Care Home: Springfield Nursing Home

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What the care home does well Good assessment processes and provision of accessible information means people and their representatives can make an informed decision about moving into the home. For people being admitted to the home for intermediate care effective communication with staff from the Primary Care Trust (PCT) means it can be assured that the needs of the person being admitted for intermediate care can be met at the home. They also receive information about the home so they know what to expect when they move into the home. People living at the home receive the care and support they need in the way they like. This is achieved by effective and responsive care planning, people living at the home being informed and involved in the medical care they are receiving and good liaison and appropriate referrals to health care professionals. Medication procedures protect the welfare of people living at the home. Self management of medications is encouraged for those people assessed as able to do so. There are effective recording systems that detail all care and interactions that people living at the home have with staff members and visiting health care professionals. This means there is a clear audit trail of the care and support people receive. The provision of activities and social interaction enables people living at the home to contribute to the planning and development of activities. This means people have the opportunity to take part in social activities that they have an interest in. People told us they enjoy the meals provided and that they have a choice of what to eat at all meal times. People benefit from living in a clean, safe and homely environment. Changes to the environment are done to improve outcomes for people living there. This is done by responding to requests of people living at the home or their representatives and by the home`s own assessments of the environment that identify areas for improvement. Staffing rota`s ensures there are sufficient numbers of staff on duty at any one time to meet the needs of people living at the home. This is done by planning the numbers of staff to be on duty around the activities of people living at the home. Training is provided for all staff to ensure they have the skills and knowledge to care and support people living at the home. Quality assurance processes used by the home ensure the views of people living at the home are listened to with their views being incorporated into the development plan and running of the home where possible. What has improved since the last inspection? The AQAA told us that home had identified areas for improvement and the inspection evidenced action has been taken to ensure the improvements occur. These include the provision of regular formal supervision for all staff members and the introduction of the use of a professional recognised tool for the assessment of people`s nutritional needs. What the care home could do better: No requirements have been made as a result of this inspection. The service has demonstrated a variety of tools and methods are used to identify areas for improvement and actions are taken to make the identified improvements. Key inspection report Care homes for older people Name: Address: Springfield Nursing Home 26 Arthurs Hill Shanklin Isle of Wight PO37 6EX     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: Gina Pickering     Date: 0 3 0 2 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 32 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 32 Information about the care home Name of care home: Address: Springfield Nursing Home 26 Arthurs Hill Shanklin Isle of Wight PO37 6EX 01983862934 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.sciohealthcare.co.uk Scio Healthcare Ltd Name of registered manager (if applicable) Mrs Lisa Newnham Type of registration: Number of places registered: care home 46 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is: 46 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 categories: Old age, not falling within any other category - OP Dementia - DE Physical disability - PD Date of last inspection Brief description of the care home Springfield is a registered care home providing nursing care and accommodation for up to forty-six people. The home accommodates older people, up to thirty of whom may have a physical disability, up to fifteen of whom may have a terminal illness and up to fifteen of whom may have dementia. The home has ten intermediate care beds, Care Homes for Older People Page 4 of 32 46 0 46 Over 65 0 46 0 Brief description of the care home contracted by the NHS, that may accommodate adults over the age of eighteen years, for which separate facilities are available. The home is located near the centre of the town of Shanklin with local bus stops and shops nearby. The home occupies an extended older property in its own grounds with limited car parking available to the front of the property. There have been a number of extensions to the original home, the most recent having been completed in the summer of 2003. All bedrooms, with the exception of two twin rooms, are for single occupation with many having en-suite facilities. Various communal facilities including several lounges and pleasant secluded gardens are provided. The home is owned by Scio Healthcare Limited and managed by the matron, Miss Lisa Holmberg. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection process considered information received about the home since the last key inspection in February 2007. Since that inspection two Annual Service Reviews have been completed from which we had concluded there had been no changes in the standard of care provided at the home. Visits were made to the service on 18 January 2010 and 3 February 2010. We looked at documentation relating to five people living at the home, had conversations with the registered manager, deputy manager, the Responsible Individual who is one of the Directors of Scio Healthcare Ltd, a second Director of Scio Healthcare Ltd, four staff members, six people living at the home, as well as looking at various documentation and viewing several areas of the home. We sent surveys to people living at the home, their relatives and staff members to gather their views about the running of the home. We had surveys returned from five staff members, one person living at the home and three relatives of people living at the home. Care Homes for Older People Page 6 of 32 Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: No requirements have been made as a result of this inspection. The service has Care Homes for Older People Page 8 of 32 demonstrated a variety of tools and methods are used to identify areas for improvement and actions are taken to make the identified improvements. 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 32 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 32 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. Pre admission processes mean people move into the home believing the home can meet their needs. Information is provided to give people an understanding of what it is like to live at the home. Evidence: The AQAA told us that people interested in living at the home are provided with a brochure that details the services offered at the home. We looked at this document evidencing details in it comply with the Care Home Regulations 2001. Information is presented in easy to read formats with pictures illustrating several areas of the home. People are informed, for example, about what sort of meals are provided, about how to complain and are told what accommodation and care that they can expect to receive. The service user guide also talks about the staff employed and tells people how to identify staff roles and responsibilities by describing their uniforms. Additional information from other organisations such as the NHS and the Registered Nursing Homes Association is added to the statement of purpose. This provides information Care Homes for Older People Page 11 of 32 Evidence: about choosing a care home and paying for care home accommodation and care. Staff told us that each person has a service user guide in their bedroom. We observed this to be the case. Information about the service is also accessible on the registered providers website. People living at the home confirmed they had received information about the service offered at the home before they moved in. People admitted to the home by the Primary Care Trust (PCT) for intermediate care also receive information about the services offered at the home. The AQAA told us that visits from the person wishing to move to the home or their relatives are encouraged. One person told us his/her relatives visited the home prior to the decision being made to move into the home. He/she was unable to visit the home at that time because of his/her medical condition. People living at the home and relatives told us in surveys they had received sufficient information from the home for them to make a decision about moving into the home. The AQAA told us that a full assessment of an individuals needs is carried out by one of the nurses at the home prior to the decision being made as to whether the home can meet that persons needs. Records we looked at detailed that full assessments are completed including personal, health and social care needs, moving and handling needs and risk of falls. Again conversations with people living at the home confirmed that someone from the home had visited them prior to them moving into the home. For people being admitted for intermediate care by the PCT the process of assessment is different. Nurses from the PCT assess individuals for their suitability for intermediate care at Springfield Nursing Home. We were told that their assessment is discussed with staff at the home who make the final decision as to whether the persons needs can be met at the home. The home receives a folder of information including a care plan, copy of medicine charts and information about ongoing specialist support needed, for example if occupational therapy or physiotherapy have been arranged. We discussed the information that the home had obtained with one person who had recently been admitted for intermediate care. They confirmed that the information accurately reflected their needs. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans for people living in the home are person centred detailing the actions needed to meet peoples individual personal and health care needs. Health needs of people living at the home are met by effective use of monitoring processes and prompt referral to relevant healthcare professionals. Management of medications is protecting the welfare of people living at the home. People living at the home have their privacy and dignity protected. Evidence: As part of our inspection process we looked at the care planning documents for three people living at the home and two people who had been admitted for intermediate care. Staff at the home told us that for people admitted to the intermediate care area the home receives a folder of information including a care plan, copy of medicine charts and information about ongoing specialist support needed, for example if occupational therapy or physiotherapy have been arranged. Staff said that although these plans provide adequate information they are in the process of reviewing them with the hospital and the intermediate care nursing team to bring them more in line with their own care planning system which is more person centred. Care Homes for Older People Page 13 of 32 Evidence: The assessment of each persons needs results in care plans being completed for each identified needs or risk. Instructions in the care plans details individual preferences and the actions needed to be taken by care staff to