Care Home: Springfield Manor Nursing Home

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What the care home does well All people that wish to use service benefit from a pre-admission assessment and care plans are then generated from this initial assessment. The pre-admission assessment is kept in the persons individual care plan folder. The assessments are carried out by the manager and a senior carer. The home is situated in well maintained grounds. People using the service are able to make use of the patio area which has views across the Surrey Hills. Some seating is available. Regular training takes place and this includes the NVQ (National Vocational Qualification) which all staff have access to and have gained this qualification. Surveys returned to us from relatives and residents were all complimentary about the care they received and the attitude of the staff toward them. The care staff told us that they work as a team and would always help and support each other. Those that returned surveys to us confirmed that they had a thorough recruitment process. Staff reported that they all received an induction. What has improved since the last inspection? During the winter this year the home experienced problems with their hot water and only parts of the home had hot water available for washing. The provider arranged for work to be carried out to ensure that this problem does not reoccur and this has now been completed. The provider and person in charge have worked cooperatively and openly with CQC and we are kept informed of any changes planned in their home. What the care home could do better: Eleven requirements and one recommendation have been made following this key inspection. Arrangements must be made to ensure that residents preferred choices and wishes are respected with regard to their personal care and residents are supported at all times with dignity, privacy and respect. Arrangements must be made to ensure that all staff must accurately document and monitor residents health care records in order to ensure that the residents records accurately reflect and promote the health, well being and welfare of the residents. Arrangements must be made that residents have their calls bells available in order to summon staff assistance to promote their safety and meet their needs. Arrangements must be made for the medication procedures of the home to be strengthened in order to promote safe working practises for residents receiving medicines in the home. Arrangements must be made to ensure that all residents are consulted and informed regarding changes to the agreed programme of activities in order to promote and ensure residents are consulted and their wishes and feelings taken into account. Arrangements must be made for the appropriate provision of the care, health and welfare of all residents at meal times to ensure residents have sufficient supervision and choice regarding their meals. Arrangements must be made to ensure that a documented menu is available for residents in order that individuals can make an informed choice regarding the meals offered by the home. Arrangements must be made for improved management regarding the prevention and spread of infection in the home. Arrangements must be made to ensure that an identified risk regarding a residents bed situated next to an unguarded radiator is appropriately risk assessed and so far as possible the risk eliminated to ensure the safety and well being of the resident when the radiator is working. It has been recommended that the use of a shared bedroom is reconsidered to ensure that the residents and staff have adequate space which offers comfort and safety to the residents and staff whilst undertaking their duties. Arrangements must be made to ensure that the staffing levels and management of the homes routines are reviewed in order to promote and make proper provision for the health and welfare of residents in the home at all times. Key inspection report Care homes for older people Name: Address: Springfield Manor Nursing Home Hogs Back Puttenham Guildford Surrey GU3 1AQ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Lesley Garrett     Date: 1 0 0 6 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Springfield Manor Nursing Home Hogs Back Puttenham Guildford Surrey GU3 1AQ 01483810177 01483810611 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springfield Manor UK Limited Name of registered manager (if applicable) Mrs Julie Kim Billington Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 30 The registered person may provide the following category/ies of service only: Care home with nursing (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home Springfield Manor Nursing Home is registered to provide nursing care for up to thirty older people. It is located on the Hogs Back in extensive grounds, overlooking the Surrey countryside. The home provides ample communal space, including an attractive conservatory. Residents accommodation is provided in single and shared rooms some of which have en-suite facilities. There is a shaft lift to access the first Care Homes for Older People Page 4 of 33 Over 65 30 0 2 4 0 9 2 0 0 9 Brief description of the care home floor and a ramp to access the patio garden at the rear of the home. parking provided as the home is not accessible by public transport. There is ample 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: one star adequate 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: This inspection was an unannounced key inspection conducted by Mrs L Garrett and Ms S Magnier, Compliance Inspectors. The registered provider and person in charge represented the service throughout the day. For the purpose of the report, the people using the service are referred to as individuals or residents. The inspectors arrived at the service at 07:45 and were in the home for seven hours. The inspection was a through look at how well the service was meeting the Key National Minimum Standards for Care Homes for Older People and has in the report made judgements about