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Care Home: Springfield

  • 69 Freelands Road Bromley Kent BR1 3HZ
  • Tel: 02084668158
  • Fax: 02084661238

Springfield is registered as a Care Home providing care for 10 people with physical difficulties looking to live more independently. The service aims to meet physical, emotional and social needs. As a part of the Leonard Cheshire Disability, Springfield works within the framework of the organisations Charter, standards, policies and procedures. Springfield is a large house set in lovely grounds near to the centre of Bromley town centre with good access to public transport links. 10 Over 65 10

  • Latitude: 51.409999847412
    Longitude: 0.023000000044703
  • Manager: Ms Sarah-Louise Carrier
  • Price p/w: -
  • UK
  • Total Capacity: 10
  • Type: Care home only
  • Provider: Leonard Cheshire Disability
  • Ownership: Private
  • Care Home ID: 18875
Residents Needs:
Physical disability

Previous Inspections

This may not be the latest inspection for this service as we are having techinical problems updating from CQC - please check directly on the regulators website for the most recent report; bestcarehome hopes to be back to regular updates shortly.

For extracts, read the latest CQC inspection for Springfield.

Key inspection report Care homes for adults (18-65 years) Name: Address: Springfield 69 Freelands Road Bromley Kent BR1 3HZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: David Halliwell     Date: 1 7 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 40 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Springfield 69 Freelands Road Bromley Kent BR1 3HZ 02084668158 02084661238 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Leonard Cheshire Disability Name of registered manager (if applicable) Ms Sarah-Louise Carrier Type of registration: Number of places registered: care home 10 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: Date of last inspection Brief description of the care home Springfield is registered as a Care Home providing care for 10 people with physical difficulties looking to live more independently. The service aims to meet physical, emotional and social needs. As a part of the Leonard Cheshire Disability, Springfield works within the framework of the organisations Charter, standards, policies and procedures. Springfield is a large house set in lovely grounds near to the centre of Bromley town centre with good access to public transport links. 10 Over 65 10 Care Homes for Adults (18-65 years) Page 4 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The stars quality rating for this service is adequate. This means that people who use these services experience adequate quality outcomes. Service users said that they like to be called residents. This was the first inspection of this new service for 10 people with physical disabilities. It was an unannounced inspection visit undertaken over the period of a day. The Inspection covered all the key standards and involved a tour of the home, a review of all the homes records and formal interviews with the Manager, 2 members staff and 3 residents. Informal interviews were conducted with other residents as a part of the inspection of this home. As a first inspection it is recognised that this service is in the early stages of its establishment. The inspection has identified 19 requirements or recommendations and the Manager and the staff team have demonstrated their commitment to meeting the Care Homes for Adults (18-65 years) Page 5 of 40 needs identified. As a result of this key standards inspection 9 requirements have been made and 9 recommendations have also been made. Feedback on all the requirements and recommendations was given verbally to the Manager at the end of this inspection visit. Care Homes for Adults (18-65 years) Page 6 of 40 What the care home does well: What has improved since the last inspection? What they could do better: Specific areas identified in this report and requiring improvements are as follows: It is a requirement that the Manager ensures that needs assessment and care planning information is obtained from the referring authorities for each new resident. The Manager must also ensure that Springfield staff carry out their own needs assessments and care planning together with the residents. The Manager is required to ensure that each resident has a contract which specifies all the terms and conditions as set out under Standard 5 of the National Minimum Standards. It is required that care plans are reviewed now that residents have settled at Springfield and that they include clear care plan objectives that have been based on the identified needs assessments and on the wishes and preferences of the residents. These care plan objectives will inform key workers as to how the residents needs may be met and will form the basis of the care plan reviews. It is recommended that diary sheet entries link residents activities with their care plan objectives and what they say they want to do. As a part of the care plan review it is recommended that significant relationship links for the residents are recorded in the care plans. It is required that the Manager ensures that all residents are registered to vote in elections and that they are supported by staff to do so if the residents wish to. It is a requirement that photographs of the residents must be attached to their MAR sheets. It is recommended that guidance be provided for staff about PRN medications that is used for the residents. This should state when PRN medication is to be used and the potential side effects for the individual resident. Care Homes for Adults (18-65 years) Page 7 of 40 It is recommended that a complaints record be drawn up so that all complaints are registered can be seen as to whether they have been resolved within the stated timescale and to the satisfaction of the complainants. It is recommended that the Manager ensures a record book is implemented so that any allegations of abuse are appropriately followed up according to the units procedures and so that the matter is referred to all the appropriate authorities in the correct way. It is recommended that staff are asked to sign to say that they have read and understood the homes policies and procedures. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self harm. Procedures supporting these processes need some improvement so as to fully ensure both residents and staff protection. The 4 residents who we spoke to confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. A copy of the complaints procedure was seen to be included in the service users guide that each resident receives a copy of when they are admitted to Springfield. Staff confirmed that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes complaints policy was inspected and was seen to be satisfactory except that the details for the Care Quality Commission now needs to be updated. We asked the Manager to see the homes complaints record. The Manager told us that while a complaints record needs to be drawn up, no complaints have been made or received to date. It is recommended that a complaints record be drawn up so that all complaints that are made become registered in the record book and it can be seen as to whether they have been resolved within the stated timescale to the satisfaction of those people who had complained. Residents feel that their views and complaints are listened to. The home has an adult protection policy and the Manager informed us that it is planned for the whole staff group to receive appropriate training this year. It is essential that all staff do receive this training and it should be provided by a recognised independent trainer such as the local authority. We asked the Manager how allegations of abuse are recorded. The Manager said that no allegations have been made but that there is not a record book in place as yet. It is recommended that the Manager ensures a record book is implemented so that any allegations of abuse are appropriately followed up according to the units procedures and so that the matter is referred to all the appropriate authorities in the correct way. The policies and procedures manual for the home include a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and Care Homes for Adults (18-65 years) Page 8 of 40 procedures is a part of the staff induction process. It is recommended that the Manager ensures there is a process put in place that updates all the staff about the homes policies and procedures through discussion in team meetings or in supervision. It is recommended that staff are asked to sign to say that they have read and understood the policies and procedures. The Manager told us that it is usual practice for an inventory of each residents valuables to be maintained by key workers for all residents. However inspection of residents files showed that this had only been carried out for 1 of the 3 residents concerned and in that case the inventory was not signed or dated. It is recommended that as part of the admission process an inventory is drawn up for each resident and the key worker ensures that inventories a re maintained, signed and dated by both parties. This should help protect the resident and staff from allegations of abuse, neglect and self harm. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self harm. Procedures supporting these processes need some improvement so as to fully ensure both residents and staff protection. It is recommended that a complaints record be drawn up so that all complaints are registered can be seen as to whether they have been resolved within the stated timescale and to the satisfaction of the complainants. It is recommended that as part of the admission process an inventory is drawn up for each resident. The key worker should ensure that inventories are maintained, signed and dated by both parties. This should help protect the resident and staff from allegations of abuse. It is recommended that staff are asked to sign to say that they have read and understood the homes policies and procedures. It is recommended that the Manager ensures a record book is implemented so that any allegations of abuse are appropriately followed up according to the units procedures and so that the matter is referred to all the appropriate authorities in the correct way. It is recommended that as part of the admission process an inventory is drawn up for each resident. The key worker should ensure that inventories are maintained, signed and dated by both parties. This should help protect the resident and staff from allegations of abuse. It is a requirement that the Manager ensures the emergency pull cords are repositioned to appropriate places in order to ensure the safety of the residents. It is required that all staff have an NVQ at level 2 or above. This is so as to ensure that residents are supported by competent and appropriately qualified staff. It is recommended that documentary evidence is completed at the time induction is provided to new staff and held on staffing files. Care Homes for Adults (18-65 years) Page 9 of 40 It is a requirement that documentary evidence is held on staff training files that confirm which staff have attended what training courses. It is recommended that discussions are undertaken with all staff in supervision about keyworking with residents and the work that is carried out with the residents in meeting care plan objectives. This should be recorded on the supervision notes. It is a requirement that regular fire drills are initiated as part of the fire regulation procedures. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 40 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 2, 4, & 5 were inspected at this inspection. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Prospective service users cannot be fully assured that their needs are being assessed or that their individual aspirations and wishes will be taken into account in an assessment process. They may be assured that they will be offered an opportunity to visit and to test drive the home. Each service user will need to have an individual written contract and be provided with a copy of it. Evidence: The Manager told us that the first residents were admitted to this new service in Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: December 2008. At the time of this inspection there were 9 residents living at Springfield with 1 vacancy. We reviewed the files of 3 of the residents. We found that there was not any needs assessment information gained from referring agencies before prospective residents were admitted to the home. The Manager confirmed this to be the case. It was also the case that none of the 3 residents had received a post admission needs assessment carried out by Springfield staff that identified the needs of the residents concerned. This is important so that residents and prospective residents know that their individual aspirations and needs are assessed; that this information is gained from referring agencies and that Springfield staff also make their own assessment of the persons needs. It is a requirement therefore that the Manager ensures that needs assessment and care planning information is obtained from the referring authorities for each new resident. The Manager must also ensure that Springfield staff carry out their own needs assessment together with the residents. Evidence of comprehensive needs assessment information will need to be seen on the residents files. The combined information from both sources form a comprehensive information base for each resident from which accurate and relevant care plans can be drawn up. The needs assessment process is also about ensuring that staff can meet the identified needs of the prospective resident in that they have the appropriate skills, training and knowledge to enable them to do so. The residents should be involved in the assessment process as much as is possible, given their level of disability. Where appropriate, families or advocates may speak for residents and together this provides them with the opportunity to express their wishes and preferences and to comment on their identified needs. The Manager told us that all prospective residents are encouraged to make a preliminary visit to Springfield in order to familiarise themselves with the home and to provide them hopefully with enough information from which they may decide to live there. Following this visit prospective residents are offered a trial period over which they can better decide if Springfield is right for them. Families and friends are said to be encouraged to visit the home over this period. Residents confirmed the process above and said that they had found it very useful in helping them to decide whether they wanted to live at Springfield or not. Care Homes for Adults (18-65 years) Page 13 of 40 Evidence: As already indicated we inspected 3 of the 9 residents files. None of the files inspected contained a written contract. The Manager is required therefore to ensure that each resident has a contract which specifies all the terms and conditions as set out under Standard 5 of the National Minimum Standards. Residents should sign the contract in their agreement and they should be given a copy of the contract together with their service users guide. These contracts will need to be renewed each year. Care Homes for Adults (18-65 years) Page 14 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Residents cannot be assured that their assessed and changing needs and personal goals will be reflected in their care plans. They may be assured that they will be able to make decisions about their daily lives and should be enabled to take risks as part of developing a more independent lifestyle with support when the risks assessed are integrated with care plans. Evidence: 3 residents files were inspected and 2 had person centred care plans. The Manager told us that the care plan for the 3rd resident was in the process of being drawn up. The person centred plans were drawn up prior to the residents coming to live at Springfield. They were seen to be comprehensive and included detailed information on the residents health, social and domestic activities and communication needs. The Care Homes for Adults (18-65 years) Page 15 of 40 Evidence: plan, being person centred was completed by the resident with help from an allocated key worker. Plans examined included photographs of residents. It is required that these care plans are reviewed now that residents have settled at Springfield and that they include clear care plan objectives that have been based on the identified needs assessments and on the wishes and preferences of the residents. These care plan objectives will inform key workers as to how the residents needs may be met and will form the basis of the care plan reviews. This is so that residents may know that their individual wishes and needs will be reflected in their individual care plans. During the course of this inspection staff were seen to respect residents rights to make their own decisions. It was also clear that residents are involved in making decisions within this home. Residents who we spoke to said that they felt staff do respect them and that staff are supportive in helping them to decide about how they are to move forward in their lives. The Manager told us that residents meet to discuss appropriate issues to do with the home every 2 months. The Manager told us that areas of discussion will be minuted, as will any actions that have been agreed. It is noted that staff record in the daily record sheets or diaries all important decisions and discussions with residents. This better protects residents and staff from possible misrepresentation at a later stage. 2 of the 3 residents files inspected showed that residents had had risk assessments carried out for different activities. The Manager told us that these risk assessments will be reviewed on a regular basis and will also be referred to in the residents care plans. The 2 residents concerned had signed their risk assessments. The Manager told us that both care plans and risk assessments will be reviewed regularly as a part of the homes procedures for care planning. This will help staff and residents in taking risks as a part of developing a more independent lifestyle. Care Homes for Adults (18-65 years) Page 16 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will be able to take part in appropriate activities, some of which will be based in the local community. That they will be supported to maintain appropriate personal relationships with family and friends; and that their rights will be respected and their responsibilities recognised in helping them to