ensure preferences and needs are met. In the care plans we looked at there were clear details about how the personal hygiene needs of people are to be met including what the person can or cannot do for themselves. For one person it was detailed full assistance was required and there were clear instructions about what this involved. For another person who was able to wash him/herself this was clearly detailed including any areas of personal care he/she did need some assistance with. Each person had a moving and handling risk assessment from which a relevant plan of care was developed detailing the assistance required for that person to move safely. This included details about any equipment used to support the person with moving including the type of hoist and sling used. Details about peoples continence needs were included in the assessments and care planning documents. This described the help they needed to remain continent including any assistance needed to go to the toilet and if required the type of protective pad and how often they are changed. Assessments for dietary requirements included the use of a professionally recognised tool for assessing a persons nutritional status, details of food and drink likes and dislikes, details of any problem the person might have with eating or swallowing and any restrictions in diet due to medical needs. Care plans detailed involvement of relevant health professionals for people with specialised dietary needs. This included speech and language therapists, dietitians and specialist nutrition nurses. For one person who was receiving nutrition through a feeding tube into the stomach there were clear details about when the feeds needed to be given which ensured there was no adverse interaction between the feeds and the medication this person was having. Information in this persons files from specialist nutrition nurses indicated the home is following the instructions given about administering this feed. Records were maintained in each persons documents about contacts with health professionals. This included GPs, district nurses, occupational therapists, physiotherapists, chiropodists, dentists, community psychiatric nurses and opticians. One person had had contact with the tissue viability specialist nurse about the management of wounds. The details in this persons care plan were the same as that Care Homes for Older People Page 14 of 32 Evidence: detailed in the notes by the specialist nurse. The person who had these wounds also told us about the dressings nurses used on his/her wounds indicating he/she was informed about his/her care. We were told by a person living at the home the chiropody service that visits the home is very good. We spoke to the chiropodist who was visiting the home at the time of our visit who expressed that he had no concerns with the provision of care at the home. All chiropody was carried out in the privacy of peoples own bedrooms. Care plans paid detail to meeting the psychological needs of people. For example it was detailed in one persons care plan the triggers that caused him anger. Notes made it clear that staff had liaised with relatives and had given information to help them make decisions about the persons welfare. For another person it was detailed that there were occasional low moods because of loss of independence and there were details about how care staff should support this person in this situation. Discussion with both people living permanently at the home and those there for intermediate care indicated that although people might not have been fully involved in writing their care plans the care and support they were being provided with was meeting their preferences and what they needed and was the same as what was detailed in their care plans. Staff told us in surveys they always have up to date information about how to meet the needs of people living at the home. Staff surveys also told us they believe the home provides good care on an individual basis. Care plans are kept in each persons bedroom. This means both the person living at the home and staff members have easy access to the plans which ensures people always receive the care and support they need. A daily record sheet is maintained in the care plan. All staff at the home make entries in this whenever they have an interaction with the person living at the home or enter the persons room. This record sheet includes details of housekeeping tasks, personal care tasks, visits from health care professionals and any maintenance completed in peoples bedrooms. For people who require assistance with changing of positions or assistance with meeting nutrition and hydration this is also detailed on this document. It was observed that the care plans and daily record sheets are taken with the relevant person to the dining areas at mealtimes. This means that any support and assistance provided at meal times can be entered directly onto the record sheets and information is available about the support people need without staff having to leave the person to find that information. The use of daily record sheets provides a clear record of care provided and an effective tool to audit whether the care received by Care Homes for Older People Page 15 of 32 Evidence: people matches the description of the care and support to be provided as detailed on care plans. The AQAA told us that the service has continued to improve the procedures for the receipt, recording, storage, handling, administration and disposal of medication. We spoke with one of the nurses who was completing a drug administration round who described the process for ordering and receiving medications into the home which includes the home having copies of each persons prescription, meaning it could be assured that people were receiving the medications prescribed to them by their medical practitioner. Policies and procedures are in place for people to manage their own medications. We were