Care Home: Springfield Care Centre

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What the care home does well Provide residents with good quality health care and opportunities to shape the service and lead fulfilled lives. Provides for the diverse needs of residents focussing on individuality. The management and staff encourage and engage relatives and friends in maintaining positive networks with residents. Work well with external agencies to provide improved standards of care, including `End-of-Life` care. Provides a dedicated, motivated and skilled staff team to provide high standards of care. Provides good quality care for Dementia sufferers including the design of the environment and in the provision of stimulation through one to one activities. Continuously striving to improve the quality of life for residents through monitoring, listening, engagement and implementing new strategies to reduce dependence and distress. The service is led by a manager who leads by example and works tirelessly to develop a skilled workforce to secure improved outcomes for residents. What has improved since the last inspection? Improved in the quality of records held on food intake charts. Developed a Reminiscence Pub and Garden for residents. Achieved a major award i.e. the Gold Standard Framework Award for providing `Endof-Life` care. There has been as a result of this, an improvement in the quality of life that residents now receive, in their final days. More residents preferring to spend their final days at Springfield Care Centre. A memorial wall has been dedicated to residents. Staff have dedicated resources for bereavement counselling - should they need this, as a result of working much closer with residents. Provided more specialist training for staff to reduce the frequency of residents having to go into hospitals for various procedures. What the care home could do better: Ensure that all care staff including the manager records on the roster how they have worked. Take the steps outlined in their action plan arising out of the Safeguarding matter (AJR), to improve further, the quality of care and safeguards for all residents living in the home. Key inspection report Care homes for older people Name: Address: Springfield Care Centre 20 Springfield Drive Barkingside Ilford Essex IG2 6BN     The quality rating for this care home is:   three star excellent 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: Stanley Phipps     Date: 2 2 0 9 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 Older People Page 2 of 36 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 Older People 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Springfield Care Centre 20 Springfield Drive Barkingside Ilford Essex IG2 6BN 02085189270 02085180813 manager.springfield@yahoo.co.uk www.schealthcare.co.uk Southern Cross (LSC) Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Mary Edwin Oniah Type of registration: Number of places registered: care home 80 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Springfield Care Centre is a purpose built care home registered to provide nursing care. The home can accommodate up to eighty people, in three categories: older physically frail people (55); older people with dementia/ mental disorder (15); and younger people who have physical disabilities (10). The home is operated by Lifestyle Care plc. All residents have single rooms with ensuite facilities. The building is divided into units, where smaller groups of people with similar care needs share communal Care Homes for Older People Page 4 of 36 15 15 0 10 Over 65 0 0 55 0 Brief description of the care home rooms. The home is situated close to shops and public transport - buses and underground. There is ample parking space within the grounds. On the day of the inspection the range of fees for the home was between #544.00 and #800.00 per week. A copy of the Statement of Purpose and Service User Guide to the home is made available to both the residents and the family. There is a copy of the guide in each bedroom, and copies of both these documents are available at the main reception and on each unit. Copies of the most recent inspection report are available on request. Care Homes for Older People Page 5 of 36 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: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was unannounced and involved a site visit, which was carried out on the 22/09/09. It was a key inspection of the service and the registered manager was available throughout the course of the site visit. During the course of the inspection detailed discussions were held with her and other members of the management team. The inspection considered the views and experiences of relatives, residents and friends. It also considered, the roles, input and understanding of the service from key players such as: care and nursing staff, the administrator, the head cook, the laundry staff and the activity coordinators. Feedback was also obtained from the visiting consultant, external professionals from the placement authorities to include the London Borough of Redbridge Commissioning Department along with, professionals from the Primary Care Trusts (PCT) Assessment and Review Team. An assessment was carried out on; residents case files, staffing records, staffing Care Homes for Older People Page 6 of 36 rosters, medication records and practices, menus, training records, cleaning and maintenance schedules, accident/incident records, activity programmes, the complaints records, staffing recruitment practices. quality monitoring records, and all health and safety records held by the home. Consideration was also given to information provided in the Annual Quality Assurance Assessment (AQAA) submitted by the registered persons. A tour of the premises was undertaken as part of the inspection process. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? What they could do better: Ensure that all care staff including the manager records on the roster how they have worked. Take the steps outlined in their action plan arising out of the Safeguarding matter Care Homes for Older People Page 8 of 36 (AJR), to improve further, the quality of care and safeguards for all residents living in the home. 