Care Home: Springfield Residential Home

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What the care home does well We found that Springfield House presents a genuine commitment to providing care with a competent, yet open and personable approach. We found that this was reflected in our observation of a confident relationship that exists between carers, and those people using the service in offering a good standard of service: "Since being at Springfield she has improved, becoming more calm and content. This in turn has meant family life generally has improved". "Good care for the residents, ensuring they are happy and their individual needs are met, as well as giving support and reassurance to relatives". From our examination of care records we established that there was an effective assessment, care planning and review of individual needs, which are meaningful and robust in formulating a good standard of care. No person was admitted to the Home without a full assessment of his or her needs. When we discussed the quality of care with those people using the service, it was made clear that they appreciated this highly personable attitude and approach to care. We observed staff to be polite, amenable and responsive to the daily routines and needs of the people who use the service. We saw at first hand the impact of a positive activity co-ordinator and the importance of the socialisation aspect of care, appreciated by the people spoken with at the time during the course of the inspection. We considered that the overall management style demonstrated a very positive approach in maintaining an environment conducive to the care of the physically disabled and elderly. There is a regular appraisal and review process of facilities and services by the Providers to maintain that environment. The Care Manage presented a positive and enthusiastic attitude in meeting her responsibilities. What has improved since the last inspection? The Home has demonstrated a commitment to caring for the elderly with good quality standards, which need to be maintained. There has been a consolidation of the activity coordination and socialisation approach, and that people are given an opportunity to be actively involved in the planning of care. There have been meaningful advances made in staff training and awareness, with courses arranged to meet specific and mandatory requirements. What the care home could do better: We have advised that the presentation of an audio and pictorial version of the Service User Guide would help people with poor eyesight to make an informed choice as to whether or not that the Home can meet their needs. There were several instances where it would be advisable to consider a formal management base in the Home, to improve communications and day to day awareness of care, and secure storage for confidential files, a staff handover and communication point, with a suitable room to talk in confidence. We also recommended that the Care Manager ensure that a night report is logged at all times, to maintain an effective monitoring record. Having a base will facilitate supervision and management of care, including when care staff observe any untoward event, that the matter is reported to the Care Manager immediately. There is a need to reinforce staff training in matters regarding safeguarding and the recognition of events that may affect vulnerable people. We have advised the care management to ensure that all medicinal ointments and drops are dated when first used, to ensure that out of date stock are not used. It was a feature of many suggestions made by relatives and visiting staff that the Provider make good the access road to the Springfield site, to ensure the safe passage of vehicles, and render the surface fit for wheelchair access. There is a need to ensure that each of the people using rooms accessed by steep steps and lack of mobility aids, have a suitable risk assessment made and discussed with them regarding the safety factors. That the practice of using one of the lounges to store wheelchairs during the day ceases, to present a safe environment, and fulfill the purpose of a pleasant lounge area. We advised that consideration be given to the continuation of a double bedroom unsuited for the purpose, due to lack of active ground floor space, blocking of radiators with furniture, lack of privacy and poor en-suite facilities, and that the practice of using wheeled curtain screens be discontinued with the fitting of overhead curtain tracks in double bedrooms. We have noted that the number of staff with a NVQ qualification fail meet the expected 50% rate to ensure that a suitably qualified care staff offer a quality care to people living in the home. That the recording of staff appointments and maintenance of staff records be reviewed to ensure a consistent and thorough approach to effective employment procedures. Key inspection report Care homes for older people Name: Address: Springfield Residential Home Oaken Drive Codsall Wolverhampton Staffordshire WV8 2EE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 0 6 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Springfield Residential Home Oaken Drive Codsall Wolverhampton Staffordshire WV8 2EE 01902844143 01902845093 springfield.house@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Springfield House (Oaken) 2001 Limited (wholly owned subsidiary of Four Seasons Health Care Limited) care home 35 Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 35 Dementia (DE) 6 Date of last inspection Brief description of the care home Springfield House is located on the periphery of the village of Codsall. Standing in its own grounds the home is accessed via a long drive. The home was registered some years ago to offer