Springfield Lodge

Updated 20 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection site visits were carried out by two inspectors. One inspector supported the inspection remotely by speaking to relatives and staff.

Service and service type

Springfield Lodge is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. [Care home name] is a care home [with/without] nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

At the time of our inspection there was a registered manager in post.

Notice of inspection

This inspection was unannounced on the first day and announced on the second day.

What we did before the inspection

We reviewed information we had received about the service since it registered. We sought feedback from the local authority who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

This inspection was carried out by conducting a site visit and speaking to relatives and staff remotely. We spoke with three people who used the service and three relatives about their experiences of the care provided. We spoke with and contacted nine staff including the nominated individual, finance and operations director, provider representative, registered manager, team leader, care workers, agency staff, activities coordinator and housekeeper. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

We reviewed a range of records. This included two people’s care records in full and five care records in part. We looked at multiple medicines’ records. We reviewed staff recruitment and supervision records. A range of records relating to the management of the service, including staff training records, accident and incident records, quality assurance checks, health and safety records and a sample of the provider’s policies and procedures were also reviewed. We sought feedback from health professionals that worked alongside the service.

Updated 20 December 2022

About the service

Springfield Lodge is a residential care home providing personal care to up to 15 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 14 people using the service.

Springfield Lodge accommodated people in one adapted building across two floors.

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

People were at risk of harm because of failures to adequately identify and address concerns about the safety and quality of the service. The leadership of the service was ineffective; the registered manager and provider were not fulfilling their regulatory responsibilities. The provider did not have effective systems in place to maintain oversight of the service and had not identified the issues we found during inspection. The registered manager was responsive to our feedback and had started to make improvements.

People were at risk as health and safety, including fire safety had not always been robustly assessed and known issues had not been fully addressed. Falls risks to people were not always effectively managed to ensure preventative measures were considered. People were at risk as systems to support the safe and proper use of medicines had not always been established.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. We have made a recommendation about the provider's visiting policy.

People were not able to access outside space at the service as ongoing work was in progress. We have made a recommendation about the provider setting a timescale for this work being completed.

People’s care records did not always give full details of their care and support needs, including any health needs to guide staff in how to provide their care. People were at risk of receiving inconsistent care as systems were not established and followed to monitor and support staff practice. Appropriate referrals were made to relevant professionals to meet people’s health needs.

The provider’s approach did not always ensure people’s care was planned in person-centred ways and that people were able to make decisions about their own care and support. Although people were given choices about their day to day routines and asked about their preferences, their care records did not reflect this. We have made a recommendation about people being involved and supported to make decisions about their care and the recording of this. Despite this, people and their relatives consistently praised the caring approach by staff. People were treated with dignity and respect; privacy and confidentiality were maintained.

People were supported to maintain their relationships with relatives and friends, who were able to visit. An activities programme had been developed, which provided people with stimulation and catered to varying interests. People and their relatives knew how to raise any concerns they may have and were confident in how these would be responded to.

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

Rating at last inspection

The service registered with us on 28 April 2021 and this is the first inspection.

The last rating for the service under the previous provider when the service was under the name Springfield Retirement Home Limited was good, published on 03 September 2020.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We identified breaches in relation to safe care and treatment, need for consent and good governance. We issued warning notices for the breaches of safe care and treatment and good governance. You can see what action we have asked the provider to take at the end of this full report. The provider started to make improvements in these areas based on our feedback. These changes were still in development and had yet to be embedded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.