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 Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to benefit from having comprehensive assessments carried out on them, prior to moving into the home. Care plans were drawn from these assessments to ensure that the residents needs are not only identified, but set out in detail as to how - they would be met. Evidence: A random sample of the most recently admitted residents files were assessed and care plans were in place for every resident under consideration. The assessments were carried out by staff that are suitably qualified to so do and it was clear that wherever possible residents, their relatives and/or representatives are involved in the process. It was also observed that summary information is gathered from referral authorities as part of the assessment process, where this was appropriate. A statement of purpose and service user guide is made available to prospective residents, their relatives and/or representatives, which forms the initial part of the Care Homes for Older People Page 11 of 36 Evidence: admissions process. The documents are available in writing as well as in audio format. Residents are given opportunities to visit the home prior to agreeing to live there, which is positive. Care Homes for Older People Page 12 of 36 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from having their health, personal and social care needs set out in their individual care plans, which are used as working tools in meeting their goals and aspirations. Relatives and residents are exceedingly pleased with the standards of which the management and staff uphold the principles of dignity, privacy and respect in the delivery of all aspects care and support. The recent achievement of a key Endof-Life kite mark - the Gold Standard Framework Award and its application has had a major impact on the quality of service in that area. Evidence: On the day of the visit, care plans were sampled across all units i.e. Sparrow, Nightingale (1&2), Kingfisher, Robin and Starling. They were found to be very detailed and comprehensive, irrespective of the unit from which they came. Staff spoken to had a good understanding of the content of the care plans and it became evident that they were used as working tools in the delivery of care and support to residents. It must be said that this was the case despite the complexity of needs that most of the residents had. The care plans did not only focus on the physical needs of residents, but also detailed their preferences for example; bedtime and personal routines, which Care Homes for Older People Page 13 of 36 Evidence: in itself gave a sense of individuality to each of the cases seen. What was also clear was the detailed actions that were in place around specific needs for example dementia, someone in need of palliative care, or someone with specific communication needs. From a diversity perspective, residents cultural. social, and religious requirements were clearly set out in line with their choice and aspirations. In a significant number of cases, there was evidence of resident and/or relatives involvement in the care planning process. Every relative spoken to on the day had a good command of what was being done for, and with their loved ones, and positive yet detailed interactions were observed between the manager, staff, relatives and residents regarding their(residents) health and welfare. It was quite noticeable that the quality of the care plans across all units were of a consistently high standard. They were reviewed monthly or as and when a change is required. There was evidence of a minority ethnic resident whose needs, including that of communication were quite complex, and in her case the care plan was randomly and regularly audited to ensure that her needs were met. As part of enabling and supporting this process, her life story(Autobiography) was used to ensure that the best possible care was given to her. In another case seen, an Advanced Care Plan was in place to capture what the individual would like to do should his condition worsen. The resident concerned stated; The staff here are excellent - I would not go anywhere else. It must be stated that this advanced care planning takes into consideration the Endof-Life wishes of residents and relatives, which is now in full swing in the home following a major award that was achieved by the service in 2009. Apart from the monthly reviews, care plans were reviewed annually, with key players such as - a team leader, key-worker, where possible the resident andor their relatives, an activity coordinator and external professionals as appropriate. In all cases care plans had routinely linked to them, risk assessments covering areas such as; nutrition, manual handling,continence, pressure sore prevention and management, and risk of falls. They were developed to ensure that residents remain safe and are able to retain as much of their independence as possible. From the documentation viewed it was clear that there was an improvement in the quality of recording with respect to how food intake charts were maintained. Food intake charts now bore more detailed evidence as to the type of food given, as well as the amounts given at any period. As such, a more accurate picture is recorded of the nutritional status of residents on a daily basis. All other monitoring charts for example Care Homes for Older People Page 14 of 36 Evidence: - fluid intake and turning charts, seen throughout the course of the inspection, were maintained to a very high standard. A close examination of the other health care records indicated that staff not only understood the needs of residents, but also, the importance of maintaining accurate and updated records on residents health. This ensures that residents get the best possible health care support both in the home,as well as when they are seen externally. At the time of the visit, there were very good records held on residents involvement with the: opticians, dentist, tissue viability nurse, GP, physiotherapist, speech and language therapist, psycho-geriatrician and other community health services. Staff were observed supporting residents with Dementia and it was clear that they