told that people admitted to the intermediate care area of the home are greatly encouraged to manage their own medications as they will have to be managing their own medications when they return home. We looked at Medication Administration Record (MAR) charts for the peoples whose care plan documents we had looked at. All clearly detailed the name and dosage of the medication and the time that it was to be administered. There were clear guidelines for the use of medications to be taken when required, for example the use of pain killers. The storage of medications was in a clean and orderly manner. The self medicating protocol and risk assessments were completed for people managing their own medications. Suitable lockable storage was available in bedrooms for people to store their medications safely. Staff training records detailed that all staff who administer medications had completed training about the safe management of medications. Throughout the inspection process we observed the privacy and dignity of people living at the home is respected. Details of individual wishes in care plans were evidenced to be followed including how people like assistance to be given with their personal care. A system is used where by a notice on the door of each persons bedroom indicates when personal care is taking place. This helps to ensure their privacy and dignity is being respected and alerts housekeeping staff not to enter the room but return at a later time. Discussion with staff members evidenced they consider Springfield Nursing Home to be the home for people living there and therefore peoples wishes and requests should be respected in their own homes. Staff told us in surveys that the home respects individuals rights, privacy and dignity, indicating staffs awareness of the need to protect and promote the privacy and dignity of people living at the home. Surveys from people living at the home and their relatives indicated that their personal and health care needs are met by the staff at the home. One person talking about his relative told us all possible is done to ensure his/her wellbeing Care Homes for Older People Page 16 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have the opportunity to take part in meaningful activities and social interaction that are of interest to them. Visitors can be received at times suitable to people living at the home. People living at the home benefit from the provision of a varied and balanced diet that allows them choices at meal times. Evidence: At the last key inspection it was identified that there was no formal plan of activities with the activity coordinator arranging activities on a daily basis dependant on the wishes of people living at the home. The AQAA told us we ensure service users enjoy a varied activity programme which tries to meet their individual needs and preferences and that we have a social isolation care plan which allows our service users who dont wish to attend organised activities to stay in their rooms and have access to their own entertainment. There is now a planned programme of activities for each month that is displayed on the entrance hall to the home and is available in each persons bedroom. On the first day of our visit to the home a game of bingo was planned for the afternoon. People living at the home were involved in organising the activity by cutting out bingo cards and setting the table up. Discussion with several people living at the home indicated Care Homes for Older People Page 17 of 32 Evidence: that people living at the home are involved in the planning and organising of activities. One person told us he/she had suggested better ways of designing bingo cards to make it easier for people to use and this idea had been adopted. Another person told us he/she suggested a particular singer should be invited to perform at the home and this was arranged. This person was also involved in arranging the summer fete and raised 100 pounds. We observed the bingo session. The people who took part appeared to be enjoying it. There were impromptu singing sessions during the game. People who do not like group activities are visited by the activity co ordinator who will check if if they want large print books, videos and will spend time chatting with them. On the second day of our visit the afternoon activity was arm chair exercises that was being run by a visiting professional. People told us they enjoyed this session. People living at the home told that even if there are no activities organised there always games they can borrow. One person told us that he/she enjoys playing dominoes with others living at the home or enjoys the socialisation of watching television with other people. One person told us that staff at the home will accompany him/her across the road so he can visit a shop or access his money from his bank. There is a small shop managed by the activity coordinator where people can purchase toiletries and sundries. The activity co ordinator told us she run errands for people who wish to buy items that are not stocked at the home. We heard people ask the activity co ordinator to go to shop for them, she agreed to do this. Information provided in surveys from people living at the home and their relatives indicated satisfaction with the level of activities provided at the home. Staff surveys also indicated they believe the provision of activities is good but that there could be more activities for people outside the home. However this was not a view we encountered during conversations with people living at the home. The statement of purpose details people can receive their visitors when they wish. This was confirmed in conversations we had with people living at the home. The visitors log book detailed people received visitors at varying times of the day. Meal provision at the home allows choices at all meal times for people. A system of coloured menu cards is used ensure people who have special