the standard of the service The information contained in this report was gathered from observation by the inspectors and speaking with a number of residents and care workers. The commission has received responses to questionnaires sent prior to the inspection from residents, relatives and staff. Some of the comments received have been included within the Care Homes for Older People Page 6 of 33 report. Documents sampled during the inspection included some individuals care plans, daily records and risk assessments, medication procedures, some health and safety records and some of the homes policys and procedures including complaints and safeguarding. The final part of the inspection was spent giving feedback to the registered provider and the person in charge about the findings following this visit. One complaint and one safeguarding vulnerable adults referral remain on going. From the evidence seen by the inspectors, it is considered, that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. The commission has noted that all requirements made during the previous inspection in September 2009 have been complied with. The registered provider and staff have worked closely with the commission in order to improve the services to the older people receiving care and accommodation at the home. 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: Eleven requirements and one recommendation have been made following this key inspection. Arrangements must be made to ensure that residents preferred choices and wishes are respected with regard to their personal care and residents are supported at all times with dignity, privacy and respect. Arrangements must be made to ensure that all staff must accurately document and monitor residents health care records in order to ensure that the residents records accurately reflect and promote the health, well being and welfare of the residents. Arrangements must be made that residents have their calls bells available in order to summon staff assistance to promote their safety and meet their needs. Arrangements must be made for the medication procedures of the home to be strengthened in order to promote safe working practises for residents receiving medicines in the home. Care Homes for Older People Page 8 of 33 Arrangements must be made to ensure that all residents are consulted and informed regarding changes to the agreed programme of activities in order to promote and ensure residents are consulted and their wishes and feelings taken into account. Arrangements must be made for the appropriate provision of the care, health and welfare of all residents at meal times to ensure residents have sufficient supervision and choice regarding their meals. Arrangements must be made to ensure that a documented menu is available for residents in order that individuals can make an informed choice regarding the meals offered by the home. Arrangements must be made for improved management regarding the prevention and spread of infection in the home. Arrangements must be made to ensure that an identified risk regarding a residents bed situated next to an unguarded radiator is appropriately risk assessed and so far as possible the risk eliminated to ensure the safety and well being of the resident when the radiator is working. It has been recommended that the use of a shared bedroom is reconsidered to ensure that the residents and staff have adequate space which offers comfort and safety to the residents and staff whilst undertaking their duties. Arrangements must be made to ensure that the staffing levels and management of the homes routines are reviewed in order to promote and make proper provision for the health and welfare of residents in the home at all times. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who wish to use the service benefit from a pre-admission assessment from a suitably trained person to ensure that the home can meet their needs. Evidence: The home last had a key inspection on the 24th September 2009. The provider told us that the pre-admission assessment documentation had changed since that time but the process of assessment is unchanged. The person in charge told us that all residents that are admitted to the home have a pre-admission assessment which she carries out. The person in charge said that she will often take a carer with her. This ensures that together they assess the care needs of the individual to ensure the home can meet their needs. We were also told that the prospective resident has then had the benefit of meeting two members of staff from the home prior to their admission. The assessment looks at their activities of daily living and the assessment is placed in their individual folder. Documentation sampled during the inspection showed us that these assessments had taken place and that care plans are then generated from this Care Homes for Older People Page 11 of 33 Evidence: document. The home does not offer intermediate care. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are offered an inconsistent provision of personal support by the home. Care is provided in way that does not consistently promote residents privacy and dignity. Medication procedures in the home need to be strengthened to ensure residents safety, welfare and well being. Evidence: A number of residents personal care records were sampled and it was noted that a significant amount had not been completed. There was limited evidence to support that residents received regular showers or baths and some residents spoken with confirmed that they didnt have many baths. There was no evidence to support that the homes staff encouraged residents who have capacity to be responsible for their own personal care. Where residents had been supported with personal care, and left in their rooms, attention had not been paid to making the residents bed and tidying up their bedroom. One resident advised that some staff speak in their own language and talk over the residents and they have asked staff to speak in English. One incident observed by an inspector, which