had the benefit of dementia training, as the level and quality of the interactions between them was of a high standard. Despite the wide range of complex needs presented by dementia sufferers, there was little or no evidence to indicate that residents were unduly distressed. All residents and staff were extremely complimentary about the staff and managements ability to meet the health care needs of the residents living at Springfield Care Centre. Clear policies and procedures on the handling of medication, were in place for staff to follow and the staff charged with this responsibility are well-qualified to support residents in this aspect of their health care. The inspector examined the medication storage in the home including that of controlled drugs and oxygen. This was done to a safe and professional standard. A medication audit was also carried out and this indicated that the staff practices were clinically sound and in line with related guidance including that of the Nursing and Midwifery Council. In one of the cases examined a clear protocol was put in place for a resident placed on paracetamol - which was prescribed to be given to him only when necessary. The protocol ensures that the drug is used only within the guidance outlined and as such every staff must pay credence to it. This is good practice, as it reduces the risk of the drug being inappropriately used. Staff demonstrated a sound understanding of the uses of the medication for which they were responsible and all emergency equipment were suitably maintained. It was clear that the health care of residents is also safeguarded and promoted by the support given to them by staff working in the home. Throughout the inspection residents and their relatives were extremely complimentary about the support provided by the management and staff. Staff were observed being engaged during various procedures and practices and throughout the inspection, demonstrated flexibility, sensitivity and patience, always carrying a pleasant front as though nothing was ever too much to ask of them. This is backed by the sound training programme that is in place from the induction stage of their employment. It Care Homes for Older People Page 15 of 36 Evidence: was revealed that up to four carers have been acting as dignity champions and they go on related training, bringing back and sharing the core values with the rest of the team, which is then translated into practice. This is enhanced by a strong sense of team and valuing each other in the quest to provide the highest standards of care possible. The registered manager continued to work closely with the Primary Care Trust in effort to reduce the level of admissions to hospital, as this is often quite distressing to most residents. Since the last inspection she has gone a step further by sending staff for further training in areas such as; anti-biotic therapy via Intravenous(IV) infusion and sub-cutaneous hydration. In this way residents would not necessarily have to go through the experience of going in and out of hospital for such procedures. One relative summed up the views of most of the relatives when she commented; The quality of care and kindness of staff is excellent. You could walk into the home at any time and see and feel that the care is personalised. At the time of the last inspection, the registered manager in conjunction with partner agencies and two representatives from the Commission did embark upon developing a Department of Health(DOH) initiative in relation to the provision of End of Life care in the home. To the credit of the management and staff, as well as to the benefit of residents - the home did achieve the kite mark for that aspect of care i.e. the Gold Standard Framework Award becoming one of the very few in the London Borough of Redbridge to have acquired this achievement. This outcome was celebrated with a ceremony at the home, involving the Shadow Minister of health, the local MP and the Mayor. It was also well-attended by residents, staff, relatives and friends, and a host of community professionals. It has been reported that staff have been much more confident and enthusiastic about providing end-of-life care in the home, since the event. On the day of the visit there was a buzz of excitement as the management, relatives and some residents recalled the momentous occasion. Photos of the ceremony were widely available during the inspection and it was reported that residents, and relatives of past residents gave testimonies of their experience of care in general, and end -of-life; care in the home. This development is an example of the registered persons commitment to do whatever it takes to give residents the best possible service, when they come in for care and support. Palliative care provision in the home has been taken to another level, with more and more residents choosing to spend their final days in the home, as opposed to anywhere else, for example in hospitals. A sound network of resources is in place to include; community nurses, the Primary Care Trust, the GP and McMillan nurses to promote as comfortable an experience as possible during those final moments. Residents wishes are detailed in their care plans and all key parties have open discussions around what is best for the individual. Relatives have opportunities to stay Care Homes for Older People Page 16 of 36 Evidence: with their loved ones for as long as they wish - and to participate and/or assist in their care provision, should a resident request this. From observation, talking to: relatives, residents, the manager,and staff, and from reading letters and cards - it was clear that the care and support with end-of-life is of a very high standing. On the day of the visit, the manager was observed supporting a family whose relative was thought to be in his final moments. Her intervention brought comfort, peace and warmth to the terminally ill resident and his family. Staff are also very involved in End-of-Life care and are given good support to take an active part in comforting and supporting residents that are terminally ill. Some of the staff have had End-of-life training and there are plans for others to have the same. They get opportunities for: counselling which