dietary needs such as diabetic diets and pureed meals receive the appropriate diet to meet their health needs. Records are maintained of the choices offered and taken by people living at the home. People living at the home have the choice of where to take their meals whether it is the dining room, the lounge or their bedrooms. People we spoke with confirmed they have the choice of where to take their meals. We observed meals being delivered to people in their bedrooms as well as to people in the lounge and dining areas. People Care Homes for Older People Page 18 of 32 Evidence: admitted to the continuing care area are encouraged to take their meals in the dining area as part of their rehabilitation. We observed people taking their lunch in both the dining room of the main home and the dining area in the intermediate care area. There was a friendly social atmosphere in both dining areas with people chatting among themselves. For people who needed some assistance with their meals this was observed to be given unobtrusively and with sensitivity. People we had conversations with spoke with great satisfaction of the meal provision at the home and confirmed they always have a choice of meals and that snacks are available at all times if they require them. Conversation with the cook indicated the menu plan takes into account the known food preferences of people living at the home and current good practice guidelines about nutrition in the elderly. As detailed in the health and personal care section of this report, for people who require specialist nutritional support such as tube feeding the relevant guidelines from health care professionals are followed. This ensures the wellbeing of people requiring specialist nutritional support is protected. Care Homes for Older People Page 19 of 32 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. The service responds to complaints in a prompt and positive manner, incorporating complaints into part of their quality assurance processes. People living at the home are protected from the effects of abuse by a staff team that has a good understanding about safeguarding procedures. Evidence: The home has a complaints procedure which is available in the Statement of Purpose and service users guide. A record of complaints received is maintained. A complaint log book details the complaint received and the action taken to resolve the complaint. Details in the complaints log book indicated that all concerns raised are considered important and staff act promptly to resolve any concerns or complaints. People living at the home that we had conversations with told us staff at the home listen to their concerns and act on them. The service also provides opportunity with regular quality audit surveys for people to express any concerns or complaints they may have. People living at the home and their relatives expressed in surveys they know who to approach to voice concerns and complaints. One person who told us they knew about the complaints procedures commented that I have never had any concerns. Procedures are in place about the safeguarding of vulnerable adults. Records detailed that all staff have completed training about the protection of vulnerable adults. Care Homes for Older People Page 20 of 32 Evidence: Discussion with staff members indicted a good understanding about safeguarding and they knew what actions to take should they suspect an act of abuse had occurred. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with a homely and well maintained environment to live in that has the relevant aids and equipment to allow their needs to be met. Evidence: Communal areas of the main home consist of a dining room and lounge. In the intermediate care area there is a large lounge/dining room and a small balcony area on the first floor that has easy seating and tables. We were told by staff that although these areas are separate it does not preclude the main areas and the intermediate care areas being used by either group living at the home. This was confirmed in conversation with people living at the home. We observed on the first day of our visit activities for all at the home taking part in the communal area of the intermediate care area and on the second day of the inspection activities for all taking place in the dining room area of the main building. The statement of purpose details that bedrooms can be personalised with items belonging to the individual. Bedrooms that we looked at were individualised with personal belongings to varying degrees. All rooms were single occupation. Appropriate equipment to meet the personal, health and social care needs of people was evident in their bedrooms. This included pressure relieving equipment, call bells, profiling beds, televisions, and sensory equipment. The AQAA told us that in the past year there has been a period of refurbishment of the home including redecoration in several bedrooms, one of the lounges, the manager Care Homes for Older People Page 22 of 32 Evidence: and nurses offices, the laundry and kitchen areas being re furbished with new equipment and improvements being made to the staff room including the provision of lockers. It was evident from our visit that the home is well maintained, new carpets had been fitted throughout the home the day before our first visit. A maintenance man is employed for the home. Conversations with him evidenced good systems in place for reporting maintenance issues which are dealt with promptly. Scio Health Care Ltd care employ two other maintenance man located at their other two care homes. This means there is always one of the companys maintenance men on call 24 hours a day all year round to attend to any maintenance issues that arise. The home was warm and tidy on the days of our visit. There were fresh flowers on display throughout the home. We were told by staff that a regular supply of flowers is maintained so there are fresh flowers at all times