Care Home: Springfield House

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What the care home does well Springfield House has a calm and peaceful atmosphere, beautiful views over a valley and, a well-maintained and established landscaped garden. People at Springfield House have their health needs met efficiently and effectively, and staff understand how to relate to and reassure people and their families. People are supported in making choices about their lifestyle and treated with dignity, respect and consideration, and so a feeling of positive self-worth is promoted. The system for managing complaints and concerns in the home is accessible, and people are confident and empowered enough to make comment to staff when necessary. People enjoy the meals served in the home. Risk assessment concerned with pressure area care, falls prevention and diet has improved further. Care plans provide detailed information about the specific actions required by staff to meet peoples needs. People are supported to achieve a good level personal hygiene and grooming. Medication was, administered, stored and managed correctly. Staff training and guidance is readily available. Staff are deployed in sufficient numbers for them to meet health, social and psychological needs of residents. The manager is approachable, has high expectations of staff conduct and competency, and she cooperates with the, Care Standards Act 2000, inspection process. People involved with the home told us: `The atmosphere is pleasant and caring. Indeed I cannot find anything negative. I am completely satisfied.` and `The home provides a very good care service with full support for staff and residents.` What has improved since the last inspection? Since the previous inspection the refurbishment program has continued. Since the previous inspection the information in care plans is now more specific and relates to how a need impacts on the life of the individual. Since the previous inspection peoples social histories, interests and hobbies have beenrecorded and so activities and routines can be more tailored toward individual preference. Since the previous inspection interests, and an accurate record of the activities individuals have enjoyed would also be of benefit for future planning. What the care home could do better: The registered person must make sure that people have had criminal record and protection of vulnerable checks completed before they start working at the home, this will protect against employing people who put residents at risk of exploitation or other harm. The manager should make sure that radiators in communal areas are covered as this will reduce the risk of people being accidentally scalded. The manager should review and update policies, procedures and guidelines used at the home, this is so that staff have up-to-date written information to follow, so that the actions they take are in keeping with the most up-to-date information about care. The manager should analyse falls and accidents so that any patterns can be identified and the correct changes made to protect people from preventable harm. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Springfield House 79 Waterworks Road Waterhead Oldham OL4 2JL     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Michelle Haller     Date: 2 9 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Springfield House 79 Waterworks Road Waterhead Oldham OL4 2JL 01616204794 01616204794 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Masterpalm Properties Limited care home 24 Number of places (if applicable): Under 65 Over 65 0 24 dementia old age, not falling within any other category Additional conditions: 24 0 The registered person may provide the following category of service only: Care home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Dementia - Code DE. The maximum number os service users who can be accommodated is: 24. Date of last inspection Brief description of the care home Springfield House is a privately owned care home, which has 24 registered places for people over 65 years of age and whose needs fall within the following categories: dementia, physical disability and old age. Master Palm Properties Limited, who owns three other residential care homes within the Oldham area, operates the home. The building, which is a detached property, is located in the Waterhead area of Oldham. It is approximately 2? miles from the town centre. Care Homes for Older People Page 4 of 33 Brief description of the care home Accommodation comprises 18 single bedrooms, and three double bedrooms. All the rooms have en-suite toilet facilities. Lounge/dining facilities comprise three lounges and a separate dining room, the latter being situated next to the kitchen. Springfield House charges #360.00 each week. The previous Commission for Social Care Inspection (CSCI) report was available on request. Care Homes for Older People Page 5 of 33 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: two star good 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: We conducted this inspection by visiting the home without informing the manager before hand, and we looked at all of the most important or key Care Homes for Older People National Minimum Standards (NMS). This is called a Key Inspection. The inspection involved looking at the information we had received about the service during the previous year and before visiting the home. This included notifications or events that the manager has told us about, information from other sources such as social services, health workers or people using the service. We also considered the outcome of the Annual Service