takes place in their staff library, attending funerals, and to send floral tributes and sympathy cards to families. A wall located in corridor of the home has been dedicated in memory of those residents that have passed - where a picture of the deceased is hung, if the family so wishes. Some of the relatives comments were; The kindness, understanding and support given by the home is second to none, This is such a peaceful place - as staff help to make those final days so comfortable and The team here really promote the principles of dignity, privacy and respect right up to the final moments. This is a very strong area of the homes operations. Care Homes for Older People Page 17 of 36 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to enjoy a lifestyle that matches their expectations in respect of their social, religious. cultural and recreational interests and needs. Good opportunities are provided for them to maintain their friends and family networks and to make decisions that impacts on the quality of life they experience at Springfield Care Centre. Meals provided in the home meets the nutritional requirements of the residents group, who have expressed a high level of satisfaction with them. Evidence: There continues to be a seven - day general programme of activities available for all residents on all units in the home and more importantly, they were individually designed and regularly delivered with residents being the focal point. An activity assessment is in place for each individual which provides guidance on the appropriate level of activity in each case. Residents participation in activities are routinely recorded with regards to the type and level of participation. The activities are coordinated mainly by two dedicated activity coordinators who are respected and treated as invaluable members of the staff teams. Their input is pivotal to the residents well being and quality of life in the home to the extent that they are also involved in residents reviews. During a tour of the building residents were observed being engaged in various forms of activities to include; pursuing their own interests Care Homes for Older People Page 18 of 36 Evidence: such as; reading or relaxing in one of the quiet rooms, watching films that were consistent with individual culture, engaging with their relatives, reminiscing using personal possessions and in some cases just sitting around having a chat. It must be stated that given the complexity of needs provided for, none of the residents were observed in any form of distress. Importantly each member of the staff team including the activity coordinators were akin to the communication needs of the residents and so made the experience of participation - a meaningful one. Activities in the home also included the recognition and celebration of residents birthdays and other seasonal events. It was clear that religious and cultural affiliations were taken into account prior to determining the types of activities that residents engage in. One non-practising Jewish lady was supported to attend a friendship club in Ilford, while records bore evidence of regular visits from the local clergy. Staff were also aware of the specific needs of two practising Muslims and appropriate arrangements are identified e.g. the local mosque to ensure that personal choice is respected. What was remarkable is that the management and staff are flexible and actively participate in a range of activities in the home. A good example could be drawn from the ceremony that was held in the home in 2009 for achieving the Gold Standard Framework Award for End-of-Life care. Residents were extremely well presented for the day and from reports, actively participated in one of the latest developments in the home. There was evidence of a fun-fair being held recently, which was followed by a barbecue for the staff- and again the residents were involved. Up to five residents with relatives and staff reportedly went to Southend in August 2009. A physically disabled resident commented how he goes to a specialist centre twice per week and really appreciate the efforts of staff in making life exciting at Springfield Care Centre. He described the staff as pretty good and humble. Further developments have taken place since the last inspection which included; the creation of a Reminiscence Pub, a reminiscence garden and a vegetable garden. At the time of the visit an aviary was in the process of being developed. The reminiscence pub is open to residents and is designed similar to one back in the sixties, with old vinyl records that are played, while residents enjoy free drinks with their relatives who at times make donations to the home. This is a popular and really special feature in the home, which makes it a place that residents love to be. There was clear evidence to indicate that residents are encouraged to maintain their friends and family networks, which is supported by an open-door approach to visiting. All relatives and residents spoken to confirmed that they enjoy a warm and friendly environment in the home with significant opportunities to meet up, be it at reviews, Care Homes for Older People Page 19 of 36 Evidence: support with end-of life care or social events. Visiting times are flexible and this flexibility and support was observed throughout the visit. Relatives/residents meetings are held quarterly and from the records they were well-attended. There was but one case that came to the Commissions attention following the conclusion of the inspection in which the relatives were not happy with how their relative was cared for. They were also unhappy with the treatment that was meted out to them as a family during the course of the the residents stay and the period immediately after she died. This matter was investigated by professionals from the Redbridge Primary Care Trust and the London Borough of Redbridge local authority. The outcome of this is summarised under the Complaints and Protection outcome group. Despite this, the general feedback from most residents and relatives was that the management and staff were exemplary in their engagement with them. The whole process of assessments, care planning including that of end-of-life planning is one