Care Home: Springbank House

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What the care home does well People live in a safe, clean and comfortable environment, which suits their needs and where their needs are mostly well accounted for and met, including their health care needs.Peoples` rights to be treated with dignity and respect are upheld and well promoted by a cohesive staff team. That are effectively recruited, inducted, trained and supervision. People can be confident that their concerns and complaints will be taken seriously and acted upon by the home and they are protected from harm and abuse. The home is well managed in peoples` best interests. What has improved since the last inspection? Record keeping has improved, in respect of individual`s admission and needs assessment information, with a revised needs assessment and care plan format introduced. This has promoted a more person centred approach to people`s care. Opportunities for people to engage in social activities are improved. People are better informed about these and a standardised format for recording people`s preferred lifestyles and daily living routines is introduced for staff to record in consultation with each person. Information regarding advocacy services is now prominently displayed. Information about how to complain is prominently displayed in a large print format to assist those people who may have visual difficulties. The arrangements for staff deployment are better managed (see below also for further improvements), and staff personal/recruitment records are well kept. The home is well managed and usually in people`s best interests. Strong management and leadership have promoted good staff morale and team cohesion. What the care home could do better: Further develop the service user guide by way of its content and availability in different formats in order to promote equality of opportunity for people to access key information about the home and its services. Ensure that people are effectively consulted and their preferred lifestyles and daily living routines are fully recorded by staff in the standardised format provided within their individual care files, together with their agreement. Seek to maximise people`s rights and capacity to exercise their personal autonomy and choice and to safeguard their financial interests. Which, should be recorded in their needs assessment and care planning information in accordance with the Mental Capacity Act and its implications for care homes.Ensure that accurate information is provided in the home`s complaints procedure regarding the role of the Commission with regard to complaints about the home and our contact details. Ensure the routine cleaning of windows and the underside of bathing hoist seats. Review the staffing provision for the late afternoon/evening periods to ensure improved staff availability for people during this period. CARE HOMES FOR OLDER PEOPLE Springbank House 17 Ashgate Road Chesterfield Derby S40 4AA Lead Inspector Susan Richards Unannounced Inspection 10th April 2008 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 Springbank House DS0000069548.V362236.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. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Springbank House Address 17 Ashgate Road Chesterfield Derby S40 4AA 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) 01246 237 396 01246 554 073 springbank.house@hillcare.net Hill Care Ltd Vacant Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Hill Care Limited may provide the following categories of service :Care Home with nursing - Code N To service users of the following gender: Either Whose primary needs on admission to the home are within the following categories:2. Old age, not falling within any other category - OP The maximum number of service users to be accommodated is 41 Date of last inspection 24th April 2007 Brief Description of the Service: Springbank House provides nursing, personal care and support for up to fortyone older people. The home is located within walking distance of Chesterfield town centre with level access into well-kept grounds, including a garden with seating areas and car parking provision. Accommodation is over two floors, with thirty-three single bedrooms and four shared. Eighteen of the single bedrooms have an en suite facility. Environmental aids and adaptations are provided made to many areas of the environment to assist those who may have mobility problems. These include a passenger lift. Handrails to corridors, grab rails in bathrooms and toilets, hoists and other aids to assist people in moving and handling and an emergency call system throughout. There are adequate bathing and toilet facilities. Although two of these are not be accessible to service users with significant mobility problems. There is a choice of lounge and dining rooms on each floor, including a smokers’ lounge. The registered manager has the support of a team of registered nurses, carers and hotel services staff and also via external management arrangements. The current scale of charges as 24 April 2007 is as follows: £325.05 - £350.30 for those funded via Derbyshire County Council (NB those with en suited rooms are subject to an additional £10.00 top up fee in addition to the fees determined by Derbyshire County Council. £380.00 - £550.00 for those who are privately funded. Fees are determined in accordance with level of need and care provided. There are additional charges for private chiropody, in house visiting hairdresser Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 5 and newspapers and magazines delivered to the home. All are as charged by the vendor. A copy of the most recent key inspection report is available in the reception area and information about its availability is also provided within the home’s service user guide. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars **. This means the people who use this service experience good quality outcomes. For the purposes of this inspection we have taken account of the information we hold about this service. This includes our previous key inspection report of 24 April 2007, which was the first inspection of this service under the current registered provider, who had taken ownership of the home a few months before that inspection. Also the home completed our annual quality assurance questionnaire (AQAA). This was well completed giving key service information as requested. At this inspection there are thirty-two people accommodated, including twelve who receive nursing care. We used case tracking as part of our methodology. This involved the random sampling of three people, whose care and service provision was more closely examined. We did this by talking with those people, looking at their written care plans and associated health and personal care records and their private and communal accommodation. We also sent out written surveys to fifteen residents, fifteen relatives and ten staff before our visit to the home. And we received returns of these from nine residents, four relatives and eight staff. We spoke with staff about the arrangements for their recruitment, induction, training, deployment and supervision and we examined related records and observed some of staffs’ interactions and approaches with people. We spoke with the acting manager about her role and responsibilities for the management and administration of the home and examined associated records. All of the above was undertaken with consideration to any diversity in need for people who live at the home. At the time of our visit all people accommodated are of British white backgrounds and of Christian based religion (either practising or non-practising). What the service does well: People live in a safe, clean and comfortable environment, which suits their needs and where their needs are mostly well accounted for and met, including their health care needs. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 7 Peoples’ rights to be treated with dignity and respect are upheld and well promoted by a cohesive staff team. That are effectively recruited, inducted, trained and supervision. People can be confident that their concerns and complaints will be taken seriously and acted upon by the home and they are protected from harm and abuse. The home is well managed in peoples’ best interests. What has improved since the last inspection? What they could do better: Further develop the service user guide by way of its content and availability in different formats in order to promote equality of opportunity for people to access key information about the home and its services. Ensure that people are effectively consulted and their preferred lifestyles and daily living routines are fully recorded by staff in the standardised format provided within their individual care files, together with their agreement. Seek to maximise people’s rights and capacity to exercise their personal autonomy and choice and to safeguard their financial interests. Which, should be recorded in their needs assessment and care planning information in accordance with the Mental Capacity Act and its implications for care homes. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 8 Ensure that accurate information is provided in the home’s complaints procedure regarding the role of the Commission with regard to complaints about the home and our contact details. Ensure the routine cleaning of windows and the underside of bathing hoist seats. Review the staffing provision for the late afternoon/evening periods to ensure improved staff availability for people during this period. 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. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 9 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 Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 10 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): NMS 1 & 3. (NMS 6 was not assessed, as it is not applicable to this service). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further development of the home’s service guide content and its availability in different formats, may better promote equality of opportunity for people to access key information about the home Overall peoples’ needs are reasonably well accounted for. EVIDENCE: At our last key inspection of this service we judged that admission information and needs assessment records was not always obtained or maintained in accordance with recognised practise, which did not consistently promote the best interests of existing or potential service users. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 11 We made two requirements in respect of the above. These are complied with at this inspection. In our annual quality assurance questionnaire completed by the home they say that they provide an atmosphere which is welcoming and where possible enable people to choose their own room. They also gave us with other information that we asked for here about the number and needs of people admitted to and living at the home. At this inspection we looked at how information is provided for people about the home and the services it intends to provide. We did this by talking with people and looking at key written information. This included the home’s service user guide. We looked at how peoples’ admissions to the home are arranged and the arrangements for ensuring that their needs are assessed. We did this by talking with people about these and examining individuals’ needs assessment and related admission records for those people that we case tracked. We also asked people by way of written survey if they received enough information about the home to help them to make decisions. The service guide had been revised and updated since our last key inspection and details many aspects of key service information in standard print format. It does not contain any information as the views of people who live at the home about the services there, including as to the qualifications and experience of staff employed. A copy of the guide is available in the main reception area. We asked about the availability of the guide in other formats, such as that which might better assist a person with either partial or total sight impairment. The manager advised that this could be made available in large print, although the guide does not detail this availability and it is not currently available in any other formats. One of the people case tracked was partially blind and said he could read large print, although had not been offered any service information in this format. Information in the guide about complaints does not give accurate or up to date information about the Commission. Most people said that they felt were provided with the information they needed about the home to help them decide whether to live there, or that their relatives arranged matters for them. However, three people said they were not provided with a service guide and three people surveyed said they are not provided with any information about staff skills and training. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 12 Overall, people’s needs assessment records are well recorded, although for two people their social profiles were not completed. These are standardised assessments, (introduced since our last key inspection), which prompt staff responsible to assess and record key information about peoples’ preferred daily routines and lifestyle preferences. People told us that they usually receive the care and support they need and that staff is mostly conversant with their needs, including their daily living preferences. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 13 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): NMS 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health and personal care needs are usually well met and their rights to be treated with dignity and respect are upheld. EVIDENCE: At our last key inspection of this service we judged that peoples’ health care needs are reasonably well met and they are treated with dignity and respect. And that the proposals for the introduction of a different care planning methodology should better promote a person centred approach care. We made a requirement that policy and procedural guidance for staff responsible for the administration of medicines must be kept under review so that it accurately reflects current practise and recognised guidance. This is achieved at this inspection. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 14 In our annual quality assurance questionnaire completed by the home they say peoples’ health needs are met and that they are treated with dignity and respect. They also say they have improved their care planning systems over the last 12 months, including staff training in respect of these to ensure they are regularly reviewed and kept up to date. They feel they could improve these further by developing of a more person centred approach and more active involvement of care staff in the care planning for those people who receive personal care only. It is their stated aim to achieve this over the next twelve months. At this inspection we looked at the arrangements for peoples’ health and personal care delivery, including medicines practises. We did this by talking with people and by examining the care plans and associated health care records kept for those people we case tracked. We also asked people, including by way of written survey if they receive the care and support they need, including medical support and if staff listen and act on what they say. We spoke with staff about how they determine care delivery to people and we observed staff interactions with people during the course of our visit. All people consulted said that always, or usually they receive the care and support they need, including medical support and that staff listen and act on what they say. We observed staff to be respectful in their approaches with people and to relate well with each other. Feedback from staff indicates a good working awareness the principles of person centred care. Relatives/representatives said they felt that the home always or usually meets the needs of their relative or friend. Very positive comments are received, which include: ‘I am very happy here.’ ‘The care my mother receives is excellent.’ ‘We are always kept informed and any worries or concerns are discussed through regular reviews of care.’ However, people consistently commented that there are times when they have to wait, usually evenings when they say staff are not available when they need them, which often means they may have to wait for the toilet or to go to bed. (See staffing section of this report). Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 15 Peoples’ written care plans are up to date, have regularly recorded reviews and are reflective of recognised guidance concerned with the care of older people. Inputs from outside healthcare professional are also well accounted for, including for the purposes of routine health screening. The arrangements for the ordering, receipt, storage, administration and disposal of people’s medicines are satisfactory. They are in accordance with people wishes and the home’s policy and procedural guidance for safe medicines practise, which accords with recognised practise. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 16 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): NMS 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunities for people to engage in social activities are much improved. However, their individual capacities to exercise personal autonomy and choice may not always be maximised in their best interests. EVIDENCE: At our last key inspection of this service we judged that peoples’ social, cultural, religious and recreational interests and needs are currently not effectively determined or met, although food provided is to a reasonable standard. We made a requirement that people must be consulted about their social interests and spiritual needs in order for them to be able to engage/participate in local, social and community activities of their choice. We also recommended that up to date information about activities should be circulated to all service users in formats suited to their capacities