was reported to the registered provider Care Homes for Older People Page 13 of 33 Evidence: and person in charge, evidenced that staff members treated a resident in a way which did not respect the individuals rights to privacy and dignity. One resident told the inspector that they had requested to be supported in a specific way yet staff had told them that this was not possible yet the resident was unsure why their request was not accommodated. This information was relayed to the registered provider and the person in charge for them to investigate. It has been required that arrangements must be made that residents preferred choices and wishes are respected with regard to their personal care and residents are supported at all times with dignity, privacy and respect. Specific records relating to residents health and well being were sampled and it was noted that the pressure sore relieving chart of one resident who remained immobile for long periods of time had been inconsistently recorded and did not offer sufficient information regarding the interventions staff had made to ensure that the resident had received appropriate care and support whilst being immobile. A fluid intake and output chart was sampled for one resident and the recordings were noted as inconsistent as some staff had completed the quantity of fluid yet other staff had not completed the quantities or the 24 hour total of fluids given and the residents output was not recorded on several charts. The senior staff member on duty was questioned regarding the recordings and advised that the resident did not need to have the records documented and the records should have been archived yet had been left in the residents bedroom. The senior staff member confirmed that the resident was eating and drinking well yet there was limited evidence available to support this statement. It has been required that arrangements must be made that all staff must accurately document and monitor residents health care records in order to ensure that the residents records accurately reflect and promote the health, well being and welfare of that resident. During the tour of the service it was noted that several residents did not have access to their call bells. It was observed that one resident had their call bell placed on their pillow yet they were unable to reach it and staff had not ascertained that the call bell cord would not extend further in order for the resident to use the bell. This was brought to the registered provider and person in charges attention during the inspection. The resident, when asked, stated that they call out for staff support when they need help and this was witnessed by an inspector during the inspection. It has been required that arrangements must be made that residents have their calls bells available in order to summon staff assistance to promote their safety and meet their needs. Written surveys received by the commission from residents relatives stated Mother is Care Homes for Older People Page 14 of 33 Evidence: very well looked after, she is always clean and well dressed and can decide what she wants to do and when she wishes to retire at night, I am satisfied with the service. The service takes exceptional care of my father and caters for all his personal needs and health needs. The carers are always willing to go the extra mile if needed. They keep me well informed on all aspects of my dads care and needs. Whilst observing the administration of medicines in the home it was noted that the person in charge of the medications did not comply with the safe administration and disposal of medicines. It was observed that on one occasion the medicine trolley was left open and unsupervised. It was also observed on one occasion the nurse failed to follow the procedure for the appropriate disposal of medicines. The shortfalls in the current practises could potentially put residents at risk. This practice did not ensure the safety and well being of people receiving medicines in the home. It has been required that arrangements must be made for the medication procedures of the home to be strengthened. This is in order to promote safe working practises for residents receiving medicines in 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents rights to make choices about their daily routines need to be further promoted. Residents enjoy and choose from a range of activities offered by the home yet further arrangements to consult with residents needs to be promoted. The home provides a healthy and balanced diet yet residents need to be more fully informed and consulted regarding the homes menu and receive an appropriate level of support at meal times. Evidence: The provider now employs an activity organiser who works part time at Springfield Manor. She is responsible for the activity arrangements at the three homes that the provider owns. On the day of inspection no activities took place. It is acknowledged that the home has a printed document that details the activities provided by the home and this was observed in residents bedrooms. One resident spoken with was unaware why they had not been collected by staff to attend the morning activities. The inspectors were advised that the activities co-coordinator was on a training course yet this information had not been relayed to the resident who would have liked to attend the mornings planned activity. It has been required that arrangements must be made that all residents are consulted and informed regarding Care Homes for Older People Page 16 of 33 Evidence: changes to the agreed programme of activities in order to promote and ensure residents are consulted and their wishes and feelings taken into account. The provider informed us following the inspection that the activity organiser had spoken to the residents to inform them of her absence. We were given further information to demonstrate to us that a full activity programme is provided. A newsletter was also sent to us which showed us those activities that had taken place and those that were planned. The provider