in the home. People living at the home told us the home is always clean and tidy. The AQAA told us that improvements had been made to the housekeeping staff by employing housekeeping staff in the evening and having a staggered shift pattern during the day to ensure the building is kept clean and tidy at all times. Staff rotas evidence that this is happening. The cleanliness of the home evidenced that the present housekeeping shift patterns are working to ensure good cleanliness of the home. The laundry room is located on the ground floor consisting of two washing machines and two tumble driers. A separate sluicing washing machine is located in the sluice room located next to the laundry room. Procedures are followed to ensure clean laundry is kept separate from dirty laundry to reduce risks of cross contamination. Separate laundry staff are employed, with a member of the laundry staff being on duty every day. There was sufficient hand washing facilities for staff including hand gels and protective equipment such as gloves and aprons to effectively promote good infection control practices. Staff records evidenced training about the control of infections had been completed by staff members. Any risks associated with the environment are identified in a risk assessment and action is taken to reduce any identified risks. The monthly reporting about the running of the service supports the home to identify any environmental issues that need attending to. We saw copies of these reports that detailed environmental issues such as the need to have new carpets and the decorating of individual rooms. We noted that the views of people living at the home and their relatives/representatives about the environment are considered. Quality auditing surveys we looked at identified that the car park should be made accessible for visitors following which alternative parking has been made available for staff and visitors are now to park in the car park at the home. Care Homes for Older People Page 23 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing rotas which are planned around the activities of people living at the home mean people are being cared and supported by staff members in sufficient numbers at all times. People living at the home are supported and cared for by staff members who have undertaken relevant training to equip them with the relevant skills and knowledge. Recruitment practices are ensuring that people employed at the home have the relevant skills and experience and are suitable to work in the care industry. Evidence: The AQAA told us staffing rosters show that the number of staff and skill levels ensures the home is sufficiently staffed across the 24 hour period. We looked at the staffing rostered for the month prior to our visits. These indicated that flexible shift patterns meant that there were increased numbers of staff on duty during periods of greater activity. For example on a morning between the hours of 8am and 2pm there are two nurses on duty with 9 care staff. Between the hours of 3pm to 4pm there are only 2 nurses with 4 care staff on duty. However at this time the activity coordinator supports people to take part in activities and this is the time many people are having a mid afternoon snooze. Staff numbers increase again at 4pm to 6 care staff and from 5pm there are 7 care staff on duty to support people at meal times and assist those wishing to get ready for bed. Night duties consist of one nurse and three care staff. People living at the home told us in conversations there are sufficient staff on duty Care Homes for Older People Page 24 of 32 Evidence: with call bells generally being answered straight away. The staff rota detailed there are good numbers of ancillary staff such kitchen staff, housekeeping laundry and maintenance staff on duty at any one time. This means that people living at the home do not have their care hours eroded by care staff having fulfil non care duties. Staff we had conversations with confirmed there are sufficient staff on duty at any one time to meet the needs of people living at the home. The home has been divided into zones with a member of the senior care staff (Clinical Team Leader) being responsible for a zone which improves the continuity of care for people living at the home. A training manager has been employed by Scio Healthcare Ltd for the past three and half years. This person is responsible for coordinating the training for all staff employed by Scio Healthcare Ltd which includes the staff working at Springfield Nursing Home. We had a conversation with this staff member who spoke very enthusiastically about her job. She told us all new staff complete a two day induction and those new staff who have not completed NVQ level 3 in care complete an induction programme that complies with Skills for Care common induction guidelines. All staff given folder which contains relevant codes of practice and handouts on all mandatory training including health and safety, infection control, safeguarding, moving and handling, food hygiene, safe handling of medication and fire safety. She told us that staff receive 21 - 22 paid hours per year to complete training. A training matrix maintained by the training manager enables easy monitoring of the training staff have undertaken and identifies training required. This record detailed that all staff have completed mandatory training about health and safety issues such as fire safety, moving and handling, food hygiene and the protection of vulnerable adults. Further records evidenced training staff have completed other than the mandatory training. Examples of such training include dementia awareness, palliative care, management of medications, nutrition and nutritional assessments, challenging behaviour and diabetes. This means that people living at the home are being cared and supported by a staff team who have been provided with relevant training so ther needs can be met. The