Updated 23 September 2025
Date of inspection: 09 October to 03 November 2025. Springfield Care Home provides accommodation with personal care for up to 65 people. Accommodation is arranged in 2 houses, each over 2 floors with stair and lift access. At the time of this inspection there were 47 people using the service. Our inspection was prompted by concerns received about the safety of care being delivered. We reviewed all the quality statements. At the last inspection the service was rated good. At this inspection the service is now rated requires improvement. At this inspection we found the provider was in breach of 2 of the legal regulations for safe care and treatment and governance. Although quality assurance processes were in place to monitor all aspects of the service; systems and processes were ineffective and had not identified the shortfalls we found at this inspection. This included shortfalls in relation to risk management of skin integrity, incident management, safe environments, and medicines. Although leaders were responsive to our feedback, systems and processes in place had failed to identify and drive improvements across the service delivery.
We were not assured the provider had effective governance systems in place.
Not all incidents and accidents had been reported or investigated. Lessons learned had not been formally shared with staff, although staff did tell us they were verbally informed. We found some shortfalls in medicines management processes and oversight which included inconsistencies around the safety of medicines storage and record keeping.
Safety checks had been carried out for the premises and for any equipment being used. However, records in place were inconsistent, and the checks had not identified the shortfalls we found. Fire risks to people were assessed. Risk assessments had been completed but not always regularly reviewed, and care plans did not always inform staff how to keep people safe from harm and had not always been updated to reflect changes in people’s needs.
Overall, the service was clean, and we observed staff following infection prevention and control guidelines. People had enough to eat and drink to stay healthy. Staff were working with all agencies involved in people’s care. However, we received mixed feedback on how effective this was. Following the inspection, we were told there was now closer working relationships between agencies and the service to improve outcomes for people. Staff told us there was an open culture and they felt valued and respected by the management team. They spoke positively about the changes being implemented by the new manager and told us they felt valued and listened to.
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We have asked the provider for an action plan in response to the concerns found at this assessment.