designed to enable residents to exercise choice and control over their lives. Sound arrangements were in place in most cases where residents were unable to maintain their independence over a range of bodily functions, activities, and indeed more complex decisions around their future. In every case seen, the support provided by the home, as well as the arrangements that were made to enable residents relatives or their representatives to participate in decision-making with regards to health, safety and welfare of residents - were extremely good. From observation of the quality and level of engagement by all levels of staff with residents, indicated that the values of respect and dignity was of a high significance. Risk assessments were in place in a number of key areas in which a balance needed to be drawn between - exposure to the risk of harm, and promoting residents independence. From the samples viewed they were well-maintained and specific to each resident. For the Dementia sufferers appropriate signage and fixtures were in place to assist in their orientation. This resulted in those residents being less confused and in many respects, less distressed. The menu-plans were assessed and food was observed during the course of the inspection. From the evidence gathered, meals were well-presented, wholesome and nutritious. Pictorial menus were available from which all residents could make a more informed choice. Another option that was available was the use of small-plated portions, in which residents could use the sense of smell to decide on their food. The presentation of food in various forms like smaller portions, finger foods, religious and culturally requested foods, and alternative nutritious snacks, ensured that all residents could partake and enjoy both the nutritional value and pleasant experience of mealtimes. Residents have the option of eating in dining rooms or in their private Care Homes for Older People Page 20 of 36 Evidence: spaces if they so wished, and each of the dining areas were attractively presented. Staff observed supporting residents with their meals did so in a dignified and unhurried manner. Specific meal requirements were recorded in residentscare plans and additional monitoring is carried out to assess residents levels of satisfaction with the catering at Springfield Care Centre. In discussion with the head caterer, he demonstrated a sound knowledge of food nutrition and hygiene. It also was noted that a sound system was in place to ensure that residents on special diets promptly received them. Food supplies both fresh and frozen were in satisfactory amounts and good storage arrangements were in palace for them. Food safety practices were evident on the day of the inspection, which included; appropriate labeling of all foods, fridge/freezer temperature monitoring and food safety signage in and around the kitchen. Approximately ninety-five percent of the feedback received from residents and their relatives indicated that they were happy with the meals provided in the home. Care Homes for Older People Page 21 of 36 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Sound systems are in place to ensure that complaints and concerns are dealt with in a manner that is reassuring to residents and their relatives. Staff are generally well prepared through safeguarding training, in ensuring that residents remain safe with a limited risk of coming to harm from abuse. As a result one of its most recent safeguarding matters, the registered persons have had to review and take steps via the submission of an action plan to the local Safeguarding Authority (London Borough of Redbridge) detailing a range of measures that would enhance the safety of all residents in the home. Evidence: A written policy and procedure is in place on complaints is in place and available to all residents and their relatives, as well as the staff. Residents and relatives spoken to were aware of how and who they could complain to, and the general feedback was that they felt able to. On examining the complaints log it was noted that details were held on: the nature of the complaint, the action taken to resolve it and the outcome/feedback to the complainant. An audit trail was possible on the timescales in which complaints were resolved and this was in line with the homes guidelines. It was observed that the manager advertises a dedicated day i.e. Wednesdays between 6 p.m. and 7 p.m. for anyone wishing to raise a concern. A log of issues and concerns is subsequently maintained with the actions taken to resolve them. She indicated that she adopts an open-door approach to concerns and/or complaints on any aspect of the service. This is to ensure that opportunities to further develop the service are not lost. Care Homes for Older People Page 22 of 36 Evidence: It is true to say that the management team takes complaints seriously. Staff spoken to were aware of their role in supporting residents to raise a complaint should they be unhappy with any aspect of the service. There were no complaints made to the Commission about the service, since the last inspection. As of September 2009, up to ninety percent of the staff did have the benefit of safeguarding training, which is positive. What was interesting was that the safeguarding training was extended ancillary staff/administrative staff. A sample of staff spoken to demonstrated a sound understanding of their role in keeping residents safe from harm and this included - understanding the importance of using the whistleblowing procedure. They were also aware of situations that may arise between residents, which could lead to abuse. More importantly, they were clear of the steps that they would take to ensure that all residents are safeguarded. At the time of the visit there were three safeguarding matters on record, two of which were concluded, while one was in process. There were no major implications for the staff and/or the home regarding the resolved matters and a good log was maintained of safeguarding matters in the home. This includes the referral of cases where residents are sent from hospitals with pressure sores and/or other signs of compromised care practice. In this respect the manager works well with the