. The staff that I observed were interacting with residents on the second floor with genuine warmth and affection. A number of staff have undertaken dementia training however they must be supported to put this training into action by the management of the home, who are at present, relying too much on the medical model of care. A requirement, issued at the last inspection, relating to a need for a more holistic approach to care planning has been restated. Satisfactory records were examined in relation to the receipt, administration and disposal of medication. Three good practice recommendations have been issued as a result of this inspection. Where residents with cognitive impairment are prescribed PRN pain control a detailed description of possible pain indicators may be of benefit and information regarding what effect medication has and any possible contra indications should be detailed on every individual MAR chart. The signatures of all staff who administer medication should be recorded at the front of the medication records. A requirement issued at the last inspection that the temperature of areas where medication is stored are maintained at 25C or below has been complied with and satisfactory records were being maintained. People I spoke with confirmed that the staff treated them with respect and their privacy is upheld. I saw a number of examples of excellent staff interactions with people and staff were able to describe to me how they ensure the privacy of people they support. On the second floor I saw a number of written notices in peoples’ rooms giving instructions to staff about the personal care needs of residents. It is not appropriate to have written notices in clear view in residents’ rooms detailing personal information. The manager took all these notices down immediately and agreed that this practice does not enhance the privacy and dignity of residents. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff at the home provide a wide range of stimulating activities and residents are able to exercise choice and control over their lives. Visitors to the home are welcomed and can visit at any reasonable time. Residents receive a wholesome and appealing balanced diet in pleasing surroundings. EVIDENCE: The home had a programme of weekly social and therapeutic activities. The programme was displayed on the ground floor in the reception area. Activities provided were noted to be varied and included arts and crafts, bingo, music, exercise, entertainment sessions and outings. Pottery and other items made by residents were on display in the activities room and on the ground floor next to the kitchen. People that I spoke with said they were satisfied with the activities organised. I saw the activities coordinator carry out an excellent activities session with the residents on the second floor. The manager stated that the home has two full time activities organisers. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 13 Visitors to the home that I met on the day of the inspection were very positive about the management and staff at the home and confirmed that they could visit at any reasonable time and that they were always made to feel welcome at the home. People that I spoke with confirmed that they were able to exercise choice and control over their lives. The home has a proactive residents’ committee and meeting minutes examined indicated that residents have a say in how the home is run. The minutes also provided evidence that residents are consulted about the menus in the home and have made a number of suggestions, which the home has implemented. The chef was interviewed and had a good knowledge of individual resident’s dietary needs and preferences. A requirement relating to dietary needs and preferences, issued at the last inspection has now been complied with. Freezer temperatures are now being recorded in order to ensure that food is maintained at appropriate temperatures. This was another requirement from the last inspection that has now been complied with. The kitchen was very warm on the day of the inspection and a recommendation has been made that the registered providers look at ways of reducing the ambient temperature of the kitchen. People I spoke with were positive about the quality of the food and the variety of the menus offered. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ complaints are taken seriously and acted upon. Residents are protected from abuse by a well trained staff group and by clear policies and procedures in relation to adult protection. EVIDENCE: The complaints record was examined. There was documented evidence that complaints recorded had been promptly responded to. Staff who were interviewed were found to be knowledgeable regarding adult protection procedures. The staff records examined indicated that staff had been provided with instruction and guidance on adult protection. There was evidence that arrangements had been made for new staff to be provided with instruction and training on adult protection. Residents that I spoke to confirmed that complaints were taken seriously and that they felt safe and supported at the home. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, well equipped and furnished to a high standard. EVIDENCE: The premises were inspected and found to be clean and decorated and furnished to a high standard. Residents who were interviewed stated that they were happy with the accommodation provided. No offensive odours were detected. The laundry area was satisfactory. However a requirement has been issued that the lint tray in the dryer be cleaned on a more regular basis as there was some confusion as to how often this was cleaned. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good level of care and support from a well trained and caring staff team. Residents are protected by the home’s recruitment policies and procedures. EVIDENCE: Residents who were interviewed indicated that staff were well mannered and had treated them with respect and dignity. On resident commented that the staff, “bend over backwards to please”. The duty rota was examined. It indicated that in addition to the manager, there were normally at least 11 staff during the morning shift, 8 staff during the afternoon and evening shifts and 4 staff on waking duty during the night shifts. The manager informed me that a requirement, issued at the last inspection, that the staffing numbers be reviewed has taken place. Residents I spoke with said they thought the staffing levels at the home were satisfactory. Staff who were on duty were interviewed on a range of topics associated with their work (such as health and safety, adult protection, fire procedures and the healthcare of residents). They were noted to be knowledgeable regarding their roles and responsibilities. Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 17 Individual staff training profiles have been completed for all staff at the home. This was a requirement from the last inspection that has now been complied with. According to pre inspection records received by the CSCI, 70 of care staff have an NVQ level 2 or equivalent. This exceeds the requirements for Standard 27 of the National Minimum Standards. Records seen indicated that staff are undertaking the required essential training needed for the work they carry out. The individual training profiles have highlighted the gaps in training and the manager told me that training has been booked for these staff. The requirement relating to this that was issued at the last inspection has now been complied with. Staff interviewed were positive about the training opportunities available to them. The staff records examined indicated that the required recruitment standards and procedures (including obtaining satisfactory CRB disclosures and references) had been followed. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure that the home is effectively managed and to protect the interests, safety and welfare of residents and staff. Those people with dementia are not receiving the same high standard of care provided to the other residents at the home. EVIDENCE: Both staff and residents that I spoke with were positive about the manager of the home. One resident said, “He listens”. The manager told me he would be starting the required Registered Manager’s Award in June of this year. A requirement issued in this report that the management of the home must adopt a more “person centred” approach to the care of those people with Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 19 dementia also relates to this standard. From discussion with the manager it was clear that he works hard to improve the quality of care provided but he must also ensure that those people with dementia receive the same standard of care that the home provides for all other residents. There are good systems in place to monitor the quality of the care provided including resident questionnaires and a proactive residents’ committee. This standard will be fully met when the results of any quality monitoring are published and made available to all interested parties. Satisfactory records were examined in relation to the management of residents’ personal finances. Records were accurate and contained receipts and clear audit trails. A requirement relating to residents’ finances, issued at the last inspection has now been complied with. The manager and the registered provider confirmed that there were no concerns as to the home’s financial viability. Satisfactory records of the home’s finances have been received by the CSCI. A requirement relating to this that was issued at the last inspection has been complied with. Records in relation to Health and Safety were examined. Fire records seen indicated that some fire drills for staff have taken place at night. These need to continue on a three monthly basis to protect residents and staff. During a tour of the home I found that all window restrictors were functioning and in use. This was a requirement from the last inspection that has now been complied with. There are two instances were residents have wanted their windows opened more fully. The manager told me that where this is the case a full risk assessment has been undertaken. The fire risk assessment has now been reviewed and the requirement relating to this has now been complied with. All other records in relation to Health and Safety were satisfactory. During a tour of the home I noticed that the temperatures in a number of hand basins were higher than 43 degrees. Although this has not resulted in any injury to residents, a requirement has been issued in the relevant section of this report that water temperatures are close to 43 degrees. The manager responded to this issue immediately and the maintenance person checked and adjusted all thermostats. The manager assured me that water temperatures would be checked every week on the second floor from now on. Springview DS0000010649.V333148.R01.S.doc Version 5.2 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 3 X X 3 Springview DS0000010649.V333148.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 13(1)14(1 )15(1) Requirement The registered person must provide comprehensive care plans, which address the holistic needs of service users (this must include mental, social, cultural and spiritual needs). (Timescale of 01/10/06 not met) This requirement is restated. 2. OP7 12 The registered person must ensure that the management and staff at the home use a “Person Centred” approach to the care and support of people with dementia. 3. OP26 13(4) a The registered person must ensure that the lint tray in the home’s dryer is regularly cleaned. The registered person must ensure that the outcomes of quality monitoring reviews are complied and published for existing as well as prospective service users and their DS0000010649.V333148.R01.S.doc Timescale for action 01/07/07 01/07/07 01/06/07 4. OP33 24(2) 01/07/07 Springview Version 5.2 Page 22 representatives and other stakeholders. 5. OP38 13(4) a The registered person must ensure that all temperatures of hand basins in residents’ rooms are maintained close to 43 degrees 01/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations The registered person should look at ways to reduce the ambient temperature of the kitchen in order to provide a more pleasant working environment. The registered person should ensure that where people with cognitive impairment are prescribed PRN pain control a detailed description of possible pain indicators are detailed on their individual MAR chart. The registered person should ensure that information regarding what effect medication has and any possible contra indications should be detailed on every individual MAR chart. The registered person should ensure that the initials and signatures of all staff authorised to administer medication are recorded at the front of the medication records. 2. 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