Review (ASR) which we conducted in 2008. The ASR includes reviewing all the information received about the service to check that it continues to be well run. We do not visit the service for the ASR. All the information Care Homes for Older People Page 6 of 33 received prior to this key inspection indicated that outcome for people using the service continued to be good. We received five completed Care Quality Commission (CQC) surveys from staff and seven surveys completed by people living at Springfield House. We visited Springfield House, we looked around the home and checked through written information, including service user care files and staff employment records. We read through policies, guidelines and other documents concerned with running the home. We also talked to residents, their relatives and staff working at the home. We also interviewed a health care professional who was visiting the home at the time of the inspection. We observed the interactions between service users, staff and others at the home. We interviewed manager and talked to one of the registered providers. The manager returned to us the CQC Annual Quality Assurance Assessment (AQAA). The information requested included data about staff training, development of policies and procedures and compliance with health and safety checks when applicable. The information also influenced the outcome of the inspection. What the care home does well: What has improved since the last inspection? Since the previous inspection the refurbishment program has continued. Since the previous inspection the information in care plans is now more specific and relates to how a need impacts on the life of the individual. Since the previous inspection peoples social histories, interests and hobbies have been Care Homes for Older People Page 8 of 33 recorded and so activities and routines can be more tailored toward individual preference. Since the previous inspection interests, and an accurate record of the activities individuals have enjoyed would also be of benefit for future planning. What they could do better: 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 set out 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 33 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 33 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Springfield House benefit from having their needs fully assessed before they move into the home so that staff know what these needs are and how to support them in settling in as quickly as possible. Evidence: We looked at four care files and found that each contained a comprehensive needs assessment that provide information about health, social and psychological needs. The format for the assessments includes a checklist and an admissions form which allows the assessor to provide more information as needed. We noted from the date on the forms that these were completed prior to the date of a persons admission, thereby demonstrating that this information was made available to staff before the person moved into the home. The manager also confirmed to us that whenever possible people were visited in hospital or at home as part of the admission process. Care Homes for Older People Page 11 of 33 Evidence: We saw that pre-admission information included: sensory and communication skills, mobility,personal care skills, eating, drinking and appetite, likes and dislikes, social skills, family involvement and hobbies, interests and social history. We found that people with social services involvement also had assessments completed by a social worker. These provided very detailed information about peoples needs and the actions required by the home to meet these needs. In the information she returned to us the manager told us about a seven day screening plan that has been introduced for new admissions. We looked at these and found that they provided a detailed picture of how people had settled into the home. Staff identified changes in sleeping pattern and mood, and staff described in detail the steps they took to solve any difficulties. We also found that these observations helped to build a picture of the persons individual routine and preferences, for example time to go to bed, likes and dislikes with respect to food, and preferences in relation to socialising. People told us that they had the opportunity to visit Springfield House and that the manager asked about their needs before they moved into the home. Comments included: We came and looked, they asked about medication and health needs. and At first I felt a bit nervous but settled in and I am now comfortable and happy. Care Homes for Older People Page 12 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Springfield House are treated with respect and dignity and they receive effective care that is based on their individual needs. Evidence: We found that each care file examined contained care plans that had been reviewed monthly. The information in each plan was in depth and provided staff with detailed information about all the needs of the residents. We noted that this included complex needs such as emotional and behavioural support. We saw that instructions were specific and individualised to the person, and instructions such as how to provide emotional support, moving and handling support or dietary support was broken down into stages and easy for staff to follow. We noted that pressure area care in the home was very good with staff having the responsibility of documenting the condition of peoples skin at least once a week after each bath, shower or full body wash. And records confirmed that medical assistance was requested as soon as any