accommodation to older people; the home has been extended sometime ago, but retained the majority of its original features. Within the grounds Care Homes for Older People Page 4 of 33 Over 65 0 35 6 0 Brief description of the care home and screened by trees there is a large lake. Bedrooms are located on the first and ground floor; the first floor can be accessed via the stairs or one of the two shaft lifts. Some of the bedrooms have an en-suite facility, the bathing and separate toilet facilities are located throughout the home; the provisions of toilets are located near to the communal area. The dining room is central to the home and while not extensive provided sufficient space for those people that chose to use it. Lounges were spacious providing exception space for people to wander freely. The lounge near to the dining room tends to be used by the frailer person. At the rear of the home there was a large conservatory, the home was generally well furnished and maintained. The full range of charges were not detailed in the services Statement of Purpose or Service User Guide documents as routine. The reader may wish to contact the service to obtain more detailed and up to date information about fees. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Registered Care Manager and senior care staff on duty. Our inspection of the building allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 32 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with health care needs. To do this we looked at (case tracked) three peoples files from referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people living in the home, relatives and members of staff, who took an active role in the inspection process, and contributed to the subsequent report. We acknowledged receipt of the Annual Quality Care Homes for Older People Page 6 of 33 Assurance Assessment (AQAA), and thirteen survey forms returned from those we sent out to people before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming consistent good practice and effective management. There followed a report feedback, in which we offered an evaluation of the inspection to the Care Manager and the Deputy Care Manager, indicating those recommendations resulting from the inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: We have advised that the presentation of an audio and pictorial version of the Service User Guide would help people with poor eyesight to make an informed choice as to whether or not that the Home can meet their needs. There were several instances where it would be advisable to consider a formal management base in the Home, to improve communications and day to day awareness of care, and secure storage for confidential files, a staff handover and communication point, with a suitable room to talk in confidence. We also recommended that the Care Manager ensure that a night report is logged at all times, to maintain an effective monitoring record. Having a base will facilitate supervision and management of care, Care Homes for Older People Page 8 of 33 including when care staff observe any untoward event, that the matter is reported to the Care Manager immediately. There is a need to reinforce staff training in matters regarding safeguarding and the recognition of events that may affect vulnerable people. We have advised the care management to ensure that all medicinal ointments and drops are dated when first used, to ensure that out of date stock are not used. It was a feature of many suggestions made by relatives and visiting staff that the Provider make good the access road to the Springfield site, to ensure the safe passage of vehicles, and render the surface fit for wheelchair access. There is a need to ensure that each of the people using rooms accessed by steep steps and lack of mobility aids, have a suitable risk assessment made and discussed with them regarding the safety factors. That the practice of using one of the lounges to store wheelchairs during the day ceases, to present a safe environment, and fulfill the purpose of a pleasant lounge area. We advised that consideration be given to the continuation of a double bedroom unsuited for the purpose, due to lack of active ground floor space, blocking of radiators with furniture, lack of privacy and poor en-suite facilities, and that the practice of using wheeled curtain screens be discontinued with the fitting of overhead curtain tracks in double bedrooms. We have noted that the number of staff with a NVQ qualification fail meet the expected 50 rate to ensure that a suitably qualified care staff offer a quality care to people living in the home. That the recording of staff appointments and maintenance of staff records be reviewed to ensure a consistent and thorough approach to effective employment procedures. 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. The needs of people who may use the service are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services Statement of Purpose and Service User Guide and found them to provide an informative description of Springfields aims, objectives, and the way it operated, and we acknowledged that the documents were presented to all enquirers. We acknowledged that the informative Service User Guide is presented to all enquirers, and is produced in large print as and when necessary. We also advised that the Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. The weekly fees are not included in the Service User Guide, should people require more Care Homes for Older People Page 11 of 33 Evidence: information they should contact the Care Manager direct. Our examination of three peoples care records and plans, confirmed that each person had an individualised pre admission Assessment, and were invited to