AQAA told us that over 50 of the care staff working at the home have completed NVQ level 2 in care. Training plans indicated that further care staff are undertaking NVQ studies in care. Ancillary staff are also given the opportunity to complete NVQ training in their area of work, with the housekeeper having completed NVQ 2 in housekeeping. Staff that we spoke with told us they have the opportunity to Care Homes for Older People Page 25 of 32 Evidence: complete training relevant to their role and that if there is an area they feel they need instruction about the company will provide it. Information in staff surveys returned to us indicated training provision is good with comments received including we can attend training and are encouraged to do so. Th AQAA told us the home follows relevant recruitment procedures to ensure people working at the home are suitable to work in the care industry. We looked at the recruitment files for four staff members recruited in the past year. These evidenced that all necessary information was received prior to the person commencing employment at the home. This includes satisfactory written references, the receipt of checks against the Criminal Records Bureau(CRB)and Protection of Vulnerable Adults List (POVA) and for nurses checks with the Nursing and Midwifery Council. Discussion with staff indicated they believed that recruitment procedures were robust and that relevant checks were received by the home prior to them commencing employment at the home. Care Homes for Older People Page 26 of 32 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. The management of the home is committed to improving outcomes for people living at the home. The views and opinions of people living at the home are listened to and considered in the development and running of the home. The finances of people living at the home are protected. The health and safety of people at the home is protected. Evidence: The registered manager who is a registered nurse has been managing the home for the past six and half years. Over that period she has demonstrated her continued commitment to improving outcomes for people living at the home. She is supported by a deputy manager and has recently implemented Clinical Team Leaders for each of the four areas of the home to take management responsibility for those areas including clinical auditing and supervising of staff. Training records detail that both the manager and her deputy have completed training to equip them with managerial skills. This report details many areas where the actions taken by staff and the Care Homes for Older People Page 27 of 32 Evidence: management of the home result in positive outcomes for people living at Springfield Nursing Home. This includes effective care planning processes, involvement of people living at the home in planning social activities, good provision of training and inventive rostering of staff ensuring the number of staff on duty at any one time always meets the needs of people living at the home. The AQAA told us that quality assurance systems ensure the home is run in the best interests of people living at the home. We discussed quality assurance with the manager and the responsible individual for the home who is one of the companys directors. We were told that surveys are completed six monthly, with responses being collated and acted on. People were asked not only about their practical experience of living at the home eg whether they are assisted properly with their personal care but also asked their opinion about whether they feel valued and whether they are involved in decision making. Examples of actions taken as a result of responses to surveys include the car park being made available for visitors, garden courtyards to be upgraded, alternative activities such as massage being offered, improvements to the building with window treatments for front and back and alternative snacks being made available such as fruit and herbal teas. Regulation 26 reports support the quality assurance of the service. These involve the visit to the home of a representative of the registered provider who considers all areas pf the running of the home. This includes discussion with people living at the home, staff members, inspecting the environment and documents following which a written report is completed. As detailed in the environmental section of this report, there is clear evidence in these reports that identified issues are being acted on. The AQAA identified that improvements were needed to ensure staff at the home receive regular formal supervision. A plan for supervision has been implemented with clinical team leaders being responsible for supervising a team of staff. Staff training records detail that those staff who supervise have received relevant training. Staff we spoke with told us they receive regular and relevant supervision from senior staff members. Health and safety policies are in place with staff receiving regular training about health and safety topics. Records detailed there are sufficiently appointed first aiders. A first aid risk assessment covers all risks to people posed by the environment and working practices with action detailed to be taken to reduce identified risks. We looked at a sample of service certificates which indicated the home ensures equipment and services are maintained in accordance with relevant guidelines for the Care Homes for Older People Page 28 of 32 Evidence: protection of all people at the home. We saw documentation to indicate the service complies with relevant fire safety legalisation. Care Homes for Older People Page 29 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 32 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 Care Homes for Older People Page 31 of 32 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 32 of 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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