Commission, local safeguarding authority, and other relevant agencies. There was one safeguarding matter that was raised after the inspection i.e. in November 2009, which at the time of writing this report has not been fully concluded. However, the Commission was involved in the early stages and have since been kept abreast of the developments to date. In this respect the safeguarding concern was reportedly partially substantiated as the family of the now deceased resident felt that they were let down, as was their relation. Responsibility was therefore placed on the registered persons to draw up an action plan reflecting improvements with regard to the shortcomings identified. The Commission had the benefit of seeing this plan which contained a number of areas for improvement such as: Breaking bad news, Enhancing the recognition and understanding of the legal aspects of care-planning, Further training on pain management to include acute and chronic manifestations of symptoms, Completion of all care planning reviews along with a care plan audit of all residents care plans, The maintenance of a more detailed record of communications held with relatives, Detailing of individual toileting regimes to ensure that privacy, dignity and hygiene is evident, Reviewing all charting processes, which would be subject to an internal audit and the convening of a staff meeting to share the and take some ownership of the Safeguarding of Vulnerable Adults (SOVA) outcomes. It is important to note that these actions are skewed towards enhancing the quality of protection that each resident is entitled to receive at Springfield. As part of the Care Homes for Older People Page 23 of 36 Evidence: Commissions monitoring - written confirmation would be requested to evidence that the action points have been implemented by the time-line given in the action plan - of 30/06/2010. Care Homes for Older People Page 24 of 36 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, 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. 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. At Springfield Care Centre residents enjoy living in an environment that is safe, homely, clean and designed with their needs, wishes and safety in mind. Evidence: The inspector undertook a tour of the premises to include the external aspects i.e. the garden facilities. Both aspects were clean, hygienic, well-lit and pleasant with good accessibility for the residents. Despite its size and the level and range of needs that the home provided for, there were no offensive odours in any areas of the home. Residents and staff were observed throughout negotiating all aspects of the environment safely and this includes residents with Dementia, as good signage was in place to enable this. Specialist equipment such as hoists and handrails were available for residents who needed assistance with mobility and/or support to retain their independence. The communal areas were well-maintained and feedback received from relatives, residents and external professionals about the environment was positive. It was noted that there were developments to the home to include a reminiscence bar and garden with an aviary in the process of being built. A good programme of routine maintenance and decoration for the home was included in the homes Quality Action Plan (September 2009), covering all aspects on the building - internal and external, as well as furnishings and fixtures. The level of detailed maintenance carried out on the home was to ensure that the physical structure remained fit for its purpose-which was clearly established during the inspection. Care Homes for Older People Page 25 of 36 Evidence: Throughout the tour of the home, the decor was appropriate to the type of service that was provided e.g. toilet door frames painted in a different colour to aid orientation for Dementia sufferers. Photographs and other appropriate signage were also in place throughout the communal areas and corridors to ensure a similar outcome - enabling residents to maintain their independence and safety. Residents were observed reflecting on the points of interests detailed in some of the photographs on display. They were observed on Sparrow Unit relaxing in the restructured quiet/dining area with staff available in support of them. The laundry area was also found clean and generally in a good condition. Some redecoration works were required around the skylight windows in the laundry room, but the manager advised that this was in line to be completed. Sound arrangements were in place to deal with soiled and/or infected linen and laundry staff were aware of health and safety procedures to include; infection control, the storage of chemicals and the use of Personal Protective Clothing(PPE). Hand washing facilities were prominently cited and staff demonstrated the ability to maintain good standards of hygiene throughout various procedures during the course of the inspection. Care Homes for Older People Page 26 of 36 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the benefit of receiving services from a staff team that is suitably trained, motivated, skilled and strategically deployed to work with them. Robust recruitment procedures ensure that residents do not come into contact with staff that may be unsuitable to work with them. Evidence: An examination of the staffing rosters indicated that the staffing levels and skill mix of care staff and qualified nurses were based on the needs of the residents on each unit. In this respect they were of well-suited to meet the needs of residents and this was confirmed by an overwhelming majority of residents and their relatives. They commented that staff were generally always available and visible regardless of the time they visited. The staffing deployment also took into consideration those residents choosing to stay in their rooms or those that needed to be nursed/cared for in bed. The home has in place a night duty roster, which also is based on residents needs, dependency levels and other eventualities that may occur during the course of a night shift. Clear rosters were also in place for the ancillary staff and this ensured that care staff staff spent dedicated time in providing for the care and support