construct an appropriate programme of activities in their daily lives. Evidence: The Manager said that in order to ensure that each resident is involved in daily activities appropriate to their abilities, needs and wishes, the staff will maintain daily activities sheets. These sheets record the activities of each resident. Inspection of 3 of Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: the residents files indicated that these daily diaries had been maintained for each resident. When the care plans have been drawn up it will be important and it is recommended therefore that the diary sheets link the activities with their care plan objectives and what they say they want to do. 3 residents interviewed by us said that they participate in the activities they wish to do. Residents said that if they wanted to do an activity, staff would usually support them to do so. The Manager told us that as a part of trying to maintain continuity for the residents in their daily lives where ever possible previous interests, pastimes, hobbies and relationship are encouraged and are built into the daily activities plan for residents. Residents who we spoke to said that they do much more at Springfield than they had done at previous homes they had lived in. As a part of the care plan review it will be necessary and is therefore recommended that significant relationship links for the residents are recorded in the care plans. Information about local activities was seen on the notice boards within the home and staff who were interviewed said how they will support residents, in their capacity as care support workers, to take as much of an active role in the community as is appropriate for residents. Residents are being supported and enabled to take part in appropriate activities and they are able to express their wishes and be listened to and responded to with active and appropriate support. This process will more structured and appropriate when new care plans have been put in place. Interviews with residents and staff identified that some residents are involved in local activities all of which assists residents in developing their social interactions and in their integration into the community. It is required that the Manager ensures that all residents are registered to vote in elections and that they are supported by staff to do so if the residents wish to. Some residents told us that they had not yet been registered to vote in this their new home. We saw information made available within the home about local activities for residents to take up if they wish. Discussions with the Manager, staff and residents made it clear that this service actively encourages residents to develop and maintain social, emotional and independent living skills where ever possible. Staff were seen by us to be actively Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: supporting residents to make informed choices about the things they want to do. The Manager said that relations with the local neighbours are good with no problems arising up to this point in time for the home or for the neighbours. Interviews with 3 of the residents confirmed that where possible they do maintain regular contact with members of their families and either go out to visit their relatives or receive them at Springfield. Residents told us that they are enjoying the opportunities that they experience at Springfield. Staff that we interviewed said that they encourage these visits and are sometimes involved in helping the residents sort out difficulties that they experience their relationships with their relatives as this often has a direct bearing on the mental well being of the resident. Visitors to the home are encouraged to use the visitors book to sign in. We saw information made available within the home about local activities for residents to take up if they wish. Policies seen by us to be established within the unit ensure that residents rights to privacy, respect and dignity are supported. 3 residents confirmed with us that they felt staff respected their rights. Residents said that their mail is unopened, staff use their preferred form of address and staff do knock on their doors before entering. We observed staff to be interacting with residents in a friendly and respectful manner. Interviews both with staff and residents confirmed that residents participate where appropriate in household chores as a part of the rehabilitative process and this participation needs to be detailed in residents care plans. With regards to meals and meal times the Manager told us that all residents plan their own meals and take these meals in their flats. We were told that where ever possible residents take the lead role in planning and shopping for their meals and in cooking their own meals. But that where assistance is needed staff will help residents to plan a varied and nutritious menu. Residents told us they enjoyed their meals and that they felt properly supported by staff when needed. Care Homes for Adults (18-65 years) Page 19 of 40 Evidence: The Manager told us that where a resident has special needs, appropriate help is provided. One resident is diabetic and the Manager told us that a community nurse and a dietician provide assistance with menu planning. The resident concerned told us that they found this support very helpful. Care Homes for Adults (18-65 years) Page 20 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that they will receive personal support in the way they prefer and require, they may also be assured that their physical and healthcare needs will be appropriately met. Service users are protected by the homes policies and procedures for dealing with medicines. Evidence: Residents who were interviewed at this inspection confirmed that they receive their care in the way they prefer. They said that, as far as they are able to, they decide themselves about their daily routines and this was backed up by care staff who were also interviewed by us. Support staff at Springfield ensure that their care support is person led, flexible, consistent and is able to meet the changing needs of the residents. This assistance will be improved when needs assessments and care plans have been implemented and care plan objectives drawn up that detail how identified needs are to be met. Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: It was confirmed by the staff and the residents that they are able to choose when they get up, when they go to bed, when they have a bath, what they wear and what they will do during the day. The Manager told us that residents are registered with dentists, opticians, chiropodists and community nurses in order to maintain their all round good health. Residents interviewed were able to confirm this. Information in their case files also evidences it by the recording of their contact with these services. It was confirmed that annual healthcare checks are routinely carried out by GPs. This all means that residents healthcare needs are being met. The policies and procedures manual contains appropriate policies for the control of medication. We reviewed the records for the administration of medication to residents (MAR sheets) and these were seen to be appropriately completed and in line with the homes policies and procedures. So as to ensure that staff (especially agency staff who may not know each resident well) administer medications to the right resident, photographs of the residents must be attached to their MAR sheets. This is a requirement. We also recommend that guidance be provided for staff about PRN medications that is used for the residents. This should state when PRN medication is to be used and the potential side effects for the individual resident. The residents GPs are often involved in this process and the information should be placed together with a medication profile for each resident. We did a spot audit check on the stock control system and this proved satisfactory with the levels of medications being as stated on the control sheets. A check on the storage facilities for the medication was seen to be appropriate. Although controlled drugs are not currently in use within the home, appropriate provision for being able to do so will be required in the future i.e. there will need to be a lockable metal cupboard within the existing metal cabinet. There is also a refrigerated cupboard for those drugs requiring cool conditions. Training is provided for staff in medication by Boots the Chemists. The Manager informed us that this is mandatory training for all staff. The staff interviewed said they had both received this training. We were told that at present some residents are unable to administer their own medication. The home actively supports residents who Care Homes for Adults (18-65 years) Page 22 of 40 Evidence: wish to self medicate. Care Homes for Adults (18-65 years) Page 23 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users may be assured that their views will be listened to and that they will be protected from abuse, neglect and self harm. Procedures supporting these processes need some improvement so as to fully ensure both residents and staff protection. Evidence: The 4 residents who we spoke to confirmed that they feel their views are listened to and acted upon. They said that if they had a complaint they know the procedure to be followed and would do so if they needed to. A copy of the complaints procedure was seen to be included in the service users guide that each resident receives a copy of when they are admitted to Springfield. Staff confirmed that the residents were all aware of the complaints process and that the whole staff group took any issues raised by residents seriously. The homes complaints policy was inspected and was seen to be satisfactory except that the details for the Care Quality Commission now needs to be updated. We asked the Manager to see the homes complaints record. The Manager told us that while a complaints record needs to be drawn up, no complaints have been made or received to date. Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: It is recommended that a complaints record be drawn up so that all complaints that are made become registered in the record book and it can be seen as to whether they have been resolved within the stated timescale to the satisfaction of those people who had complained. Residents feel that their views and complaints are listened to. The home has an adult protection policy and the Manager informed us that it is planned for the whole staff group to receive appropriate training this year. It is essential that all staff do receive this training and it should be provided by a recognised independent trainer such as the local authority. We asked the Manager how allegations of abuse are recorded. The Manager said that no allegations have been made but that there is not a record book in place as yet. It is recommended that the Manager ensures a record book is implemented so that any allegations of abuse are appropriately followed up according to the units procedures and so that the matter is referred to all the appropriate authorities in the correct way. The policies and procedures manual for the home include a whistle blowing policy and a policy on dealing with violence and aggression. Understanding the policies and procedures is a part of the staff induction process. It is recommended that the Manager ensures there is a process put in place that updates all the staff about the homes policies and procedures through discussion in team meetings or in supervision. It is recommended that staff are asked to sign to say that they have read and understood the policies and procedures. The Manager told us that it is usual practice for an inventory of each residents valuables to be maintained by key workers for all residents. However inspection of residents files showed that this had only been carried out for 1 of the 3 residents concerned and in that case the inventory was not signed or dated. It is recommended that as part of the admission process an inventory is drawn up for each resident and the key worker ensures that inventories a re maintained, signed and dated by both parties. This should help protect the resident and staff from allegations of abuse, neglect and self harm. Care Homes for Adults (18-65 years) Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users at Springfield are able to live in a homely, comfortable and safe environment. The home is also clean and hygienic and