Spring Lodge

Spring Lodge is a residential care home providing personal care to 31 people at the time of the inspection. The service provides support to older people, some of whom may be living with dementia. The service is registered to support up to 46 people in one adapted building.

People’s experience of using this service and what we found

People were not consistently protected from the risk of harm. Our observations showed that not all people were consistently safe when using equipment to transfer them or transport them. People’s health was not adequately monitored. We have made a requirement relating to the safe care and treatment of people.

The service was not consistently well led. There had been ongoing changes in management in the service. There was no registered manager. We have made recommendation to the provider around best practice regarding recruitment.

A programme of audits and monitoring supported the provider and management to identify shortfalls and address them. The comments received from people, relatives and staff and analysis of incidents were used to drive improvement.

There were systems in place designed to reduce the risk of abuse. There were systems in place to provide people with their medicines safely. There were ongoing improvements being made in the staffing levels, including recruiting new staff. Vacancies and the use of agency staff had reduced. There were enough staff on duty to meet people’s needs.

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

The service had kept up to date with guidance relating to the coronavirus pandemic, ensuring systems were in place to reduce the risks to people.

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

Rating at last inspection

The last rating for this service was requires improvement (published 11 September 2021).

Why we inspected

The inspection was prompted in part due to information we had received relating to people’s care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Spring Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spring Lodge is a residential care home providing personal and nursing care to 35 people at the time of the inspection, some of these people were living with dementia. The service is registered to support up to 46 people in one adapted building.

People’s experience of using this service and what we found

People’s care records, including care plans and risk assessments did not always provide guidance for staff in reducing risks and the specific care people required to meet their needs. This was in the process of being addressed but was not yet fully implemented.

Whilst there were improvements needed in the assessment of risk in people’s daily living, risks associated with the environment and equipment being used were assessed and mitigated. There were systems in place designed to reduce the risk of abuse.

There had been changes in management in the service. A new manager was in post and was making improvements in the service. A programme of audits and monitoring supported the provider and management to identify shortfalls and address them. The comments received from people, relatives and staff and analysis of incidents were used to drive improvement.

There were systems in place to provide people with their medicines safely. There were ongoing improvements being made in the staffing levels, including recruiting new staff. Vacancies were being covered by agency staff to ensure there were enough staff on duty to meet people’s needs. Staff were recruited safely.

The service had kept up to date with guidance relating to the coronavirus pandemic, ensuring systems were in place to reduce the risks to people.

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

Rating at last inspection

The last rating for this service was good (published 22 November 2017).

Why we inspected

The inspection was prompted in part due to concerns received about staffing and safe care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Spring Lodge on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection of 26 November 2014 the service was rated Good. At this inspection we found the service remained Good.

A registered manager was not 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. An acting manager had recently been appointed at the service and their application to register with CQC had been submitted.

The service continued to provide a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines. Staff understood their roles and responsibilities in keeping people safe. They were available when people needed assistance and had been recruited safely.

People were complimentary about the care they received and the approach of the manager and staff. They told us that they felt safe and well cared for. Staff had developed good relationships with people. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff consistently protected people’s privacy and dignity.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services. Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

People were involved in making decisions about their care and support and were supported to participate in meaningful activities. They received care and support which was planned and delivered to meet their specific needs.

People were supported by staff who were trained and supported to meet their needs. They 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.

Both the manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. 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 received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints and took action where needed.

People, relatives and staff told us the manager was accessible, supportive and had good leadership skills. The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below

We looked at five people's care records. Other records viewed included information on staff training, staff supervision, medication and health and safety. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor's book. We saw all visitors to the service were asked to sign in. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People were provided with a clean, safe and well maintained environment which supported their dementia needs. The use of bright colours, signage, themed areas and objects provided a stimulating homely environment to support people living with dementia.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

We found action was needed by the provider because people were not protected from the risk of abuse. This was because the recording and monitoring of how people obtained a bruise were not robust enough. Therefore there was insufficient information to identify the possibility of abuse and prevent abuse from happening.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). No DoLS applications had been made. However, discussions with the registered manager identified that they were not aware of the latest changes. This meant that they had not reassessed people to identify when a DoLS referral was required.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person told us, 'I am very comfortable.' One person's relative said, 'As far as we know (person's) needs are being met.' Another relative who told us that, 'Carers are usually the same ones, I think carers are a key point, those who love the job, between those who are doing a job.'

We found action was needed by the provider to ensure people's individual oral health needs were met. This was to ensure that where a person's care plan stated that they required assistance, it was given.

Staff were supported through supervision and appraisal which provided staff with constructive feedback on their work practice.

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that staff had a good understanding of how dementia impacted on the daily lives of people living with dementia.

Is the service caring?

People were supported by kind and attentive staff. One person who lived in the service told us, 'Staff are wonderful, always smiling.' Another person told us, 'I love it here,' as they walked up to a member of staff and gave them a hug.

Throughout our inspection we saw positive staff interaction as they supported people living with different stages of dementia. This was because we saw staff demonstrated genuine affection, care and concern for people. There was acceptance of a person's reality. This meant where the impact of living with dementia affected a person's memory, that staff did not patronise or correct them. Instead we heard staff instigate meaningful conversations, which supported the person to feel valued.

One person's relative said, 'I think they (staff) are very kind.'

Is the service responsive?

People's preferences and choices were taken into account and listened to. We saw staff involved people in making decisions and acted on the information they received.

However, we found improvements were needed to ensure that people's preferences for when they wanted to get up were followed. The service needed to demonstrate that when night staff assisted a person to get up, it was in their best interest and not to fit into the service's routines.

This was because where people lacked the capacity to inform night staff that they wanted to get up early, care records did not state if it had been through choice, or a best interest decision. When we pointed this out to the management, they took responsive action and called a staff meeting. Where on the first day of our inspection we identified a person had got up at 5.45am three days in a row, when we returned, we found that they had been getting up between 8am and 8.30am.

People's care records showed that where concerns about their health and wellbeing had been identified that staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from healthcare professionals which included a doctor, community nurse, dentist and dietician.

Is the service well-led?

The service had quality assurance systems in place and records seen by us showed that identified shortfalls were addressed. We found the provider had listened to feedback they had received from people who used, or had contact with the service. As a result the quality of the service was continually improving.

We did not talk to the people who used the service on this occasion because we arrived at 10pm and most of the people were in bed.

During our inspection we observed that the staff were attentive to people's needs. Staff interacted with people who used the service in a friendly, respectful and professional manner. We saw that staff were proactive in providing people with activities and pastimes.

We observed that staff received training essential for caring for older people and when we talked to staff we found that they were knowledgeable about the people they supported.

We spoke with four people who used the service and they told us that they were comfortable living in the service and also that staff were good to them. One person said, 'Look (indicating the room), I have what I need.' The same person also said that, 'The food is fine, I certainly get enough.'

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from Infection and that staff had received training in infection control and food hygiene.

Medication was managed and dispensed effectively and the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

During our inspection we observed that the staff were attentive to people's needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought the agreement of the people using the service before providing any support or assistance.

We observed that staff received training essential for caring for older people and when talking to staff we found that they were knowledgeable about the people they supported.

People told us that they were comfortable living in the service and also told us that they had not needed to make a complaint. One person told us that, 'This isn't too bad, I've lived in worse places.' The same person also said that, 'I have nothing to complain about.'

The building was comfortable, clean and well maintained. We saw that health and safety checks are carried out and that equipment was kept well maintained.

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally and that they had not had a formal complaint for several years.