Care Home: Springfield House Nursing Home

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What the care home does well We found that Springfield House offers a genuine commitment to care with a professional, yet an open and personable approach, which reflected the homeliness of a confident relationship between carer and those people living in the home. A quote from a relative in a returned survey stated: "Before my mother went into Springfield House my sister and I looked carefully at the options open to us and have not regretted the final choice of care home". "We are very happy with the care given to us". Through the process of inspection we considered that the establishment of a professionally accountability towards effective assessment, detailed care planning and review of peoples needs were meaningful and robust, formulating an excellent standard of care. This highly personable attitude and approach to care is appreciated and welcome by people who use the service and visitors alike. What has improved since the last inspection? We found that people who use the service and relatives are actively involved in the planning of care. We examined and confirmed that care is regarded as inclusive of peoples` wishes. We recognise the improvements made in care planning and the introduction of a `Dignity Champion` in the Home, reinforcing that health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Those people who may want to live at the home are now given the opportunity to spend time at the home prior to admission. We confirmed that the Home Manager conducts monthly audits and spot checks on routines and standards, and is reinforcing links with in the local community and with local health care professionals. What the care home could do better: The achievements in establishing a high standard of care have been recognised, areas of detail outlined through recommendations will continue to play a part in the ongoing development and maintenance of an honest, solid and homely service. Key inspection report Care homes for older people Name: Address: Springfield House Nursing Home Springfield House Nursing Home Oaken Nr Wolverhampton West Midlands WV8 2EE     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: Keith Jones     Date: 2 6 0 1 2 0 1 0 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 33 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Springfield House Nursing Home Springfield House Nursing Home Oaken Nr Wolverhampton West Midlands WV8 2EE 01902847272 01902845093 springfield.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springfield House (Oaken) 2001 Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 36 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 36. The registered person may provide personal care (with nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category 3 (OP) Physical disability (PD 36) Date of last inspection Brief description of the care home Springfield House Nursing Home was opened in 1995 sharing the site with a residential facility and Four Seasons Health Care headquarters, accommodating thirty six elderly service users; offering twenty-four hour nursing care for long and short stay visits. The home is set amidst outstanding Staffordshire countryside, convenient for public Care Homes for Older People Page 4 of 33 Over 65 3 0 0 36 Brief description of the care home transport and the local village of Codsall, a few miles from Wolverhampton. Four Seasons Health Care, one of the largest independent care providers in the UK, operates the home offering a high standard of nursing care with maximum comfort and security, in a pleasant and safe environment. 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: 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: We conducted this unannounced inspection with the Registered Manager and senior nursing staff on duty, whose input contributed this report. The Area Manager for Four Seasons joined the inspection at a later point and offered a valuable insight into Springfield House performance. Our inspection of the building allowed us free access to all areas and open discussion with people who live at Springfield House, relatives and staff. There were 31 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with health care needs. To do this we looked at (case tracked) four peoples files from referral for admission to the present time, and four staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who use the service, Care Homes for Older People Page 6 of 33 relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the very thorough Annual Quality Assurance Assessment (AQAA), and eleven residents survey forms returned, and six staff survey returns. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? 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 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 8 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose, and found it to provide an informative description of the Homes aims, objectives, and the way it operated, although it needs to be updated to accommodate contact changes and be presented in a more user friendly style. The Service User Guide provides the basic details of the service which can be expanded and presented in a more robust style, and consideration be given to produced the document in large print, as and when necessary, and an audio version would help people with poor eyesight to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose, and Clients Charter represents the basis on which the Home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Care Homes for Older People Page 10 of 33 Evidence: We closely examined four peoples care records and clearly identified that the Care Manager, or her nominated deputy, conducted a thorough pre-admission assessment, identifying a clear dependency assessment, and forming a comprehensive foundation for care planning to meet needs, which some included a copy of the care plan from social services, prior to admission. The objective is for this assessment to be produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. We found this to be true, with each individual having a plan of care, which included a detailed care plan, daily care programme, risk assessments with goals and outcomes. Any special needs of the individual were discussed fully and documented, ensuring their personal needs would be met. Comments we received from surveys we sent out before the inspection to people who use the service: Before my mother went into Springfield House my sister and I looked carefully at the options open to us and have not regretted the final choice of care home. The will tell my daughter because I forget things, they always ask me and let me choose. I think this is a very good place to live if I cant be at home, really good. We are very happy with the care given to us. Case tracking confirmed that a valuable exchange between people and the assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. From discussions it was evident that people who may use the service and their relatives are able to visit and assess the quality, facilities and suitability of Springfield House at any reasonable time, to meet with staff and management. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving those people, and their families in the admission process. The information I received was very informative and helpful. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated through our discussions, and examining records throughout case tracking. There were no people assessed and referred solely for intermediary care at the time of Care Homes for Older People Page 11 of 33 Evidence: inspection 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Those care records and case tracking we examined provided clear evidence to show that the pre-admission assessment; Care and Health Assessment Process (CHAP) process represented the foundation for well considered, and detailed care planning, including risk assessments for mobility and falls, tissue viability and nutrition. We found that peoples profiles offered an individualised plan of care, based upon awareness of social and personal needs, dependency assessment and activities of daily living. These are frequently reviewed in an individual plan of care, that is reassessed monthly, to reflect peoples changing needs and adapting care profiles, supported with a substantial and informative daily progress report. Established monitoring systems following a process of goals, care and evaluation of high quality care plans, appreciated by those people who use the service and relatives alike. Care Homes for Older People Page 13 of 33 Evidence: A comment we received from a relative: Dads health has improved since he was admitted to Springfield House, he is very content there, and very well looked after. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The AQAA stated, and we confirmed, that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. Throughout the course of inspection we examined recorded care of people receiving extensive nursing care, and confirmed that regular monitoring is carried out at a consistent and meaningful way.. A daily report is maintained to control monitoring, and offer a comprehensive account of care and service given following a process of goals. Risk assessments were carried out on an individual basis and frequently reviewed through monthly assessments. Our case tracking of four peoples care confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Through case tracking, our discussions, and inspection of records, it was confirmed that the home arranges for health professionals should special health care needs be recognised. We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the deputy care manager is responsible for overseeing all matters relating to medicines, with senior nurses taking operational responsibility for day to day actions. There is a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Controlled Drug management was comprehensive. We found that the organization of care from the Statement of Purpose, admission assessment to care planning, is geared to encourage and promote individuality and privacy. We were present throughout a residents/relatives meeting to witness this process in action, and spoke with staff to confirm that these policies are reinforced with a staff induction programme and supervised practice. The inspector observed the free, courteous interaction between people and staff based on a level of confidence of mutual trust and respect. Facilities are available to relatives or friends who wish to remain close, to meet individual needs of those who use the service and relatives. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy Care Homes for Older People Page 14 of 33 Evidence: and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff. It was noted that a member of staff has been identified as a Dignity Champion, having received appropriate training, and has commenced a cascade programme to reinforce the principle. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. Several comments we received from visitors and people who live in the home indicated: They care well for my Nan, and we are always keen to help when they are extremely busy. We visit at different times of the day, and there is always someone on hand to speak to. My Nan is lucky as we visit her every day, and I know some unfortunate people have no visitors, but the staff speak to them and take time with them. Its comfortable and feels like a home from home. There is always someone to help when I need them. Very friendly, all staff. Very good, professional expertise, excellent dignity, skin care, food, very willing to adapt for you. Great care. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. We recognized the confidence and closeness within the Home of staff, people who use the service and visitors, and the mutual respect that prevailed. It was also acknowledged that there exist good working relationships with regular professional contacts, and General Practitioners for the Home. Care Homes for Older People Page 15 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: People who use the service have the opportunity to develop and maintain important personal and family relationships. The staff practices promote individual rights and choice and also consider the protection of individuals in supporting them to make informed choices. We found daily life to be flexible to accommodate peoples needs and capabilities, offering choices at meal times, and during personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed atmosphere in which peoples needs were respected, with the security that there are familiar events to the day they could relate to. An activity co-ordinator has a high profile in contributing to the care planning process, and is clearly well accepted by people who use the service and staff alike. The recording of social activities was seen to be an integral part of care reporting and Care Homes for Older People Page 16 of 33 Evidence: planning. Evidence was clear in identifying events and results of efforts made. On the day of the inspection, a number of people were engaged in communal games, and general chatting. Individual life histories are discussed and used as a basis for personalised social care offering choice and support, performed through one to one sessions with people. Some comments we received from surveys sent out before the inspection: The caring sensitivity is the most apparent, the Home is nice, but the most important is the attitude of people who work and run it. Its friendly, warm and relaxed. If something is not right they will change it, for example: if I wanted another blanket, or to go back to bed, or if I didnt like the food, they will give me something different. The Home does well in fulfilling the individual needs of residents. Staff are supportive to residents and relatives. It was also noted that some people felt that not enough diversion and stimulation was offered: The care staff dont give me enough time, I need more stimulation and motivation. I feel the carers could spend some time with the residents, having a chat, or helping with writing, etc. They seem too busy to spend any time with them. There is too much routine, staff dont spend enough time with the residents, who want more interaction and conversation with staff. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff and visitors interact with people in a positive and polite manner. Comments received from relatives on the day confirm their appreciation and involvement with the progress of their loved ones health and social status There is a choice to be on your own or sit with others. I feel safe and well looked after. The Nurses and carers are very pleasant. Care Homes for Older People Page 17 of 33 Evidence: X is limited in what he can participate in, but he is invited by staff encouragement. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. A Dignity Champion is recognised to promote awareness, and offer support. Those individuals rooms we inspected showed a very positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. The Home operates a secure system of handling peoples monies, with only small amounts of petty cash, which was efficiently handled through the administrators office, and subject to internal inspections and audits. The Care Manager emphasised that the strength of protecting personal rights was secured through the robustness of the procedures in place. This was confirmed on examination of records. Quarterly relatives/carers meetings with people are valuable forums for open communications, and are recorded. Our attendance at a meeting showed the confident relationship that existed in freely discussing issues of interest and mutual concern. The Home offers a good catering service, observed to provide a menu on a four weekly cycle offered a wholesome, varied choice. We confirmed that the cook knew most of the people using the service, and some of the relatives, but agreed that they did not go out as much as she would have liked, due to time pressures. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant lunch of chicken and bacon wraps, with a choice of poached cod was offered during inspection, served in pleasantly furnished and clean dining rooms, accommodating dining tables which were attractively laid, and which provided a relaxing ambiance in which to meet with people at mealtimes. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people in the home. People interviewed confirmed that that the quantity and quality food provided was good: Comments we received in the course of inspection: It is friendly and like being in your own home. There is a good variety of food. Care Homes for Older People Page 18 of 33 Evidence: Its comfortable and feels like a home from home. The meals are good, which are replaced with something else if you dont want to eat it. There is always someone to help when I need them. I am really pleased with the cook, who knows my needs well, a lovely person. Good variety of meals for residents with weekly menus on the dining tables. 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 are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: The Homes complaints procedure is outlined in the Service User Guide and Statement of Purpose. The complaints procedure was also prominently displayed in the entrance hall. Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy was seen and records examined. All people who use the service had received information on the procedure to complain, including reference to the Care Quality Commission (CQC). People spoken with on the day said they felt confident that any concerns they raised with the care staff or manager would be addressed without delay. Those people who responded to surveys confirmed that they knew who to speak to if they were not happy and that they knew how to make a complaint. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. There were a few minor complaints, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples, Care Homes for Older People Page 20 of 33 Evidence: and their families concerns in a meaningful and effective manner. Comment we had received in the course of inspection stated: The only concerns we have had have been very minor ones which have always been resolved satisfactorily. I put forward concerns to the office if I do not agree to something, but everything is always sorted out amicably. They have always acted promptly. I rarely have cause to complain. Case tracking confirmed the effectiveness of a Provider, Care Manager and staff sensitive to peoples needs, and a readiness to test the robustness of their information and report structures. No complaints or safeguarding issue had been received by us since our last inspection. The overall policy of openness and transparency was acknowledged. Individuals legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning, and policies in place, including the complaints procedure. The care management showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. The Annual Quality Assurance Assessment completed by the service prior to the inspection states that all staff employed have undertaken a satisfactory, enhanced Criminal Records Bureau (CRB) check, confirmed by examining four staff files. Recently updated Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with people who use the service, especially their privileged position in protecting those people from abuse. 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 can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and a tour of the Home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking and grounds are spacious and well maintained. The open gardens and patio offers a very pleasant area for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. Visitors and people who use the service take advantage of attractive gardens and grounds; pathways were safe and recently attended to during a harsh winter. External access is via a poorly maintained country lane, set in beautiful pastoral countryside. It remains a consistent irritation for all vehicle access, and is unsuited for wheelchair use. Internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. Wheelchair access was satisfactory throughout all Care Homes for Older People Page 22 of 33 Evidence: areas of the Home. On admission the Care Manager assesses each individual persons needs for equipment and necessary adaptations. All communal areas are of a good standard, offering both social and peaceful surroundings. The conservatory is well equipped, but poorly used in the winter mornings, having inadequate heating to satisfy people. The care Manager has recognised this situation and steps are being taken with improved boiler facilities. The other lounge spaces allow activities to be presented in very pleasant areas of the Home, with furniture and fittings of good quality. All were pleasantly decorated, providing