well looked after by staff. Evidence: The home supports residents with physical disabilities and the accomodation is less than a year old. Each resident has their own flat that has been equipped to a high standard. Every resident has ensuite facilities with either a bath or a shower. Shower heads are set at assessed levels so that service users can use them. Residents with mobility problems have the use of hand rails and hoists. The kitchen work surfaces have been lowered and doors widened to aid service users who use wheelchairs. A tour of the home together with the Manager was undertaken as a part of the inspection and every part of the home was seen to be clean and tidy. The general condition of the home and the facilities is excellent; communal areas and bedrooms are kept clean and odour-free. The staff provide a homely touch through supplementary decoration and ornaments or flower decorations and pictures hanging on all the walls. Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: One resident that we spoke to told us that the emergency cords in their flat have been wrongly positioned, effectively meaning that if they were to fall in certain areas of their flats they would not be able to use the emergency cords to summon assistance. Evidently this is a problem for all the flats and it is a requirement that the Manager ensures the emergency pull cords are repositioned to appropriate places in order to ensure the safety of the residents. The Manager has ensured that the physical environment of the home provides for the individual requirements of the residents. Also the communal living areas were found to be appropriate for the needs of the residents at the time of the inspection. Four of the residents who we spoke to over the course of this inspection said that they see Springfield as their home and that they find it a nice place and are happy living there. The home is designed to provide supported living and people who live here can enjoy independence in a non-institutional environment. There is space within the home that may be used to entertain guests or for residents to sit quietly in. The Manager showed us that a fire risk assessment was carried out on 2.10.2008. It did not identify any actions that were required. Records were also shown to us by the Manager for other safety checks that have been carried out over the last year and that are part of a regular process of checks carried out to help ensure the safety of the residents. This includes weekly hot water checks of all the hot water outlets and checks of the temperatures of the homes fridge and freezers. The Manager showed us the homes infection control procedure, which seems comprehensive and to be effective in practice. At the time of this inspection the home was clean and hygienic. Staff interviewed confirmed that they are issued with appropriate clothing and equipment for them to carry out their work appropriately. The laundry facilities in the home are appropriate for the residents who are living in the home however the Manager told us that the laundry is to be moved into a larger room elsewhere in the home. It was clear that laundry is not taken through any areas where food is being prepared. Care Homes for Adults (18-65 years) Page 27 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users will benefit from competent and appropriately qualified staff when the training programme has been fully implemented. Staffing levels are appropriate and the homes recruitment policy and procedures help protect the residents. Residents can be assured that they are supported by well supervised staff. Evidence: We saw care staff working at Springfield to be approachable for the residents and to take time to deal with their questions appropriately and patiently. The Manager said that the training programme for staff is comprehensive and covers all the essential training required by the staff to do their jobs well and efficiently. The provision of funding for training is also said to be good and the Manager told us that if a training need is identified then a training course can be provided. The Manager told us that not all the care staff have achieved their NVQ level 2 awards. Inspection of 4 of the staffing files indicated that none had achieved this qualification. One member of staff who we spoke to said that they would like to enrol Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: for NVQ training at the next possible opportunity. It is required under this Standard that all staff have an NVQ at level 2 or above. This is so as to ensure that residents are supported by competent and appropriately qualified staff. We were provided with a staffing rota relevant to the week of this inspection. The rota demonstrated that there are 4 staff members on duty on the early shift, 3 on the late shift, with 1 staff member sleeping in. However the Manager told us that as from 29th June 2009 this will change and there will be 2 staff members sleeping in. The Manager told us that agency staff are being used as a part of the staffing of the home. This was confirmed by entries on the staff rota and by residents who we spoke to. All this means that residents are being supported by an effective staff team. The Manager told us that the home does have a recruitment policy and procedure and that all staffing posts are filled by application and interview. Evidence of these processes being used was seen by us on the staffing files. Review of 4 of the staffing files evidenced that suitable application forms are completed, that 2 references are obtained including one from the last employer. All staff files reviewed by us evidenced that proper CRB checks have been carried out for staff employed within this unit. Equally that all other documentary evidence required (under Standard 34) to be gathered for staff was seen to be held on the staff files reviewed. The result of this is that there is at Springfield a staff team that has a balance of the skills, knowledge and experience to meet the needs of the residents. Staff interviewed confirmed that all have a contract of employment and that they understand their terms and conditions as well as their roles and responsibilities within the home. This all means that residents are