visit the Home with family members, before any decision is made. We identified that the Care Manager or her deputy, at the point of reference, conducts the pre-admission assessment. We found that each record showed the attention to individuality, with the assessment formulating a care support plan, based on assessed, individual needs. This assessment is produced with the involvement of those people admitted and family, allowing them to have an influence in the direction of care. Following an assessment the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. Likewise people are informed of those facilities, and are encouraged to seek clarification concerning the general and specific services available for people who may use the service. Comments received: We are asked a lot of questions about my needs, and we asked a few about them, it was a pleasant and helpful exchange. Quite happy with the home, the staff and the care I receive. Its what I expected. The plan of care presented a profile with physical, mental and social assessments, stimulating a daily living plan. General comments we received from surveys, and with talking to people showed to us a confidence that people had in the service: We acknowledged through case tracking that any special needs of the individual were discussed fully and documented, ensuring their individual needs would be met. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. The Home does not provide 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A wide range of needs are addressed through the care planning process, meeting clear principles of respect, dignity and privacy towards people who use the service. Medicine administration systems are safe and secure. Evidence: Our examination of care records and case tracking showed a good quality process of assessment, with individual care plans developed for person admitted to the home. We found that the pre-admission assessment; Care and Health Assessment Process (CHAP) represented the foundation for a well considered, and detailed care planning process, including risk assessments for mobility and falls, tissue viability and nutrition. We recognise that peoples profiles offered an individual plan of care, based upon dependency assessment and activities of daily living. Each persons health, personal and social care needs were found to be appropriately assessed in an individual plan of care that is reviewed monthly, to reflect their changing needs and adapting care profiles, supported with an informative daily progress report, although there is an inconsistent night report sequence, to which the Care Manager responded immediately. We also recognised the key worker diaries held which maintains a useful Care Homes for Older People Page 13 of 33 Evidence: record of living in the Home. The AQAA stated, and we confirmed that those people who use the service, families and friends are invited to participate in the care planning process, and established monitoring systems following a process of goals, care, and evaluation of quality care plans. Case tracking confirmed to us that specialist support and advice are sought as needed, with each person using the service having access to a local Doctor, Dentist, Optician, Chiropodist, and District Nurse as required. We consider that the strength of planned care lies within the frequency of the review process in monitoring and adapting care profiles and risk assessments. Included in the care records were applications of established monitoring systems following a process of recognition and evaluation. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at Springfield. Comments we received in the course of inspection: Prior to coming to this home X was in another care home. There is no comparison between that home and Springfield. She has Alzheimers and her condition deteriorated rapidly at her first care home. Since being at Springfield she has improved, becoming more calm and content. This in turn has meant family life generally has improved. Care for the residents, ensuring they are happy and their individual needs are met, as well as giving support and reassurance to relatives. The care and support I get is satisfactory for me. Communications are good and they soon get the GP if medical problem. Always clean and tidy. Admin is good and helpful and the carers are friendly. On checking the daily report system we observed that an inappropriate incident had been recorded but not reported to the Care Manager by the care staff. The incident was found to be isolated, yet indicative of a lack of management presence in the Home, with both managers based in the Springfield Nursing Home on the same site. We advised that a base or office be established to ensure a focal point so that supervision and management of care is presented effectively. We examines the process of managing accidents and untoward incidents, which were found to be satisfactorily dealt with, although the Care Manager was advised to store accident records to care plans to comply with Data Protection. Cross referencing Care Homes for Older People Page 14 of 33 Evidence: accidents and events with care plans showed a connection of appraisal and review. The administration of medicines adhered to procedures to maximise protection to people. We saw that ordering and storage was secure. We looked at the controlled drug arrangements, and found it to be in order. Random checks of medicine stocks against Medicines Administration Record (MAR) sheets confirmed a consistent and accurate administration. We advised that prescribed ointments, drops should be dated on opening. Records were seen to be complete and easy to follow through, with no observed breaches in the system. Self medication and risk assessment policies were seen to be satisfactory with no one in at the time who wished to participate in the scheme. We confirmed that only senior care staff administer medication, all having received training in the Safe Handling of Medications. We found an effective and smooth process of ordering, receiving, storing, administering and disposing of medicines. Records were seen to be complete and easy to follow through, with no observed breaches in the system. All three people being cases tracked were found to have appropriate medication. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service, visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a fruitful exchange, all being very complimentary of care. Care Homes for Older People Page 15 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are central to the homes aims and objectives. People are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be flexible, non institutionalised to accomodate peoples abilities and wants, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, clearly identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. Families and friends are actively encouraged to participate in the daily life of the home, with no restriction being placed on visiting times. During the course of the inspection we saw staff interact with people in a positive and polite manner. General comments received from people in the course of inspection, indicated an appreciation and involvement with the progress of their health and social status. The Home shares the services of a full time activity coordinator with the Nursing Home. We observed a Care Homes for Older People Page 16 of 33 Evidence: very positive commitment in her dealings with people living in the Home and relatives. There was evidence that people are engaged, and their views are sought after when she is planning forthcoming activities within the home and trips out of the home. We saw that each person has a social activities care plan in place, evaluated on a monthly basis, or more frequent if necessary. We sat in briefly in a Residents meeting, held in the conservatory in which people were seen to be actively pursuing their opinions on a wide range of subjects concerning their residency. We also saw a relative who is to present a memorial seat to the Home, facilitated by the Coordinator. Groups from the local community are encouraged to visit the home such as the local school and church choirs, Brownies from the local community as well as outside agencies are welcome. Our discussions with people indicated a degree of appreciation of routine events, and the efforts made, although most people said they would like more activities and diversions: Someone to take us outside if we wish, usually quite good, but not always. Could provide more exercise. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms inspected showed a significant influence of personalisation in the inclusion of belongings, some furniture and general decor. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. We found that the standards of catering offered a satisfactory service, to which those people we spoke with were generally complimentary of all aspects of quality. A menu, arranged by the cook on a weekly basis, offered a wholesome, varied and suitable choice. We observed a pleasant lunch served during inspection, with choices available and optional preferences matched, served in a functional dining room. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: Feeds you well with good food, looks after our welfare. Give more choice on menu. We also received some other opinions from people living in the Home: Care Homes for Older People Page 17 of 33 Evidence: On the printed menu card there is a choice of main dish, but we are never asked which of the two main dishes we would like to have. They come and give us the first dish of their choice, but when asked to give us the other choice they do not have it and cannot give it. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people using the service. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. There were five diabetic and seven soft diets being catered for. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed peoples requirements. The manager informed us that each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. We found this to be true and saw that each person who wanted one has a lockable facility available in their rooms. The manager informed us that each individual is encouraged to be independent with regard to financial affairs with the assistance of their relatives. We discussed with the manager the arrangements for handling small amounts of personal monies, and found that they were efficiently handled, and checked by the Registered Provider. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. There are regular weekly Church of England services held, and a Roman Catholic priest attends on a request basis. A Sikh priest attends a person living in the home on a regular arrangement. No other diverse religious needs were identified at the time of inspection. We were informed that relatives are welcome to stay as long as they liked in times of stress, including overnight stay. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care: 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a meaningful complaints policy. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We found that peoples legal rights are protected by the systems in place in the service to safeguard them, including their contract, the continual assessment of care planning and policies in place, for example, the complaints procedure, which we examined. There were few minor concerns dealt with through a record of concerns, complaints and safeguarding, to record peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. We saw evidence in case tracking that people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been no complaints made to us directly since the last inspection, and have been notified of a safeguarding incident which was resolved with no further action. There is a concern regarding the interpretation of what a safeguarding issue represents, which requires a clarification from the Provider in on going training of care staff. Care Homes for Older People Page 19 of 33 Evidence: Comments we received from people who use the service on the day of inspection: The manager always sees to my problems in a very pleasant way, and gets them sorted out. Yes but havent really had the need. I know who to go to if I have a problem, but I havent had to as yet. Our discussion with the Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. It is stated in the AQAA that the home operates a responsible attitude to abuse, and emphasis is placed on staff training and raising abuse issues. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on safeguarding against abuse at induction, this includes the right to Whistle blowing, consistent with the Public Disclosure Act, 1998. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home generally provides a safe, well maintained, clean and comfortable environment for the people who use the service. Evidence: An inspection of the Home verified that the premises were fit for purpose, clean warm and tidy, and being satisfactorily maintained. External car parking and grounds are spacious and well maintained. The open gardens and patio offers a very pleasant area for fresh air and reflection. The state of repair and maintenance is generally very good, offering a comfortable, homely yet secure environment. External access is via a poorly maintained country lane, set in beautiful pastoral countryside. It remains a consistent irritation for all vehicle access, and is unsuited for wheelchair use. Visitors and people who use the service take advantage of very attractive gardens and grounds; on site pathways were safe and recently attended to. We were informed that on admission the Care Manager assesses each individuals needs for equipment and necessary adaptations, we found this to be correct, and saw those facilities in most areas throughout the Home. There are areas on the first and second floor that are unsuited for wheelchair or walking aid equipment, that cannot be fitted to assist people with mobility problems, with small, twisting corridor access, suitable only for people with full mobility. We advised that each of the people using these rooms have a suitable risk assessment made and discussed with them regarding Care Homes for Older People Page 21 of 33 Evidence: the safety factors. Nevertheless the great majority of the rooms in the Home are accessed with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors, suitable for wheelchair access. All communal areas are of a good standard, offering social as well as private reflection, as the mood takes. The home provided three lounge areas that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. One lounge is used to store wheelchairs during the day, presenting a risk factor, and undermining the purpose of a pleasant lounge area. A beautifully designed, large ballroom area can be used as a lounge, but has a deteriorating decor and maintenance that offers a place for meetings, training and storage. The conservatory provided a very popular living area where people could experience the views of the surrounding grounds, although it needs an upgrade of decor and cleaning to maximise its use. The dining room by contrast is a large, plain room which can get overcrowded if everyone decided to eat together, especially, as was observed, when a number of people require assistance with their meals. Toilets and bathrooms were located on both floors and were in close proximity to bedrooms and communal areas. The standard and presentation of all the toilets were generally of a good quality, clean, uncluttered and freshness. Three of the communal bathrooms were well equipped and of a high standard, but two were not in use awaiting refurbishment. Adequate attention has been given to ensure maximum privacy within risk assessed boundaries. Infection control is a feature within the staff induction and supervisory training programmes. Bedrooms were well maintained to meet peoples personal preferences. On inspection most bedrooms were highly personalised, displaying the persons own furniture, and personal belongings. Efforts had been made to provide a homely atmosphere, and the decor was found to be of a good standard. Some of the original furniture is in need of renewal, especially sink surrounds which were inadequate in a number of rooms. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the inspection. We found that the high standard of decor was beginning to show wear and tear in several rooms, requiring timely intervention to maintain that standard. Double bedrooms have no provisions for privacy, requiring overhead curtain screening, although we found a positive move by the Care Manager to commission some of the double rooms to single accommodation. We examined one room and found it to be unsuited for double room status, with ground space available for people to enjoy their living space inadequate. There was no provision for dignified privacy, furniture blocked the radiator and restricted movement, Care Homes for Older People Page 22 of 33 Evidence: and the single en suite was too small for two people to use. There was nowhere for people to entertain guests, and storage was extremely difficult. The remaining bedrooms have adequate space to assist with personal care and