Springfield Nursing Home

We found the following examples of good practice.

Staff had clear processes to adhere to, to welcome visitors to the home. Visitors had their temperature taken on arrival, completed a health questionnaire and were required to demonstrate a lateral flow test had been completed.

Due to the recent change in government guidance and as there is no covid currently in the service, family members and friends are supported to access their loved ones in their bedrooms. However, a screened area is also available for those who prefer to use this.

Personal protective equipment [PPE] and hand sanitisers was available throughout the home for both visitors and staff.

Staff knew how to keep people and themselves safe and reduce any risk of COVID-19. The registered manager ensured the most up to date information was available for staff and visitors.

Staff completed IPC training and were observed to be wearing the correct PPE and following best practice. The premises and equipment were visibly clean and regular cleaning schedules and audits were completed to monitor the IPC standards within the home.

There was an up to date infection prevention and control (IPC) policy. Staff were regularly updated with any changes to government guidance and procedures to follow so they could keep themselves, people and visitors safe.

Springfield Nursing Home is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Springfield is registered to provide care for up to 46 people, including people who are under a temporary rehabilitation arrangement. At the time of the inspection, there were 36 people living at the service, some of whom had a diagnosis of dementia.

People’s experience of using this service:

People were happy living at Springfield Nursing Home and received a good standard of care.

There were enough staff to meet people’s needs and they had been recruited safely. Staff received appropriate training and support to enable them to carry out their role effectively.

Individual and environmental risks to people had been assessed and were monitored regularly to keep people safe. The service was clean, well maintained and procedures were in place to protect people from the risk of infection.

Medicines were managed in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored and administered appropriately.

Staff treated people with kindness and compassion. Staff had developed positive relationships with people and knew what was important to them.

People had access to health and social care professionals where required and staff worked together co-operatively and efficiently. The service worked in partnership with other organisations to share awareness of the client group and to ensure effective, joined up care.

People had clear, detailed and person-centred care plans, which guided staff on the most appropriate way to support them. People were involved in deciding how they wished to be supported and in reviewing their care plans when needed.

Staff encouraged and supported people to take part in a wide range of activities which promoted their self-esteem and wellbeing. Staff were creative in ensuring that people were engaged and stimulated.

The registered manager sought feedback about the service from people, their relatives and staff, and this information was used to improve the service.

The registered manager and provider carried out regular checks on the quality and safety

of the service.

The service met the characteristics of Good in all areas. More information is in the full report.

Rating at last inspection:

The service was rated as Requires Improvement at the last full comprehensive inspection, the report for which was published on 03 May 2018.

Why we inspected:

This was a planned inspection based on the previous inspection rating.

Follow up:

There is no required follow up to this inspection. However, we will continue to monitor the service and will inspect the service again based on the information we receive.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Springfield Nursing Home is registered to provide accommodation for up to 46 older people. There were 41 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The first floor had further bedroom accommodation. All bedrooms were for single occupancy and most had ensuite facilities. Bathrooms and toilets were provided on both floors. There were three passenger lifts and stairs available to access the first floor. There was level access to a patio and flat garden area.

Springfield Nursing Home is a ‘care home’. People in care homes receive accommodation, nursing and personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. We found the home to be well maintained throughout the inspection.

A registered manager was in place. 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.

A previous inspection of the service in December 2016 had identified that the service had breached regulations in relation to the use of restraint when a person required essential personal care. Improvements had been made.

At this inspection we found several occasions where incidents/accidents where there had been a significant impact on people had not been reported to CQC as required. This included safeguarding concerns and where people had been injured and required medical attention. This was a breach of regulations. The home had informed the Isle of Wight safeguarding team and ensured people received any necessary medical care as well as investigating the circumstances around the accident or incident to reduce the likelihood of a repeat occurrence.

Audits to check the quality and safety of the service had not identified that the entire kitchen area was unclean and visibly dirty, including the food storage areas, kitchen equipment and beverage making area. Other quality assurance systems in place were effective and where audits had identified areas that needed improvement action had been taken.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people’s needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only staff who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

There were processes and procedures in place to protect people from the risk of abuse. Risks to people were managed safely with plans in place to minimise risks where possible.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only staff who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

Care and support were based on care plans which took into account people’s needs and conditions, as well as their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regularly. Staff were aware of people's individual care needs and preferences. People had access to healthcare services and were referred to doctors and specialists when needed. People and external health professionals were positive about the service people received.

People were supported to eat and drink enough to maintain their health and welfare. They were able to make choices about their food and drink, and meals were prepared appropriately where people had particular dietary needs.

People found staff to be kind and caring. Staff respected people’s individuality, privacy, dignity and independence. Equality and diversity were actively supported with people being able to express themselves.

People were able to take part in leisure activities which reflected their interests and provided with mental and physical stimulation. Group and individual activities were available if people wished to take part and visitors, including pets were welcomed. People were supported and encouraged to be as independent as possible and their dignity was promoted.

The home had an open, friendly atmosphere in which people, visitors and staff were encouraged to make their views and opinions known.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home.

Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

We found one breach of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

There was a registered manager at the home. 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.

The provider’s quality assurance procedures were not sufficiently robust. They had failed to identify the areas of concern we found in relation to the way restraint was being managed and that pressure relief mattresses were set incorrectly meaning that people were placed at risk harm. The quality assurance systems also failed to identify that people had not received their prescribed topical creams appropriately and records of their administration were not accurately recorded or up to date. Reviews and audits of care plans and related records had failed to identify that information within MCA assessments did not always correlate to the information held within other sections of the person’s care plan and had not been amended as people’s needs changed or reviewed on a regular basis.

Procedures for the use of restraint had not been followed placing a person at risk of harm. Otherwise people were protected from the risk of abuse and staff knew how to identify, prevent and report abuse.

Not all risks were managed safely although immediate action was taken by the provider to rectify these concerns. With the exception of prescribed topical creams medicines were managed safely and people received these when they required them.

People and external health professionals were positive about the service people received. People were also positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

People's families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The registered manager and provider were aware of key strengths and areas for development of the service.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the end of the full version of the report.

We looked at seven care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were reviewed on a regular basis. We observed care in the communal areas of the home and saw staff interacted with people in a positive way. One person said staff are 'very good, they chat away with us'.

We saw the home was clean and well maintained. The manager told us the deputy manager was responsible for overseeing infection control. We spoke with five members of staff, including the head of cleaning and the manager. They all confirmed they had received infection control training. Everyone we spoke with told us the home was always clean.

We saw there were enough qualified, skilled and experienced staff available to meet people's needs. A relative told us 'staff seem to be well trained, when [their relative] calls out they are straight there to see to her. I have no concerns around staffing levels'.

We spoke with nursing and care staff. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people's needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

We found medication was correctly managed and good recruitment and induction procedures were completed. The home was well maintained and suitable for the people living there. Care plans and related care records were relevant to people's needs. Other records related to the running of the home were also well maintained and stored securely.