protected and supported by the homes recruitment policy. As already indicated earlier in this report the Manager said that there is an overall training and development plan for the home. The Manager told us that a structured induction programme is offered to new staff within the first 6 weeks of employment. We were shown detailed papers that indicate all the areas that are covered by this induction programme. It includes: Understanding Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: the principles of care Fire awareness Use and care of equipment Orientation at work The agency and the worker role Maintaining safety Effective communication Recognising abuse However it is recommended that the elements of the induction process that have been completed by staff are signed and dated by both parties at the time and are held on staffing files. This information was not available for this inspection although the 3 staff who we interviewed did tell us that they had received induction training. The Manager told us that the homes management prioritise training and will facilitate staff members to undertake appropriate training to ensure they can meet residents needs appropriately. It is important that all staff receive training in the key areas of their work. We gained the impression over the course of this inspection that all the staff are committed to ensuring that their own skills and knowledge are developed by appropriate levels of training so that they can best meet the needs of the residents. Training records were examined by us and some evidence was seen of some staff having completed the following training courses: 1st aid Manual handling Basic food hygiene Challenging behaviour SOVA Health & safety Safe handling of medications It is important however that the Manager ensures that training certificates are available as documentary evidence, confirming staff attendances. This was not the case at the time of this inspection and so it is a requirement that this documentary evidence is held on staff training files. A useful training matrix has been developed that provides an excellent tool for management and staff to see at glance what training has been received and by which staff. Where the gaps are and therefore what training needs exist for each member of the staff team. The Manager told us that there is a properly structured staff supervision policy and procedure. Records were inspected and both the policy and the supervision tools comprehensively cover the areas that are required in order to implement an effective supervision process. Residents can be assured that they will benefit from well supported and well supervised staff. The Manager is reminded of the need to maintain the frequency of supervision practice. 3 staff members who were interviewed acknowledged that there have been some gaps in their supervision but also said that they have received informal supervision when they needed it. Care Homes for Adults (18-65 years) Page 30 of 40 Evidence: Inspection of supervision records and discussions with the Manager indicated the need to look at the direct work undertaken by staff with residents to meet their care plan objectives. It is therefore recommended that discussions are undertaken with all staff in supervision about keyworking with residents and the work that is carried out with the residents in meeting care plan objectives. This should be recorded on the supervision notes. Care Homes for Adults (18-65 years) Page 31 of 40 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the inspection visit to this service. Service users can be confident that they benefit from a well run home. When implemented the quality assurance system will help to ensure that the views of all the key stakeholders underpin the monitoring and review of the homes developments. Service users may also be confident that their rights and best interests are safeguarded by the homes record keeping policies and procedures. Evidence: The Manager has been registered with the Commission since December 2008. She told us that she is enrolled this autumn to do the NVQ level 4 in management. She said she has acted as a Deputy Manager for 3 years in her previous employment and prior to that as a senior for 2 years in a care home setting. She has gained considerable experience from this and when speaking with us demonstrated extensive knowledge about the residents and the services being offered to them. From the very positive Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: interactions the Manager has with residents and staff, she is clearly well thought of and liked by both groups of people. Interviews conducted by us with both staff and residents provided very positive feedback demonstrating the committed, sensitive and thoughtful approach the Manager has and all of this means that the service users and staff benefit from a well lead and well run home. Monthly Regulation 26 visit reports should be sent to the Care Quality Commission as required. The Manager explained the quality assurance processes being used within the home to ensure that residents views underpin all self-monitoring review and development by the home. The Manager said that there is an annual management audit undertaken that reviews all health and safety issues, statutory and legal issues, the effective implementation of the homes policies and procedures, the environment and the building, staff and employment issues and training issues. A residents questionnaire is to be used to gain feedback from the residents and other questionnaires have also been devised to get feedback on issues to do with quality, from friends, families and visiting professionals. Quality checks are made on the recruitment procedures used to employ staff and a room-by-room risk assessment of the building is to be completed annually, information from which also informs the developments to be made in the home. We were told by the Manager that evidence from returned feedback questionnaires will be available at the next inspection as the process has not yet been initiated at the time of this inspection. It is recommended that the feedback gained from all these questionnaires be analysed and used to inform an annual development plan for this home. The