good quality furnishings and items to provide comfortable areas where people were able to interact with their friends, or to entertain their guests. The recently relocated dining areas are well furnished, and presented to provide a conducive environment to enjoy a good meal. Staff supervision was seen to be available throughout the day. Bedrooms are well maintained to meet peoples personal preferences. On inspection most bedrooms were highly personalised, with most displaying the persons own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the decor in most areas was found to be of a good standard, with a development programme for continuing upgrading of decor. Each bedroom has adequate space to assist with personal care and dressing assistance. There are an appropriate number of variable height beds with integral protection rails. The nurse call alarm system was satisfactorily tested, and personal electrical equipment (PAT), including televisions, radios, where seen to be tested. There is an adequate lighting, and bedside lamps are available where risk assessed. Radiators are protected; smoke detectors fitted and adequate electrical sockets available. TV and telephone points were available in each bedroom, equipped with large keypad telephones for service users personal use. A locked facility and lockable bedroom doors was available on request, following suitable risk assessment. Several people spoken to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. The heating arrangements throughout the home are by central heating with guarded radiator convection, providing an ambient temperature, although not providing a satisfactory service to the conservatory. Lighting facilities, including individual bed lights, and overall emergency lighting were installed and regularly maintained by the handyman. Water temperature were randomly tested and found to be within normal limits. Each room was fitted with a tested fire/smoke alarm. Ventilation is by direct door and window airing. Care Homes for Older People Page 23 of 33 Evidence: Corridors were seen to be free from obstruction, fitted to aid mobility and well lit to facilitate safe access throughout the Home, although undergoing full redecoration. The housekeeping services in the home were seen by us to be of a high standard. The people spoken to generally remarked that they find the environment always very clean and fresh. To complement the presentation there were numerous floral and decorative displays. Comment from surveys we sent out before the inspection: I have been very impressed. The home achieves a high standard of cleanliness. Very clean and tidy at all times, a lovely home providing a superior environment. People have the provision of sufficient and suitable lavatories and washing facilities within the home. The standard and presentation of all the toilets and bathrooms were of a high quality, clean, uncluttered and freshness. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Infection control figures highly within the staff induction and supervisory training programmes. Care and domestic staff were approached, and were fully aware of the importance of infection control. Sluice facilities are suitable to assist in control of infection. Notices regarding chemical handling the areas that store chemicals displayed appropriate posters and information charts. Kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices. It was advised that limited access to non authorised staff be observed, and that suitable arrangements to obtain foodstuff from a fridge be organised by the side door. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 24 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the Home are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We found that there were 29 people receiving nursing care from a total of 31 at the time of the inspection. Three weeks of duty rotas were examined, in which the daily care staffing showed adequate balance between skills, qualifications and numbers to provide a foundation for a high standard of care. The Registered Manager worked supernumerary, but is supported by a Deputy Care Manager who contributes fully to the staffing rota. Agency coverage has not been necessary to support shortages of care staff, deploying overtime and flexible rostering to meet shortfalls. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection there were two Registered Nurses and five care staff on duty. The average care staff shift coverage: morning shift 2 trained and 5 carers evening shift 1 trained and 6 carers Care Homes for Older People Page 25 of 33 Evidence: night shift 1 trained and 2 carers It was understood that these care staff coverage figures represent adequate levels for 31 people, and would need readjustment if a full occupancy is to be realised. The maintenance, catering, and housekeeping hours were determined and found to be appropriate for the size of the Home, and the needs of people. The Nursing Home shares with the Residential home a full time activity coordinator, receptionist, training and development resources, and housekeeping. The Registered Providers work closely with the home through several organisational posts, and an Area Officer who offers appropriate administration and management support. We examined four staff files, and found them to be thorough, consistent and up to date. Staff are employed in accordance with the code of conduct and practice set by the General Social Care Council. We recognise that the management have established a comprehensive procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. We saw that all new team members receive a thorough induction programme, and an ongoing training and development plan for all staff. The records we examined showed that 35 of care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, with a further 50 undertaking NVQ training at the time of inspection. Overall the evidence shows a substantial account of a meaningful schedule of training to meet mandatory and specific demand. Three staff on duty were interviewed, each having had a statement of terms and conditions. It is a declared policy that recruitment is based on equal opportunity. Each member of staff spoke well of the training and supervision offered to them, and of the good working conditions that prevail. Each were very settled and enjoyed their positions, and were proud of the high standards of care given. There were no problematic issues raised by the staff. The Providers are committed to a learning environment. Staff induction programmes are well established; very well designed, forming the base upon which in service supervision and training are planned and achieved. Comments we have received from people using the service and staff members: The caring sensitivity is the most apparent, the Home is nice, but the most important is the attitude of people who work and run it. Its friendly, warm and relaxed. Care Homes for Older People Page 26 of 33 Evidence: The staff make a big effort, they