needs of the resident group. It must be noted that two activity coordinators provide stimulation for the residents with the support of the management and staff of the home. Although the rosters clearly state how staff worked on a daily basis, there was nothing recorded against the managers name in terms of her time spent at the service. Under Care Homes for Older People Page 27 of 36 Evidence: Regulation 17(2) Schedule 4[7] of the Care Homes Regulations 2001, a copy of the duty roster of persons working at the care home, and a record of whether the roster was actually worked - must be kept. As such, this regulation must be fully complied with. Staff were observed engaging with residents and each other throughout the course of the inspection and it was clear that they were a well-established, motivated and stable team. There was evidence of a very low staff turnover, as well as low levels of sickness absence. Where absence was indicated, good arrangements were in place to ensure that permanent bank staff were used to cover the vacancy, which provided consistency in the service delivery. This is very important for the all residents, but even more so for those with a diagnosis of Dementia who find it a bit more difficult to negotiate frequent changes in staff and new situations. Staff were described by relatives and residents as being; attentive and marvellous, great and giving one hundred per cent and caring and responsive. It should be noted that over ninety -eight per cent of the staff have at least an NVQ Level 2 in Care with some actually going on the achieve their Level 3. As such, most have a sound foundation in the basics of providing good standards of care, which is enhanced by more specific training that is provided by the registered persons. The recruitment files of three of the most recently recruited staff were examined and found to be in good order. They contained evidence of robust checks being carried out on all the staff concerned. Some of the key checks included; Criminal Records Bureau (CRB) checks, Safeguarding of Vulnerable Adults(SOVA) Firstchecks, health declarations, fully completed application forms, as well as where appropriate - the right to work in the United Kingdom. Following recruitment, all staff are given a copy of the General Social Care Councils code of conduct and are employed in accordance with this. It also sets out clear principles of which good standards care should be delivered, similarly to the Code of Conduct and professional practice issued to nurses on the Nursing and Midwifery Councils register. Residents are therefore assured that all staff that come into contact with are them robustly screened. This is a strong area of the homes operations, which acts as good safeguarding barrier for all residents living at Springfield Care Centre. A good record of staff training is maintained by the manager and training is provided both internally and externally. Southern Cross is proactive in ensuring that staff are given good preparation to carry out their role and functions and to this end a staff training development record is maintained by the manager. It is important to note that Southern Cross ensures that all layers of staff have appropriate training to do their jobs, which includes, nurses, senior care assistants, care assistants, activity Care Homes for Older People Page 28 of 36 Evidence: coordinators, administrative staff and all other layers of ancillary staff. It was noted that an extremely high percentage of staff have had their induction and mandatory training, including refresher training and so most of the staff were up to date in these areas. Other specific training that has been provided included; wound care, Dementia care,continence management, customer care, medication training and update, pressure area care, nutrition, challenging behaviour, safe use of bedrails, effective communication, care planning and safeguarding training. The activity coordinators have completed training that is specific to elderly customers, which is run by the National Association for Provider of Activities for Older People. One individual spoken to, did also complete the National Vocational Qualification in Health and Social Care (NVQ) Level 2, Dementia training and had started the Dignity in Care training. Nursing staff have also undertaken training in areas such as - cannulation and phlebotomy with plans in place to pursue sub-cutaneous hydration amongst others. The intended outcome is extremely positive in that this would reduce the incidence of residents going backwards and forwards from hospitals - which most find quite distressing. From discussions held with staff and the manager other staff have undertaken dignity at work training, while some nurses have completed English Nursing Board (ENB) training in Teaching and Assessing in Clinical Practice. One member of staff interviewed indicated that she had worked in the home for a long time and just loved working there, both with regards to development opportunities and range of challenges encountered at the home. All staff spoken to were very pleased to be working at the home and their quality engagement with residents and their relatives bore testimony to that. What was interesting is that they were pleased to talk about their experience, working at Springfield Care Centre. This is a very strong area of the homes operations and all staff spoken to were motivated by the training and development opportunities provided by the registered persons. Care Homes for Older People Page 29 of 36 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents continue to enjoy living in a home that is well-run and managed with their best interests at heart. Good quality assurance systems including monitoring systems, are in place to ensure that the service is developed in line with residents needs and wishes. Regular and effective staff supervision, along with sound health and safety practices help to ensure the safety, best interests and welfare of residents and staff in the home. Evidence: Despite the fact that the inspection was unannounced and from the initial and ongoing observations, it was clear that the service continued to deliver a very high standard of care to its residents. More