marks or blemishes were seen. We noted that pressure Care Homes for Older People Page 13 of 33 Evidence: care equipment was in use and this was supervised by the district nurses. We found through daily reports, records, and from what they told us, that the district nurses were made aware of changing health needs quickly. This means that health issues are dealt with efficiently and effectively so that continued good health and physical comfort is promoted. The district nurse told us that: They phone and leave a message about peoples health, they follow instructions more often than not, people are taken to their rooms for procedures to be carried out. Infection control is fine as people have running water and hand towels in their rooms and we are confident that if there were any concerns Bernie (registered manager) would deal with it. We found that observations concerning mood and emotional state was sufficiently detailed and provided specific guidance that related to the individuals assessment regarding motivation and engaging people with emotional needs. And the daily record and observations demonstrated that staff were able to work in a consistent manner. We found that the use of the Malnutrition Universal Screening Tool (MUST) which is a special way of checking what risk people may have of becoming ill due to weight loss, makes it easier to monitor peoples weight and identify when additional input, such as to increase the frequency of weight-ins and referral to the dietitian or GP, is indicated. We assessed that daily reports were written respectfully and related to the care plans being followed. We saw that records, reports and correspondence also verified that services users had timely and appropriate access to all health professionals including district nurses, general practitioners, podiatry, dental care, eye-care and other peripatetic health services. We talked to staff and they told us that it was essential to read through peoples care plans and that they have a handover between shifts to find out about the care needs of the residents. We checked the homes medication policy, observed the way medication was distributed and checked how medication was stored. We saw through certification that staff who took responsibility for medication had received up-to-date training. We looked at the medication administration record sheet (MARS) and found that the signatures of staff authorised to deal with medication was at the front of the file. Pictures of each service user was also on the corresponding MARS to aid with identification and so ensure that people received the correct medication. And there were no gaps in the records which showed that people received their medication as prescribed. Care Homes for Older People Page 14 of 33 Evidence: We looked at the storage of medication and found this to be secure. We checked the way in which medicines that need to be accounted for in more detail and stored more securely than the rest were dealt with. We noted that these were stored securely and in keeping with pharmacy guidelines. However we also found that they medication was not physically counted when new stock arrived or if it was checked out. This means that it may take time before medication found to be missing. This matter was discussed with the manager who agreed to tighten the policy so that when audited the medication on site is physically counted and no assumption is made that amount written down is correct. We noted that the manager has a good relationship with the local pharmacy who come and audit the homes medication system. We found that, overall, medication management in the home met the needs of people living there. We observed staff using specialist equipment, such as pressure area cushions and aids that assist with independence. We also saw that moving and handling equipment is also used in accordance with peoples moving and handling assessments. We noted that people in Springfield House are able to maintain their dignity and feeling of self worth as, they are supported in achieving a good level of personal grooming, and they were clean and well kempt. We found that people were very satisfied with health, personal care and support they received at Springfield House. We found that all of the people who returned surveys confirmed that they always received the care they needed and that the home always made sure they got the medical care needed. People also told us: They make sure she has her tablets and if shes not eating they do something and let me know.; If hes poorly they have informed me and health issues are dealt with quickly. and They take care of me and my needs. Care Homes for Older People Page 15 of 33 Care Homes for Older People Page 16 of 33 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. People living at Springfield benefit from experiencing a good standard of living and lifestyle and are happy with routines that they find flexible and easy to deal with. Evidence: We found that people were pleased with the frequency and range of activities the home organises, this includes, dominoes, bingo,craft sessions, group discussions and baking. We noted that trips out for meals are also arranged. We saw that the activities records and calendar indicated that the activities had increased since the previous inspection, and a more accurate record of the different activities in which people have participated is kept. On the day of inspection we observed that people took part in different activities throughout the day. People were seen enjoying baking cakes, manicures, bingo, a game of cards and playing hoopla. We noted that everyone in the home was given