work hard and really care for us. No one is perfect, I am not perfect and they are really good. The staff are lovely people, very kind and very helpful. Since my time at Springfield I have received a lot of support and guidance from the management and nursing staff. I was teamed up with another staff member until I felt fully competent to work alone. Training opportunities and professional updates ensure nurses are up to date on latest evidence based practice. Staffing levels are always good, good variety of meals for residents with weekly menus on the dining tables. Records were available to demonstrate an on-going process of regular supervision and supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Care Homes for Older People Page 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: The Registered Care Manager, Annette Butler Jones, has demonstrated a long term commitment and competence in running Springfield House, in establishing a solid professional policy portfolio that has been implemented, to achieve a high standard of set aims and objectives. She has achieved her NVQ Levels II, III and the Registered Managers Award (RMA) qualification. She is supported by an experienced Deputy Home Manager, a Registered Nurse, who also has responsibilities for supervising care at the Springfield Residential unit, and a team of registered nurses. We recognize the efforts made to enhance the Keyworker and Named Nurse team Care Homes for Older People Page 28 of 33 Evidence: concept with the establishment of a Personal room folder, in which people using the service and their relatives actively engage in the diary of events with the care staff. We also recognize the efforts to recognize a dedicated Dignity champion to further the independence and individuality of living in Springfield House. We were impressed by the openness and confidence in the observed interactions of staff, relatives and people using the service. The relationships were seen to be of mutual trust and respect. The Registered Providers have a high profile and involvement in the smooth running of the Home, and are prepared to delegate a wide range of management responsibility to good effect. Comments we received from staff interviewed on the day: I have always found the manager and deputy to be very approachable and fair, promoting a family feel in the home, and leading by example. They have my full commitment in keeping the high standards of care we enjoy with our residents. The Home does well in fulfilling the individual needs of residents. Staff are supportive to residents and relatives. Since my time at Springfield I have received a lot of support and guidance from the management and nursing staff. I was teamed up with another staff member until I felt fully competent to work alone. Training opportunities and professional updates ensure nurses are up to date on latest evidence based practice. Staffing levels are always good, good variety of meals for residents with weekly menus on the dining tables. Appropriate risk assessments are in place for people, through care planning and recording, staff selection and the maintenance of the general environment; these are up to date and accurate. Health and safety notices can be seen throughout the home. Records inspected included surveys asking people who use the service their opinion, these are conducted annually, in conjunction to a Team Audit from the Providers. The Provider with the Care Manager, have developed a formal approach to monitoring quality across a wide range of activities. This includes a care plan review process that is recorded at least once a month, a staff training programme, and a quality development programme, including the setting of objectives, and target dates to aim for. Social Workers review meetings are often a vehicle for assessing quality. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. This we found to be true. We were able to sit in on a residents and Care Homes for Older People Page 29 of 33 Evidence: relatives meeting which further reinforced this aspect of care. We identified that people are encouraged to be independent with regard to financial affairs with the assistance of their relatives. Small amounts of cash were efficiently handled by the administrative officer, although essentially the home operates a cashless society. The Home has an open door policy and a commitment to equal opportunities. As previously mentioned there is a willingness to create a training environment, and a staff supervision policy and procedure is in place in the home. Cascading supervision programmes are established as part of the normal management/training process, with all care staff receive six sessions of individual formal supervision annually. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. Random samples of records they were found to be well maintained, accurate and up to date, ensuring that the peoples rights and best interests are safeguarded. The procedures manual was randomly examined, and found to offer a very comprehensive reference. The Manager offered evidence of safe working practices including: Movement and handling training, medicines, and complaints management. Relevant legislation was discussed and is fully understood by the management, for example: Introduction to CQC updates, The Mental Capacity Act and Deprivation of Liberties paper. The health and safety of people using the service and staff are promoted with safe storage of hazardous substances, regular electrical PAT and servicing of electrical appliances and regulation of the water system. The accident book was seen and found to be in order for staff, people using the service, and reporting arrangements to Riddor. A three monthly analysis is recorded on trends and frequency. Health and safety notices can be seen throughout the home. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of people. Care Homes for Older People Page 30 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 31 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 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 1 That the Statement of Purpose and Service User Guide be updated to reflect change and that consideration be given to producing the documents in an audio versions, to assist people with poor eyesight to make an informed decision. Complaints would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples, and their families concerns in a meaningful and effective manner. That the Registered Provider ensures that access to the kitchen area is by authorised staff only. This is to comply with the requirements of environmental good practice. That the Registered Provider ensure that access to the home is secure by a suitably maintained driveway. To facilitate safe access and usage by people with wheelchairs. 2 16 3 19 4 19 Care Homes for Older People Page 32 of 33 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 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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