acknowledged that on the day of inspection the agreed arrangements for activities for that day were not actioned by staff but that all staff are now aware and there have been no further gaps in the programme. There was limited support from staff to assist some residents to eat their breakfast and during the coffee time a senior member of staff was heard to state do you need help with the feeds, leave them in the room and Ill come and help you. One resident was seen to be struggling to eat their porridge and no staff were at hand to support or assist the resident. Two residents who were eating their breakfasts were interrupted by staff in order for the staff member to put tabbards on the residents to protect their clothes. There was limited interaction between the staff member and the resident during this time and no explanation given why the tabbard was being used and no apology for interrupting the resident as a matter of courtesy. It has been required that arrangements must be made for residents to have the appropriate provision of support from staff, in a dignified manner, during their mealtimes to promote residents health and welfare regarding their meals. There was evidence that the home provides fresh fruit and vegetables and the chef advised that he meets residents to discuss the choices available. The serving of breakfasts was observed and it was noted that little thought had been given to the residents choice of breakfast or the presentation of individual breakfasts. One resident, within the hearing of the inspector, asked for toast and butter with no marmalade and the resident was given the toast and butter with marmalade as the toast had been previously prepared. There was no evidence of a printed menu in the dining area during the day of the inspection to inform residents of the choice of meals yet the homes chef showed an inspector a menu detailing the proposed meals to be served within the home over several weeks. It was acknowledged, whilst talking with the chef that residents are offered choice however this was not observed during the serving of breakfasts. It has been required that arrangements must be made that a documented menu is available for residents in order that individuals can make an informed choice regarding the meals offered by the home. It was also observed that the residents are still served hot drinks in red plastic Care Homes for Older People Page 17 of 33 Evidence: beakers instead of a cup and saucer. The provider and person in charge told us that each person has now been asked for their preference and they had chosen the beakers. There was no evidence of their preference being documented in the care plans. Care Homes for Older People Page 18 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff at the home are aware of their responsibilities regarding safeguarding adults procedures and have all received training however the home continues to be monitored by the local authority. Evidence: The complaints policy is available in the service user guide and is clear and easy to understand. The person in charge said that all complaints received by the home are documented and placed in a complaints folder. The provider is made aware of any complaints that are received by the home and all are throughly investigated or passed onto the local authority as a safeguarding alert if this is necessary. Residents that were spoken to on the day said that they knew how to make a complaint and surveys received by us from residents and relatives confirmed they were aware of who to talk to if they had a concern. Prior to this inspection CQC had received a letter of complaint raising some concerns about the home. We referred these concerns to the local authoritys safeguarding adults team in February 2010. Since that time the local authority has been holding regular senior strategy meetings under their safeguarding adults protocols. These meetings look at all of the concerns raised and CQC has also been attending these meetings. These investigations are still on going. Documentation seen on the day of inspection confirmed that staff had received Care Homes for Older People Page 19 of 33 Evidence: training in safeguarding adults procedures and refresher training takes part every year. The home has an internal policy on safeguarding adults and this is in line with the local authoritys and the home also has a copy of that procedure. Care Homes for Older People Page 20 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents experience a homely and comfortable environment that is generally well maintained yet housekeeping arrangements need to be further strengthened. Improvements need to be made regarding the prevention and spread of infection in the home and awareness of identified hazards in order to ensure the safety and wellbeing of residents in the home. Evidence: The home was generally clean and tidy. It was confirmed that the home has one full time housekeeper and their duties on their days off were covered by a carer and a catering staff member. In discussion with the registered provider and person in charge it was confirmed that the current housekeeping arrangements were not considered adequate and consideration was being given to allocating cleaning and housekeeping duties to the night staff in order to ensure that the general cleanliness of the home is more fully maintained. Hygiene equipment for hand washing facilities, soap and paper towels, disposable aprons and gloves were available yet it was observed that not all staff adhered to appropriate policies and procedures regarding disposal of protective clothing and clinical waste in the home. It was confirmed that staff hoist residents who are unable to weight bear and staff stated that they use the hoist with two members of staff. It was confirmed that there are two hoists in the home, one on each floor, yet staff advised that one sling is used to support all residents as opposed to residents having their own hoisting sling to reduce the spread of infection in the home. It has Care Homes for Older