implementation of the new quality assurance tool should mean that there is in place a very effective method of maintaining high quality standards in the home. We were shown information to do with relevant Health and Safety legislation. Policies and procedures were also seen for Health and Safety, risk assessment, moving and handling and fire. The Manager informed us that all staff will receive training in moving and handling, fire safety, first aid, food hygiene, and infection control. Care Homes for Adults (18-65 years) Page 33 of 40 Evidence: Up to date certificates were seen for: Boiler & Gas on 27.8.08 Fire alarms, emergency lights on 5.9.08 Fire equipment on 10.6.09 Electricity on 5.9.08 Track and hoists checks on 5.9.08 and 17.4.09 Legionnaires water testing on 3.9.08 Lifts on 21.10.08 Records were seen by us that confirmed regular tests had been carried out for the: Fire alarm weekly Fire extinguishers monthly The Manager told us that a fire risk assessment was carried out on 2.10.08 no requirements were made as a result of this assessment. Accident records were checked, 6 had been reported since the home opened and all 6 were seen to have been resolved satisfactorily. Hot water temperatures are checked weekly and records indicated that they came within the acceptable range. The Manager told us that hot water temperatures are also checked before a resident has a shower. Fire drills have not yet been initiated and this is an important drill that the Manager must ensure is implemented as part of the fire regulation procedures. At the time of this inspection no fire doors were seen to be wedged open and the building appeared to be secure. Care Homes for Adults (18-65 years) Page 34 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 35 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 It is a requirement that the 01/08/2009 Manager ensures that needs assessment and care planning information is obtained from the referring authorities for each new resident. The Manager must also ensure that Springfield staff carry out their own needs assessments and care planning together with the residents. In order to meet the NMS 2 5 5 The Manager is required to ensure that each resident has a contract which specifies all the terms and conditions as set out under Standard 5 of the National Minimum Standards. In order to meet the NMS 3 6 14 It is required that care plans 01/08/2009 are reviewed now that residents have settled at Page 36 of 40 01/08/2009 Care Homes for Adults (18-65 years) Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Springfield and that they include clear care plan objectives that have been based on the identified needs assessments and on the wishes and preferences of the residents. These care plan objectives will inform key workers as to how the residents needs may be met and will form the basis of the care plan In order to meet the NMS. 4 13 4 It is required that the 01/09/2009 Manager ensures that all residents are registered to vote in elections and that they are supported by staff to do so if the residents wish to. In order to meet the NMS. 5 20 13 It is a requirement that 01/08/2009 photographs of the residents must be attached to their MAR sheets. In order to meet the NMS. 6 24 23 It is a requirement that the 01/10/2009 Manager ensures the emergency pull cords are repositioned to appropriate places in order to ensure the safety of the residents. In order to meet the NMS. Care Homes for Adults (18-65 years) Page 37 of 40 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 32 18 It is required that all staff 01/12/2009 have an NVQ at level 2 or above. This is so as to ensure that residents are supported by competent and appropriately qualified staff. In order to meet the NMS. 8 35 18 It is a requirement that documentary evidence is held on staff training files that confirm which staff have attended what training courses. In order to meet the NMS. 01/08/2009 9 42 23 It is a requirement that regular fire drills are initiated as part of the fire regulation procedures. In order to meet the NMS. 01/08/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 It is recommended that diary sheet entries link residents activities with their care plan objectives and what they say they want to do. As a part of the care plan review it is recommended that significant relationship links for the residents are recorded in the care plans. It is recommended that guidance be provided for staff about PRN medications that is used for the residents. This should state when PRN medication is to be used and the 2 12 3 20 Care Homes for Adults (18-65 years) Page 38 of 40 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations potential side effects for the individual resident. 4 22 It is recommended that a complaints record be drawn up so that all complaints are registered can be seen as to whether they have been resolved within the stated timescale and to the satisfaction of the complainants. It is recommended that staff are asked to sign to say that they have read and understood the homes policies and procedures. It is recommended that as part of the admission process an inventory is drawn up for each resident. The key worker should ensure that inventories are maintained, signed and dated by both parties. This should help protect the resident and staff from allegations of abuse. It is recommended that the Manager ensures a record book is implemented so that any allegations of abuse are appropriately followed up according to the units procedures and so that the matter is referred to all the appropriate authorities in the correct way. It is recommended that documentary evidence is completed at the time induction is provided to new staff and held on staffing files. It is recommended that discussions are undertaken with all staff in supervision about keyworking with residents and the work that is carried out with the residents in meeting care plan objectives. This should be recorded on the supervision notes. 5 23 6 23 7 23 8 34 9 36 Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 40 of 40 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!

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Springfield 17/06/09

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