importantly, the management structure and the homes leadership brought together a strong team that not only worked well as a unit, but also exceptionally well with external agencies, relatives and professionals. The monitoring, communication, supervision, training and staff development systems were key to ensuring that residents received the care and support they deserved. The inspector observed a high volume of discussions held between the manager and Care Homes for Older People Page 30 of 36 Evidence: relatives on the day of the visit and what stood out was her passion, compassion for life and depth of knowledge about the residentss needs and conditions. It appeared as though nothing was too much or a problem when coming to meeting the best interests of residents. This was echoed throughout the inspection by relatives, residents, friends, the consultant, staff, and other professionals in contact with the home. These qualitites were observed on a specific occasion, amongst others, when the manager went to offer care and support to a family whose relation was dying. It was clear that this was a manager who lead from the front. The manager is well qualified and experienced to carry out her role and functions, but despite this continues to undertake further training in areas realted to the service that she runs for example- completing a Masters in Palliative Care. She also has training in relation to Sub-cutaneous hydration, Phlebotomy, Tracheostomy, and diabetes to name a few. Her thirst for knowledge and development is disseminated throughout all levels of staff, who receive regular training, one to one supervision, annual appraisals, direct observation of care practices along with regular staff meetings. There is a sense of ownership amongst the staff teams on all the units that were visited,as well as a good focus on outcomes for residents. This has been developed through the inclusive and open-style of management, which the staff relish. One of the key outcomes for residents since the last inspection was the drive to skill-up the staff further in other areas of specialist care to reduce the incidence of the residents having to go to and from hospitals. This has gone down really well with residents and their relatives and is a testimony of the efforts to improve outcomes and the quality of life for them. Good systems are in place for monitoring and improving the service, which include; monthly quality audits on accidents, monthly provider monitoring (Regulation 26) visits which importantly seeks the views of staff, relatives and residents along with other aspects of the homes operations, spot checks and audits for compliance with policies and procedures, quality asurance questionnaires, and the review of concerns, complaints and compliments. This is enhanced by having regular residents reviews, staff, relatives and residents meetings where views and comments about the service are gathered. The registered persons have demonstrated that they would go all out to improve the quality of their service delivery. One of the crucial outcomes from gathering views and comments about the service is that a development plan is produced with actions and timelines for improvement, which is positive. A good example of this could be drawn from the recent safeguarding matter referred to earlier in this report in which the registered persons responded positively. They complied with drawing up an action plan to further improve, the quality of their service provision in general, particularly in the area of safeguarding vulnerable adults. There is a good system in place for reviewing policies and procedures in the home, which were Care Homes for Older People Page 31 of 36 Evidence: updated at the time of the inspection. At the time of the visit the manager did not hold an appointeeship for any of the residents, as their financial affairs were generally managed by their relatives/ representatives, which in one case was a solicitor. The home continues to have responsibilty for the personal allowance for some residents and a computerised financial system is in place. The home has an administrator charged with this responsibility and her work is regularly audited. The inspector examined the petty cash float, a random sample of residents personal allowances with records, and the financial procedures, which were found to be in good order. The administrator was very clear about her role and demonstrated that a sound system was in place to safeguard the financial interests of residents. This included a secure facility for the safe storage of money and other personal valuables held for residents. A number of health and safety records were assessed on the day of the visit which included; food hygiene, fire safety, infection control, emergency lighting, portable appliance testing, health and safety audits,water temperature checks, and gas, lifts, hoists, and electrical safety reports and certicates. They were all found to be in order and updated and it was noted that the service received a five-star rating in Food Safety Management dated 30/6/08. The health and safety practices and protocols ensure that residents and staff live and work in a safe and comfortable environment. Care Homes for Older People Page 32 of 36 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 Older People Page 33 of 36 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 18 13 The registered persons are required to submit written confirmation to the Commission that they have carried out all the actions set out in their action plan arising out of the safeguarding matter regarding AJR To ensure that all residents have greater protection from the risk of harm from abuse. 01/07/2010 2 27 17 The registered manager is required to indicate on the roster the times/shift that she works in the home. To comply fully with Regulation 17 (2) Schedule 4[7] of the Care Homes Regulations 2001 07/05/2010 Care Homes for Older People Page 34 of 36 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 Care Homes for Older People Page 35 of 36 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 Older People Page 36 of 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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