the opportunity to participate in an activity if they wanted. Care Homes for Older People Page 17 of 33 Evidence: We noted that those who returned CQC surveys felt that there was usually an activity in which they could participate. People we talked to said: From what Ive seen theres plenty going on. and Theres all sorts- ludo, bingo, an entertainer comes, someone came with a harp, it was massive and people were able to have a try of it. We found that there are three lounge areas and the manager expects a member of staff to be present in each room at all times. During the day, staff were observed sitting and talking to people. We found that the routines of the home are flexible and people are able to develop individual routines such as bedtimes, when to get up, mealtimes and whether to join in with activities. We found that the manager took extraordinary steps to help people to settle into the home, for example by working hard and making adjustments so that a pet could be accommodated. People told us there were no problems in relation to visiting the home. We noted that people visited the home throughout the day. We were told: Staff are very friendly and they make me a cup of tea. We saw that the dining areas in the home were clean and pleasant and people were content with the meals and snacks provided. We observed that people enjoyed their meals and were supported with dignity and respect. We saw that people were provided with aids and adaptations in keeping with care plans and assessments. This also included people been given smaller plates of food if this meant they would eat more. On the day of inspection the meal choices were cheese and onion pie and vegetables or sausage casserole. The meals were nicely presented and looked very appetising. We saw that pureed meals were nicely presented with all the items put on the plate separately. We noted that cold and hot drinks were served throughout the day. The menu included a variety of traditional foods, including meat casseroles, sandwiches, soups and pies. We found that the majority of people who returned surveys said that they enjoyed the meals most of time and those we talked to said: Care Homes for Older People Page 18 of 33 Evidence: Sometimes she says its good, it depends on her mood but shes not losing weight.; I get enough to eat. and The food is good- yes theres enough variety. Care Homes for Older People Page 19 of 33 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. People at Springfield House are protected from harm and able to make their concerns known because the manager ensures that there are robust and effective complaints and adult protection policies and procedures that are followed. Evidence: We looked at the complaints procedure and the information included who to contact, the timescales for an investigation and steps to take if people were dissatisfied with the outcome. We found that people who returned the CQC surveys knew how to complain, and people we spoke to felt that staff always listened to them and were confident about telling the manager or other staff about any concerns or complaints. People told us: I would talk to staff if had any concerns.; Never made a complaint but everything seems to be dealt with in a courteous way. and Ive no complaints or worries but would take it to the office and theyre very nice. We looked at the complaint record we found that one complaint had been recorded. We Care Homes for Older People Page 20 of 33 Evidence: cross-referenced this complaint with information in the persons daily record. This, and the information in the complaints record, confirmed that it had been fully investigated, dealt with fairly and settled to the satisfaction of the complainant. There has been one adult safeguarding investigation since the previous inspection. The records showed that this had been investigated by Oldham Social Services and the outcome was that the concern had been unfounded. We looked at the homes adult protection policy and found that this informed staff of their responsibilities in relation to promoting the welfare of vulnerable people. We talked to staff and they were clear about their responsibilities in relation to protecting vulnerable adults and the training matrix confirmed that all staff had received adult protection training in the previous 2 years. Staff told us Everyone has to do POVA training, theres such a lot of things we need to know about service users. Care Homes for Older People Page 21 of 33 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. People in Springfield House benefit from an environment that meets their physical needs and, refurbishment of the fixtures, fittings and furniture continues. Evidence: We had a tour of the building. We found that the home is set in well-maintained and spacious gardens, which can be accessed safely by people in the home. We saw that the bedrooms were personalised and comfortable, and beds and carpets continue to be replaced. The en-suites were also clean. We saw that people were able to personalise their rooms by providing their own furniture, pictures or ornaments. We noted that replacement of furniture in some bedrooms needs to be made a priority as some items were very shoddy with missing handles. We found that all the communal areas were clean and pleasant to use. Chairs, tables and other items were free from stains. We noted that the home was fully accessible and had been adapted to ensure that Care Homes for Older People Page 22 of 33 Evidence: people could be as independent as possible. We noted that there were hand-rails, heightened toilet seats, a lift and other equipment to enable people to