dressing assistance. The Care Manager expressed a willingness to meet any reasonable demand for special needs. A locked facility and lockable bedroom doors are made available on request, following suitable risk assessment. The nurse call alarm system was satisfactorily tested, and personal appliance tested (PAT) equipment, that is televisions, radios, where seen to be tested. People we spoke to during the course of the inspection expressed their general approval of their accommodation standards, which was complemented with the large number of personal items brought in to enhance the homeliness of their rooms. The housekeeping services in the home were seen by us to be of a high standard. The people spoken to generally remarked that they find the environment always very clean and fresh. To complement the presentation there were numerous floral and decorative displays. Comments we received from a survey we sent out before the inspection, and from people we talked with on the day: Care for the residents ensuring they are happy and their individual needs are met as well as giving support and reassurance to relatives. The drive is a Bumby. Very much so, a very pleasant environment, its a lovely place in every way. A comfortable, friendly place to live, all comforts of home but with safety in mind. The home achieves a high standard of cleanliness. We found the kitchen presentation showed satisfactory standards of cleanliness, and evidence of sound food hygiene practices. We found the small laundry was well organised and equipped to a barely adequate standard, although the promised move to larger quarters is long overdue. Chemical and disinfection safety regulations were evidenced, and would be enhanced with posters clearly displaying, and relevant to, solutions in use. The external and internal environment was well maintained and secure. Heating and ventilation were found to be satisfactory and lighting was domestic in style. Aids, adaptations and equipment were available throughout the Home. Fire equipment was Care Homes for Older People Page 23 of 33 Evidence: inspected and seen to be serviced and up to date, although we found an extinguisher to be unsecured, leading on to a risk section of corridor. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels ensure that suitably trained staff are provided to meet the needs of people who use the service. Recruitment and training processes are satisfactory, protecting the people who use the service from harm and abuse. Evidence: There were 32 people using the service on the day of inspection. Three weeks of duty rotas were examined, from the 20.07.09 through to the 09.08.09. The consecutive duty rotas were examined, providing evidence that the home is suitably staffed in numbers, skills and qualifications to ensure the needs of people are met. On the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 4 carers Afternoon shift 1 Senior Carer and 4 carers Night duty 1 Senior Carer and 2 carers We recognised that the Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and Care Homes for Older People Page 25 of 33 Evidence: absence; agency staff are not deployed. The Manager is supported by a team of experienced senior carers and a satisfactory complement of care and support staff. The administrative, catering, domestic and laundry hours were determined and found to be appropriate for the size of the home and the needs of people. We were informed through the AQAA that some 35 of care staff have NVQ II or III, 15 being trained, with all new staff scheduled to undertaking training. This was confirmed on examination of training records and speaking with staff. It is recognised that staff received a meaningful training programme, which is not reflected in the maintainence of records to confirm achievements, and to compliment a thorough induction programme. We consider that the administration of training needs to be reviewed to ensure that all mandatory, and relevant specialist subjects are conducted in a timely schedule. The Provider and Care Manager have established, and continue to pursue a comprehensive procedure for interview, selection and appointment of staff, although there remains some inconsistencies in the records management. The Care Manager was advised to maintain a strict protocol of appointing staff and establishing a robust management of staff records. Our discussions with the staff indicated a strong morale, and satisfaction with the employers and standards of care offered. Several commented: Its good working at Springfield, the seniors are very diligent and helpful, and the manager very approachable. We are all proud of the standards of care here. It can get a bit pressurized at times, and an office base would be very helpful in our dealings with people, but having said that Im very pleased in working here and the satisfaction one gets from our dealings with people is great, a really good home. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can be assured that the home is run in their interests, based on openness and respect. Evidence: The Home Manager Annette Butler Jones, has over the past two years demonstrated effectiveness in establishing a solid management foundation, implemented to achieve a good standard of set aims, objectives and care. She has been actively engaged in quality reviews and audits with the Registered Providers, following our last inspection and registration with us, meeting compliance to requirements, and addressing recommendations we made. She has achieved her NVQ Levels II, III and the Registered Managers Award (RMA) qualification. We observed an openness, professional and pleasing confidence in the interactions of staff, relatives and people who use the service, based on mutual trust and respect. Comments from those people Care Homes for Older People Page 27 of 33 Evidence: we met in the course of inspection told us: I have settled in very well, its not my home, but you cant expect that. I have been very impressed with the kindness and willingness to help, no complaints. A lovely, friendly home, very relaxed, a homely atmosphere. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning and monitoring, staff selection and of the general environment, these are up to date and accurate. Health and safety notices can be seen throughout the Home, although Chemicals safety notices (COSHH) should be prominent in areas of use and storage. An examination of administrative, monitoring, planning and care records showed to us that record keeping has not been consistent, especially on staff training and appointment schedules to reflect the observed good standards, confirmed on speaking with staff, visitors and people using the service. Records inspected included surveys asking people who use the service their opinion, these are conducted annually, in conjunction to a Team Audit from the Providers. The Manager offered evidence of procedures and safe working practices. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. The Care Manager was advised to archive accident records to individual care files, in accordance with Data Protection requirements. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Registered Provider and Care Manager in respect of pocket money, comfort fund and petty cash management. We found that staff supervision is established as a routine practice, and was agreed that a formal approach to a delegated process would be re introduced. The administration and management of the home is affected with the lack of a management base in the home, which is presently situated in the Nursing Home on the same site. Communications and day to day awareness would be improved with an established base within the home. This would also help in having a secure storage for confidential files, a staff handover and communication point, and a room to talk in confidence. Care Homes for Older People Page 28 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 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 An audio and pictorial version of the Service User Guide would help people with poor eyesight to make an informed choice as to whether or not that the Home can meet their needs. That accident forms, once completed are kept in care plans to reflect the outcome of events and influences on care, and to comply with the Data Prortection Act. The Care Manager wil ensure that a night report is logged at all times, to maintain an effective monitoring record. That the care management establish a formal base in the home, to ensure that adequate supervision and management of care is afforded at all times. That care staff on observing any untoward event ensure that the matter is reported to the Care Manager immediately. That the care management ensure that all medicinal ointments and drops are dated when first used to ensure that out of date stock are not used. There is a concern regarding the interpretation of what a safeguarding issue represents, which requires a clarification from the Provider in on going training of care staff. Page 30 of 33 2 7 3 4 7 8 5 9 6 18 Care Homes for Older People 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 7 19 That the practice of using one of the lounges to store wheelchairs during the day ceases, to present a safe environment and fulfil the purpose of a pleasant lounge area. We advised that each of the people using rooms accessed by steep steps and lack of mobility aids, have a suitable risk assessment made and discussed with them regarding the safety factors. The Provider shall ensure that all fire equipment is secured to a wall mounting, to minimise the safety risk to people living in the home. That the Provider make good the access road to the Springfield site, to ensure the safe passage of vehicles and render the surface fit for wheelchair access. The Provider shall ensure that the decor, furnishings and presentation of bedrooms be maintained , to facilitate a suitable environment for people to live in. That consideration be given to the continuation of a double bedroom unsuited for the purpose, due to lack of active ground floor, blocking of radiators with furniture, lack of privacy and poor en suite facilities. That the practice of using wheeled curtain screens be discontinued with the fitting of overhead curtain tracks in double bedrooms, to maximise the privacy and dignity of people sharing that facility. That the number of staff with a NVQ qualification meet the expected 50 rate to ensure that a suitably qualified care staff offer a quality care to people living in the home. That the recording of staff appointments and maintenance of staff records be reviewed to ensure a consistent and thorough approach to effective employment procedures. That the documentary record of staff appointments and training schedules reflect the observed standard found on the day. That consideration be given to establish a formal manement base in the home to improve communications and day to day awareness of issues in relaion to care of peole living in the home, and secure storage for confidential files, a staff handover and communication Page 31 of 33 8 19 9 19 10 19 11 19 12 23 13 24 14 28 15 29 16 29 17 32 Care Homes for Older People 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 point, and a room to talk in confidence. 18 33 That the recording of staff appointments and maintenance of staff records be reviewed to ensure a consistent and thorough approach to effective employment procedures. 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