Springfield Care Home Limited

We found the following examples of good practice.

•The service had two visitor pods where they could book in at a time that suited people. Time slots were spaced to avoid potential infection transmission with other visitors and allowed for visitor area’s to be cleaned between visits. Visitors were offered an area to sit and wait for a negative COVID-19 test if they had not had one before arrival.

• The service provided staffing levels above their required dependency for the amount of people living at the home. This decision had been made to ensure there were enough staff in the event of another COVID-19 outbreak and potential staff sickness.

• The service had appointed a COVID-19 lead to encourage staff and people to comply with the service’s COVID-19 testing regime. The lead had been implemented in response to staff receiving inconclusive results and took an active role in ensuring tests were registered and conducted in the correct way.

The care home accommodates 40 people across two floors, some people who are living with dementia. At the time of the inspection 36 people were being supported in the home.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service had a registered manager in post. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Risks to people and the environment were assessed and plans put in place to mitigate against them. Risk assessments were reviewed regularly.

Recruitment processes were in place with all necessary checks completed before staff commenced employment.

The provider used a dependency tool to ensure staffing levels were appropriate. The dependency tool was reviewed regularly.

The provider had a business continuity plan in place in case of an emergency. People had Personal Emergency Evacuation Plans (PEEPs) in place which were updated regularly.

Staff were aware of safeguarding processes and knew how to raise concerns. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s quality assurance system.

The provider ensured appropriate health and safety checks were completed. We found up to date certificates were in place which reflected fire inspections, gas safety checks and portable appliance tests (PAT) had taken place.

Staff completed an induction on commencement of employment. We found staff received regular supervision and an annual appraisal. Opportunities were available for staff to discuss performance and development. Staff training was up to date.

People’s nutritional needs were assessed. People were supported to maintain good health and had access to healthcare professionals when necessary and were supported with health and well-being appointments.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and relatives felt the service was caring. Staff provided support in a respectful manner ensuring people’s privacy, dignity and independence was promoted.

Care plans were personalised to meet people’s needs.

People enjoyed a range of activities both inside and outside the home. The service had positive links with the community with people accessing the theatre, local centres and shops.

The provider had a complaints process in place which was accessible to people and relatives.

Staff were extremely positive about the registered manager. They confirmed they felt supported and could raise concerns.

We observed the registered manager was visible in the service and found people interacted with them in an open manner. People and relatives felt the management approach in the home was positive.

The provider worked closely with outside agencies and other stakeholders such as commissioners and social workers.

The premises were well suited to people’s needs, with ample dining and communal spaces. Dementia friendly areas were situated in several areas of the home. Bedrooms were personalised to people’s individual taste. Bathrooms were designed to incorporate the needs of people living at the home. The garden area was accessible to people.

We found that there were sufficient numbers of staff on duty in order to meet the needs of people using the service, as well as to ensure premises were clean and well maintained. Staff were appropriately vetted via Disclosure and Barring Service and other checks, prior to employment. All areas of the building including people’s rooms, bathrooms and communal areas were clean, with infection control risks well managed and appropriately resourced.

The storage, administration and disposal of medicines was generally found to be safe and in line with guidance issued by the National Institute for Health and Clinical Excellence (NICE). We found examples of good practice regarding the recording of medicine administration. We also found instances where medication audits had not successfully picked up on areas of inconsistency, particularly with regard to people’s ‘when required’ medicines and we highlighted this to the registered manager and director.

Risks to people were managed through risk assessments and associated care plans. These risks were reviewed regularly and incorporated advice from healthcare professionals to keep people safe.

Staff displayed a good knowledge of safeguarding principles and indicators of abuse. They were clear what to do should they have any concerns. People we spoke with, their relatives and healthcare professionals consistently told us the service maintained people’s safety.

Staff completed a range of training the registered provider considered mandatory, such as safeguarding, health and safety, moving and handling and dignity. Staff also completed training to equip them to support people’s specific needs, for example British Sign Language training. Staff displayed a good knowledge of the subjects they had received training in and had a good knowledge of people’s likes, dislikes and life histories.

Staff had built positive, trusting relationships with the people they cared for. Staff were well supported through regular supervision and appraisal processes as well as ad hoc support from management when required.

We saw people had choices at each meal as well as being offered alternatives. People spoke positively about the food they had and confirmed they could choose whether to eat with other people or in their room. We observed staff supporting people efficiently to eat and drink. We found the dining experience we observed to be functional but a missed opportunity to ensure people had a more positive, sociable experience.

The premises benefitted from some aspects of dementia-friendly design, although we found the ongoing refurbishment works had yet to have a significantly positive impact on people and, as yet, had not incorporated person-centred care into the design of communal areas. Person-centred care is about ensuring the person is at the centre of everything and their individual wishes and needs and choices are taken into account.

Likewise, whilst we found care planning documentation to be extensive, this did not always translate into person-centred care strategies, for example to distract and soothe people who may become anxious.

Group activities were varied and well planned, coordinated by a new member of staff with relevant experience. Improvements were planned to ensure people who could not choose to engage in group activities had alternative, meaningful options.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA. The registered manager displayed a good understanding of capacity and we found related assessments and decisions had been properly taken and the provider had followed the requirements in the DoLS. We found some care planning documentation referred to capacity in blanket terms rather than in terms of capacity specific to individual decisions. The registered manager and director agreed to review this.

People who used the service, relatives and external stakeholders agreed that staff were caring and compassionate. We saw numerous instances of warm, inclusive interactions.

Person-centred care plans were in place and daily notes were accurate and contemporaneous. We saw regular reviews took place, ensuring people who used the service, relatives and healthcare professionals were involved.

The service had built and maintained good community links. Staff, people who used the service, relatives and external professionals we spoke with knew the registered manager and were positive about their approachability, responsiveness and knowledge of people who used the service.