safely access the home. We found that people were satisfied with the environment and felt that the home was always clean and free from unpleasant odours. We also noted that there are radiators in the dining room and one of the lounge areas that need to covered so the risk of scalds is reduced. This matter was discussed with the manager who understands that it should be treated as a priority. People told us: The room is always kept nice and tidy.; The home is very clean, bright and cosy. And She has a nice room - staff allowed us to do what we wanted- we brought a lot of our own furniture. Care Homes for Older People Page 23 of 33 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Springfield House benefit from staff who are available with the skills and in sufficient numbers to meet their needs, however, the recruitment practises are unsafe because the home does not complete the checks required to safeguard people from harm and exploitation. Evidence: We found on the day of inspection that there were 19 people living at Springfield House, 3 carers, the manager and deputy manager, a domestic, laundry worker and a cook were on duty. We observed through the watching interactions that staff were able to work in a calm unhurried manner. We found that the majority of staff and residents who returned CQC surveys, confirmed that there was always sufficient staff on duty to meet peoples individual needs. We found through discussion with the manager and staff, and through staff supervision records, that there were a high expectations relating to staff conduct. We found from what they told us and from comments from people living at Springfield that staff were approachable and in the main they followed instructions and acted on what people told them. We examined the majority of staff specifically with the intention of checking that Care Homes for Older People Page 24 of 33 Evidence: majority of people had been fully vetted in respect of criminal record checks and protection of vulnerable adult checks. We found that the majority of staff files looked at held copies of application forms and references. We also found that an unacceptable number files did not contain evidence that Criminal Record Bureaus (CRB) and Protection of Vulnerable Adults (POVA first) checks had been completed. This matter was discussed at length with the manager and one of the owners of Springfield House. We were told that there had been a change in the system and the vetting organisation used to deal with vetting staff. We found, through looking at documents which the owner gave to us, that the people they had made responsible dealing with CRBs and POVAs did not always make that the vetting organisation received the correct proof of identification and other documents needed, and so the process for completing these was delayed. We found that the owner could provide evidence through an invoice that CRBs and POVA Firsts had been paid for however staff should not have been working in the home without one or both of these checks been completed. We also found that the organisation needs to complete CRBs for some longstanding staff as a number these had been taken up by previous employers and this is not acceptable. We informed the manager that the home must complete their own CRB checks for every member of staff. We believe that staff must be fully vetted before they work in the care sector. We believe that people are put at unnecessary risk of exploitation and harm if these checks are not carried out. We explained this to the manager and the owner. The owner told us that he would revert to the system by which home manager was responsible for working with the vetting agency, so that communication between the two will be direct and reduce the amount of confusion in respect of when POVAs have been approved, and also what documents are needed to progress the CRBs. We expect that the manager will also audit the CRBs of all staff working at the home and initiate CRBs and POVA firsts for everyone who has not had one conducted specifically for working at Springfield House. Care Homes for Older People Page 25 of 33 Evidence: We found that the manager ensures that there is a senior care assistant or manager on each shift and an on-call roster is in operation at night and over the weekend. We found that around 50 of staff have attained National Vocational Qualification (NVQ) level 2 in care as 14 out of 26 staff the qualification. We found that the training records confirmed that courses provided since the last inspection included: supporting continence; managing abuse; medication; dementia awareness; challenging behaviour; dysphagia awareness; Infection Control; firesafety; manual handling; continence; Basic 1st aid; pressure ulcer prevention; Control of Substances Hazardous the Health (coshh); Basic food hygiene, Manual HandlingUsing a sling and hoist and Health and Safety. We looked at the notes of the previous staff meeting and saw that issues discussed included: staff conduct, principles of care, how best to support people on soft diets, training opportunities, how to complete documents and issues concerning confidentiality. We found that staff were positive about their experience of working in Springfield House and remarked that: I get good support from the managers, seniors, everyone is willing to teach me and answer questions. And I love the job and get enough training to do my job well, and if I feel more is needed I can ask. Our job is to make sure people are comfortable and happy. We found that people living at Springfield were also positive about staff, they told us: The staff are helpful and welcoming to residents