AND that Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 17 Information should be provided for people regarding access to advocacy services. These are mostly achieved at this inspection. In our annual quality assurance questionnaire completed by the home they say employ an activities co-ordinator who organises activities in consultation with people and that they keep individual records of their provision and people’s participation in these. They feel they have improved since our last key inspection by engaging more input from peoples’ families/representatives and over the next twelve months they intend to further develop provision for peoples’ social and recreational activities and by increasing community access. At this inspection we spoke with people about their daily living arrangements, including activities and meals. And we asked people by way of written survey whether activities are organised in the home, which they can join. We also looked at the associated care records for people case tracked and made general observations during our visit. People spoken with and surveyed said that activities are usually organised, including two people who said they always are. People said that residents meetings are held and a monthly newsletter is provided. One of the residents showed us a copy of the recent newsletter, which she said she enjoyed. People said that activities regularly organised, include board games, arts and crafts, card making, gently exercise, nail manicures and bingo sessions. They also said that seasonal celebrations are always held, with a recent Easter bonnet competition. One person had some of their art work displayed and photographs of residents engaging in various activities are displayed in the home. There is also a visiting hairdresser to the home, which many people said they enjoyed the service. People say their visits come to the home as they wish and one person, case tracked said she visits her family on a regular basis. Another said he often chooses to go into town. All felt that activities arrangements are improved and are generally more satisfied with these. Although people unanimously said that improvements could be made in terms of supporting people to access to the local community, particularly by way of trips out during the summer months. However, all said they thought this was being looked at via the residents meeting with the feasibility of re-instating a mini-bus for the home currently being looked at. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 18 Records of peoples’ engagement in activities are maintained. However, there are no records kept within peoples’ needs assessment and care planning documentation as to peoples’ choices and capacities in terms of managing their own monies and individual’s social needs assessment profiles were not completed for those people case tracked. Information regarding local advocacy services is displayed. People said that staff is mostly aware of their preferred daily living routines, although that sometimes these may not always be upheld, which they perceive to be due to staffing constraints at particular times, (see staffing section of this report). One example consistently given was around preferred times to go to bed, where people said they often had to wait and felt this may be due to staff availability. Another person said they thought arrangements were going to be made regarding their expressed wish for a visiting minister in accordance with their religion, although this had not transpired to date, which they found disappointing. There was no record within that persons’ needs assessment information with regard to their religious beliefs or any expressed wishes concerning these. At lunch time people chose whether to eat in the main dining area or in their own rooms. Lunch in the dining room was a very sociable occasion. Tables were attractively set and food provided was well presented. Staff assisted people as necessary in a sensitive manner. People said they are consulted about menus on a daily basis and an alternative is always offered and available should they ‘change their mind on food selected earlier. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 19 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): NMS 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that their concerns and complaints will be taken seriously and acted upon by the home and they are protected from abuse. EVIDENCE: At our last key inspection of this service we judged that people are protected from abuse, although their rights to complain could be better promoted. We recommended that the information provided for people about how to complain be made available alternative formats. This is displayed in large print format within the main reception area. In our annual quality assurance questionnaire completed by the home, they say that people are protected from abuse and that they take and handle complaints seriously. They gave us some information that we asked for about complaints received by the home over the last six months. They say they have improved over the last twelve months by ensuring training for staff in this area and by improved management of complaints and that they intend to continue with this. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 20 At this inspection we asked people if they knew who to speak with if they are unhappy and if they know how to make a complaint. We looked at the home’s complaints procedure. We spoke with the manager about complaints received by the home, since our last key inspection and we examined the home’s complaints records. We also spoke with staff about their role and responsibilities with regard to dealing with complaints and safeguarding people from harm and abuse. People spoken with and surveyed all said they know who to speak with if they are unhappy and know how to complain. Information about how to complaint is provided within the home’s service guide and a copy of the complaints procedure is displayed in the main reception area. However, this does not give accurate information regarding the name, role and contact details of the Commission. We discussed this with the manager who agreed to amend this. We looked at the home’s record of complaints. The home has received six complaints from service users or their representatives since our last key inspection. These are well recorded, including outcomes and action taken. Three of these relate to financial arrangements. One is upheld and resolved, one partially upheld and resolved and one is pending an outcome. The two remaining concerned a missing item of clothing, which is resolved and room temperature, which was upheld and is resolved. The sixth was effectively reported by the home and investigated via joint agency safeguarding adults’ procedures, following an allegation of physical abuse of a resident. No evidence was found to substantiate this allegation. Staff spoken with is conversant with their roles and responsibilities with regard to complaints and safeguarding people from harm and abuse. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 21 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): NMS 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe environment, which is usually kept clean and well maintained and which suits their needs. EVIDENCE: At our last key inspection we judged that people live in safe, clean and comfortable surroundings, which suits their needs. In our annual quality assurance questionnaire completed by the home, they say that they that they ensure that people live in a safe, clean and comfortable environment, which suits their needs and they aim to continue to do so. Although they feel they could improve by involving people more in the choice of décor in their own rooms. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 22 At this inspection we asked people about their environment, including as to whether it is kept fresh and clean and we particularly looked at the private and communal facilities accessed by those people case tracked. We also observed cleanliness, safety and hygiene within the home. All residents said the home is always kept fresh and clean, although three relatives surveyed said they felt that more attention is needed to ensuring that windows are kept clean and two felt that ‘spring clean throughout’ would benefit. At our visit we observed that the home is clean and tidy, although some windows are ready for cleaning. People’s bedrooms are personalised and organised and equipped according to their wishes and needs. Progress has continued with the home’s programme of redecoration and upgrading, although some bathrooms are very dated in their appearance and are not particularly inviting for people to use. One bathroom in the older part of the building provided a fixed bathing hoist, which was in need of cleaning to the underside of the seat. Not all bathrooms are accessible to all people, although people can access a bathroom, which meets their needs near to their own rooms. Otherwise, the home’s layout promotes ‘cluster living’ and people can choose where to spend their time. Many people commented on this and felt it to be a very positive aspect of the home. External grounds are kept tidy and attractive and are easily accessed by people, with seating provided. Springbank House DS0000069548.V362236.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): NMS 27, 28 ,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s needs are met from staff that is suitably recruited, inducted and trained. Although staff deployment arrangements for the evenings does not always accord with peoples’ best interests. EVIDENCE: At our last key inspection of this service we judged that arrangements for staff deployment do not always accord with peoples’ best interests, although they are suitably protected by the home’s recruitment, induction and training arrangements. We made two requirements and one recommendation about staffing arrangements. One requirement is partially met and one, together with the recommendation is met at this inspection. In our annual quality assurance questionnaire completed by the home, they say that they always ensure adequate staffing levels necessary to meet peoples’ needs, which they feel they have improved over the last twelve months along with showing appreciation to staff for the work they do. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 24 They aim to continue with the above and to closely monitor peoples’ dependencies to inform staff deployment planning and also to advertise to recruit bank staff. At this inspection we asked people if staff have the right skills and experience to look after people properly. We also asked people if staff are usually available when they need them and if they listen and act on what they say. We spoke with staff about the arrangements for their recruitment, induction, training and deployment and examined associated records, including four personal records for four more recent staff starters. People said that staff, seem to have the right skills and experience, although four people said they are not informed as to the actual skills/training that the staff has achieved. One person said, ‘We have not been told that all staff are training to NVQ level or in the process of gaining the qualification, but all seem to be adequately trained to do the job they are employed to do.’ All people said that staff always listen and act on what they say and are usually available. However, some people surveyed and spoken with said that staff is not always there when they need them. That this mostly occurs during the evenings resulting in people having to wait for the toilet or to retire to bed, sometimes rather later than they would prefer. People also said that at these times. Staff, is always very busy assisting others, with little or no time to spend with them. And that often they do not see any care staff in the lounge areas for long periods of time. Two people said this was a concern to them, as they are not able to reach the call bell in lounge areas due to their poor mobility and relied on other residents who were mobile to ring for assistance. Staffing rotas indicate that during the later afternoon and evening there is one care staff less than during the morning and early afternoon, when there is also often an activities co-ordinator. The arrangements for staff recruitment, induction and training are satisfactory, although there is no formal record of individual staff induction. We discussed this with the manager. (See management section of this report). Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 25 Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 26 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): NMS 31, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and usually in peoples’ best interests. EVIDENCE: At our last key inspection of this service we judged that peoples’ health, safety and welfare is sufficiently promoted and protected and that the extensive management review of the home, being undertaken at that time may better ensure that that it is run in peoples’ best interests. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 27 In our annual quality assurance questionnaire completed by the home, they say that the home is now well managed. And that, over the last twelve months they have made areas of key improvement. These include consultation with people who use the service, improved communications and complaints handling and staff recruitment processes along with improved care systems and practises, which they aim to continue. At this inspection we spoke with the manager about her role and management systems employed, including quality assurance and monitoring systems and the arrangements for the management and safekeeping of peoples’ own monies. We spoke with and surveyed staff about management arrangements in the home, including that relating to communication, support and supervision, training, policy and procedural guidance and safe working practises. We also examined records kept in the home in respect of the above, along with other key records, which are referred to under the relevant sections of this report. And we made general observations during our visit with regard to safety in the environment. The acting manager has submitted a registered manager application to us in respect of Springbank House. A comprehensive formalised quality assurance and monitoring system is in place. This includes consistent auditing and monitoring of all systems and practises in the home. There is good support from external management. Residents meetings had recently been instigated and a satisfaction survey/questionnaire prepared, which is planned to be sent out to people over the next month in order to gain their views as to the quality of care and service provision at the home. The manager advised that the home does not manage monies for any person at the home at this time and that mainly relatives managed peoples’ monies on their behalf. Although there are no formal records kept as to individuals’ wishes, choices, capacity to consent in respect these arrangements. (See the Social Care & Activities section of this report). We discussed the Mental Capacity Act implications with the manager in respect of this. With regard to other records examined, these are properly maintained, although there is no record of individual staff induction. However, the manager was aware of this and provided a standardised recording format. That she had prepared and planned to introduce. Staff confirmed good management arrangements and said that they are provided with the necessary information, training, equipment and support they need to enable them to effectively carry out their work. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 28 Many people made very positive comments regarding the manager’s approach, availability/profile, commitment and the support leadership she provides and team cohesion and high staff morale, is evident. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 29 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 2 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 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 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 3 2 3 Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 30 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 OP27 Regulation 18(1)(a) Requirement Timescale for action 11/06/08 2. OP16 22(7) A review of staff numbers during the late afternoon/evenings must be undertaken and adequate staff provision ensured. The home’s complaints 11/05/08 procedure must give accurate information regarding the role of the Commission with regard to complaints made about the home and also our contact details. 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 OP1 Good Practice Recommendations The home’s service user guide should be available in alternative formats in accordance with individuals’ diversity of need. And to ensure equal access for people to this information. It should contain details of relevant staff qualifications and experience and give service users’ views about the home Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 31 2. OP3 3. OP14 4. 5. OP26 OP37 and its services. (NMS OP 12 also applies here). Individual’s social profile assessments should be fully completed in consultation with them. To ensure that that their diversity of need with regard individual lifestyle preferences and routines are better accounted for in agreement with them. The home should seek to maximise people’s capacity to exercise personal autonomy and choice and to safeguard their financial interests. Which should be recorded within their needs assessment and care planning information in accordance with the Mental Capacity Act and its implications for care homes. Attention should be given to ensuring regular cleaning of windows in the home and also in checking the underside of bathing hoist seats for cleanliness. The prepared format for keeping individual records of staff induction should be introduced as soon as possible. Springbank House DS0000069548.V362236.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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