People Page 21 of 33 Evidence: been required that arrangements must be made for improved management regarding the prevention and spread of infection in the home. It was observed within one shared bedroom, for two people, that the space was inadequate for the physical care of the residents. The room contained two wheelchairs and a portable hoist and one residents bed faced the en suite toilet which it was confirmed was not used. It has been recommended that the use of this room as a shared room be reconsidered to ensure that the residents and staff have adequate space which offers comfort and safety to the residents and staff whilst undertaking their duties. It was noted that a radiator in a residents room was unguarded and the bed was placed against the radiator. It has been required that arrangements must be made that an identified risk regarding a residents bed situated next to an unguarded radiator is appropriately risk assessed and so far as possible the risk eliminated to ensure the safety and well being of the resident when the radiator is working. Care Homes for Older People Page 22 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. Staff in the home are not in sufficient numbers to promote and make proper provision for the health and welfare of residents in the home at all times. Evidence: During the tour of the service during the morning it was observed that staff were busy supporting residents to receive care and be supported to get up and sit in arm chairs or wheelchairs. The staff attended to their duties in a calm manner and those residents who had been supported looked well groomed and appeared comfortable. Staff confirmed that they felt that there was a sufficient number of them to undertake their work and said when asked that they worked as a team to support each other over both of the floors of the home. It was observed that at 12 midday five residents on the ground floor were waiting for staff to support them with their personal care with one individual having been left in a wheelchair with both night and day wear on. It was considered, on the day of inspection, that the staffing levels and management of staff resources did not meet the needs of the residents and may potentially affect residents health and welfare. It has been required that arrangements must be made that the staffing levels and management of the homes routines are reviewed in order to promote and make proper provision for the health and welfare of residents in the home at all times. One survey that a relative returned to us stated Mother is very well looked after, she Care Homes for Older People Page 23 of 33 Evidence: is always clean and well dressed and can decide what she wants to do and when she wishes to retire for the night. We did not sample staff recruitment folders during this inspection as the provider told us that no new staff had been employed since our last visit. As there was no identified problems during the inspection in September 2009 this standard remained untested. The provider told us that she has a trainer for the company. She will provide some of the mandatory training for the three homes owned by the provider and this will include safeguarding adults, infection control and first aid. The home has a training matrix in place and all training that is required is documented for each member of staff and when their update is due. The provider said that the mandatory training will take place at the home and the staff will be informed of the dates that they must attend. The provider also told us that all care staff have the National Vocational Qualification (NVQ) at level 2 with some able to progress to level 3. The provider told us that this training is on going and will be available for any new staff recruited. Staff that completed and returned surveys to us confirmed that they all had recruitment checks prior to staring their employment which included CRB checks and references were requested. All staff received an induction during their first weeks in the home. One staff member told us there is quite intensive care work and up to date training concerning/regarding the ever changing obligations and responsibilities within the job to staff. Another told us that the home train staff in various aspects of care also moving and handling, health and safety etc. Care Homes for Older People Page 24 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management arrangements at the home need to be strengthened to ensure staff have the right mount of supervision and guidance from senior members of the team to enable them to carry out their duties efficiently. Evidence: We spoke with the person in charge and the provider regarding the registration process for the person in charge. The application has been received by us and the process has begun. The person in charge told us that arrangements have been made for an interview to take place at the home. The provider is very visible in the home and visits Springfield Manor almost on a daily basis. It was the provider who selected and implemented the new care planning documentation but there has been no supervision of the staff to ensure that this documentation is fully completed and available for all staff to access as mentioned earlier in the report. The provider told us that the person in charge spends a lot of time listening and talking to the residents and their families to ensure that any problems they may have Care Homes for Older People Page 25 of 33 Evidence: are caught early so this ensures that residents are settled into the home well. The person in charge operates an open door policy and this observed during the inspection with the person in charge giving time to talk with visiting relatives. During the day of inspection we observed that staff dictated how the morning routines would be organised. There was a work plan book in the dining room for staff to refer to which detailed the areas they would work and the time they should take their breaks. There was a registered nurse on duty and following her medication rounds was