and visitors. and Staff are very friendly and yes I think they are adequately staffed. Care Homes for Older People Page 26 of 33 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People involved with Springfield House benefit from a manager who is competent and her aim is to ensure that the home is run in the best interest of the people who use the service. Evidence: We found that the manager continues to update her knowledge by attending courses. Since the previous inspection she has completed training in POVA; Malnutrition Universal Screening Tool (MUST); health and safety and basic food hygiene. People told us that the manager and management of the home was effective. They felt that the manager was competent, easy to approach and accessible. We found evidence through reading the records of meetings and supervision, that staff received the information and instruction that they needed to do their jobs well. Care Homes for Older People Page 27 of 33 Evidence: We saw that the home had their Investors in People award re-approved in 2008. In order to achieve this certificate the manager will have shown that she gives people the chance to comment about how the home is run, and that she listens and responds to what people say. We read though the notes from a recent Family Meeting and found that these meeting provided people with the opportunity to make their ideas known and also learn about changes in the home and organisations concerned with care. We noted that the manager used this forum to inform people about the development of the Care Quality Commission (CQC) and to remind them that CQC could be contacted if they had any complaints or concerns that they felt the home was not dealing with properly. We found that the management of health and safety and infection control issues in the home was effective and protected people from harm. We noted that staff had been provided with aprons and gloves to use when dealing with personal care. We noted that signs and posters were displayed to remind people to wash their hands, and staff have received infection control and health and safety training. We found that food hygiene and kitchen cleanliness is dealt with under the Safer Food Better Business scheme, and this regulated by the local authoritys environmental health team. We found that staff receive regular and frequent fire safety training about what to do in the event of a fire. We found that the entries in the fire safety logbook confirmed that all safety checks were completed as necessary and records confirmed that all fire equipment had been maintained and checked in keeping with the rules and regulations. We looked at the accident records and it was clear that if a pattern of falls emerged for one person then steps were taken to reduce the number and impact of these falls. We found that the manager has not yet introduced a process of analysing accidents in the home this should be done so that the results can be taken into consideration when updating risk assessments in the home. We found that the maintenance checks for the lifts, hoists, gas, electric and other equipment used in the home were up-to-date. We could not evidence whether the homes Parker Knoll bath had been recently serviced and so the manager needs to deal with this. Care Homes for Older People Page 28 of 33 Evidence: We noted that the majority of policies and procedures in the home have not been reviewed or updated since 2005. We believe that the manager should be able to show that these documents, that provide written advice and guidance to staff about how they should do aspects their jobs, have been looked at or reviewed yearly and updated if new information from the Government, Local Authority or sources has been developed. We checked the financial records for three residents. There were no mistakes and receipts and invoices were kept in individual files. People told us that they were happy living at Springfield House and that it was well run and had a good atmosphere. When asked about what was good about Springfield House they said: Our job is to make sure people are comfortable and happy. and They look after my needs well. Care Homes for Older People Page 29 of 33 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 30 of 33 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 38 19 The registered person must make sure that all staff working at or about to work at Springfield House have had POVA first checks and / or Criminal Record Checks that have been completed for them to work specifically at Springfield House. New staff must not start before one of these checks has been returned. This is so that people living at Springfield House are protected from the employment of unsuitable people who may exploit or abuse them. 01/09/2009 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 26 The registered person should ensure that radiators in communal areas are covered as this will reduce the risk of Page 31 of 33 Care Homes for Older People people being accidentally scalded. 2 38 The registered person should analyse falls and accidents so that any patterns can be identified and the correct changes made to protect people from preventable harm. The registered person should update all the policies and procedures used at Springfield House. This is to ensure that people benefit from having staff who are following procedures that have been developed in line with the most up to date Government, Local Authority or Best Practise in Care guidelines. 3 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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. 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