prepared to help the staff but this took place on the ground floor with little supervision of the top floor. Staff on the top floor did come down to help but as previously documented five residents were still to receive their personal care at 12:15 despite lunch due to be served at 13:00. One member of staff who completed a survey told us managers and carers know very well each and every one of the residents and their needs. I think everyone works very hard to meet the residents needs and make this a great place to live in. We asked for surveys to be sent to the home and we received a number of replies from relatives. One written survey received by the commission from a residents relative stated I visited 18 homes previous to Springfield while trying to find the right place for my dad. As soon as I approached Springfield by phone I was made to feel that my Dads care was important. As soon as he arrived all the carers were immediately helpful to my dad as well as myself. Everyone working at Springfield are always cheerful which in turn rubs off on the clients. The nursing staff are also extra caring and dont just do their job but do all they can for everyone. I have peace of mind now that my Dad is being cared for at Springfield. There was an overall sense that routines in the home lacked a person centred approach for residents and there was a lack of mentorship of good practice and staff management. Some residents appeared to be over compliant with the routines of the home which compromised their well being and rights to independent choice. The person in charge told us that she regularly reviews the way in which staff work at the home and on the day of inspection she was about to do a quality monitoring visit. Regulation 26 visits take place at the home by the provider and these documents are available at the home. The provider told us that this year all residents have had a review of their care by social services and were given the opportunity to tell the care managers about the kind of care they receive at the home. Results of these reviews have been fed back to the provider and person in charge. This year surveys have not been sent to the residents or their next of kin as all have had a one to one Care Homes for Older People Page 26 of 33 Evidence: conversation and have been able to comment on their life at the home. The provider told us that she has also spent a lot of time talking individually with some of the residents and this has all been documented. Care Homes for Older People Page 27 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 28 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 8 13 Arrangements must be made that residents have their calls bells avialable. This ensures that residents can call for assistance when required. 16/08/2010 2 8 12 Arrangements must be made that all staff must accurately document and monitor residents health care records To ensure that the residents records accurately reflect and promote the health, well being and welfare of the resident. 16/08/2010 3 8 12 Arrangements must be 16/08/2010 made for residents preferred choices and wishes are respected with regard to their personal care and residents are supported at all times with dignity, privacy and respect. Care Homes for Older People Page 29 of 33 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 To ensure that all staff have access to the care plans and can support the resident in an agreed way. 4 9 13 Arrangements must be made for the medication procedures of the home to be strengthened in order to promote safe working To ensure the residents are protected during medication administration. 5 12 12 Arrangements must be made that all residents are consulted and informed regarding changes to the agreed programme of activities. To ensure residents are consulted and their wishes and feelings taken into account. Arrangements must be made that a documented menu is avialable for residents. This will ensure that individuals can make an informed choice regarding the meals offered by the home. Arrangements must be made for the appropriate 16/08/2010 16/08/2010 6 15 17 16/08/2010 7 15 12 16/08/2010 Care Homes for Older People Page 30 of 33 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 provision of the care, health and welfare of all residents at meal times. to ensure residents have sufficient supervision and choice regarding their meals. To ensure residents have sufficient supervision and choice regarding their meals. 8 19 13 Arrangements must be made that an identified risk regarding a residents bed situated next to an unguarded radiator is appropriately risk assessed and so far as possible the risk eliminated. To ensure the safety and well being of the resident when the radiator is working. Arrangements must be made for improved management regarding the prevention and spread of infection in the home. To ensure that the residents are adequately protected. 10 27 18 Arrangements must be 16/08/2010 made that the staffing levels and management of the homes routines are reviewed. Arrangements 16/08/2010 9 26 13 16/08/2010 Care Homes for Older People Page 31 of 33 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 must be made that the staffing levels and management of the homes routines are reviewed in order to promote and make proper provision for the health and welfare of residents in the home at all times. To promote and make proper provision for the health and welfare of residents in the home at all times. 11 33 12 Management arrangements at the home should be strengthened. To ensure staff are adequately supervised so that the residents receive the care and treatment required. 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 16/08/2010 1 23 It has been recommended that the use of a shared room is reconsidered to ensure that the residents and staff have adequate space which offers comfort and safety to the residents and staff whilst undertaking their duties. 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. 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