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Springfield Nursing and Residential Care Home Requires improvement

Reports


Inspection carried out on 20 March 2019

During a routine inspection

About the service: Springfield Nursing and Residential Home is a 'care home'. The home accommodates up to 65 older people living with dementia or nursing needs across two adapted buildings. At the time of the inspection there were 48 people living in the home.

What life is like for people using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive improvements. At times there was a lack of clear and accurate records regarding people’s medicines, mental capacity, support needs and any potential risks to them. The provider had not always notified CQC about incidents they are required to by law which meant these could not be monitored.

•People told us they were treated with dignity and respect, however we identified that improvements were required to ensure that there was a positive and person-centred approach to the language being used when staff were referring to people. We have made a recommendation about this.

•People were happy living at Springfield Nursing and Residential Home and people told us they felt safe. People were supported by staff who were kind, caring and who mostly understood their likes, dislikes and preferences. Where they needed external health input they were supported to receive this.

•People and their relatives knew the registered manager and felt able to speak to them if they had any concerns. Most staff told us they were well supported by the registered manager. Staff received training and people thought the staff were skilled and knowledgeable. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection:

Requires Improvement (Report published 5 January 2018)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Requires Improvement.

Follow up: The overall rating of the service remains Requires Improvement. At the last inspection, the provider was found to be in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. At this inspection, we found that these breaches remained. An additional breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 was also identified at this inspection. This is the second consecutive time the service has been rated as Requires Improvement and we will request a clear action plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

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

Inspection carried out on 23 November 2017

During a routine inspection

This inspection took place on 23 November 2017 and was unannounced. At our last inspection in July 2015 we found the service was not meeting the legal requirement for person centred care because they had not ensured staff were meeting people’s needs in a timely manner. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to ensure they were meeting the legal requirement. At this inspection, we found staffing levels met the needs of people and there was no longer a breach. However, some staff expressed concerns about staffing levels which the registered manager and provider were aware of and had made changes to resolve this.

Springfield Nursing and Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates up to 65 older people and some who require nursing care, across two adapted buildings. House 72 accommodates up to 36 people and does not provide nursing care. House 74 accommodates up to 29 people and does provide nursing care. The registered manager confirmed that House 74 was only accommodating up to 26 people at the time of the inspection, in order that people could have single occupancy rooms. However, if the need arose and people wanted to share a room this could be accommodated. At the time of the inspection there were 32 people living in house 72 and 21 living in house 74.

A registered manager was in post during the inspection. 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.

Staff worked well as a team although they did not always feel supported by the day to day management team. The provider had investigated this and implemented an action plan with the management team. The registered manager expressed a willingness to ensure this improved. There were systems in place to monitor quality and safety of the home provided, however no overarching development or sustainability plan was in place. People and their families were encouraged to provide feedback on the service through residents meetings and an annual survey. They were also supported to raise complaints should they wish to.

Prior to people moving into the home, assessments were undertaken to ensure the home and staff could meet the person’s needs. Policies were in place for care planning which guided staff to ensure people’s diverse needs were considered and where needed support was planned. People told us that staff knew them well and this was apparent throughout our discussions with staff about people. Risks associated with people’s needs were assessed and actions were taken to reduce the risk. It was evident staff responded promptly to people’s change in needs and ensured they received a person centred service, although the records were not always updated to reflect this. Activities were delivered based on individual needs at the time of the inspection.

People and their relatives provided positive feedback about staff. Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. Their privacy and dignity was respected and they were encouraged to be involved in making decisions about their care.

People told us they were always asked for their permission before personal care was provided and where needed people’s ability to make decisions was assessed in line with the Mental Capacity Act, 2005 (MCA). Care staff and the registered manager had received training in respect of the MCA and were able to demonstrate

Inspection carried out on 4 March 2015

During a routine inspection

This inspection took place on 4 March 2015 and was unannounced.

Springfield Nursing and Residential Care Home is registered to provide accommodation, nursing and personal care for up to 65 older people and people who may be living with dementia. At the time of our inspection there were 54 people living at the home. They were accommodated in two buildings, House 72 for people whose needs were less complex and House 74 for people with more complex nursing needs. Each house had a shared lounge, dining room and an enclosed garden. There were two double rooms, one of which was occupied by one person at the time of our visit.

The registered manager had left six weeks before our inspection. 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 had appointed a registered manager from another service to manage both homes as group manager, but they were not formally registered for Springfield Nursing and Residential Care Home at the time of our visit. They sent the application form to address this the day after our visit. They are referred to as “the manager” in this report.

People did not always experience care and support in a prompt manner when they asked for assistance or used the call bell system. People were satisfied overall that the care and treatment they received met their needs and took into account their choices, likes and dislikes. Records showed treatment for conditions such as pressure injuries was effective.

People were protected against the risk of avoidable harm and abuse, and against other risks to their safety and wellbeing. The service identified and managed individual risks and had plans in place for emergencies which might affect the whole service.

At our last inspection in August 2014 we asked the provider to take action to make sure there were sufficient suitably qualified and experienced staff to support people safely. They sent us an action plan which they had completed by the time of this inspection. People were supported by enough suitable staff to meet their needs and keep them safe. The provider had recruitment procedures in place to make sure staff were suitable to work in a care setting.

People were protected against risks associated with medicines because procedures were in place and followed to store, handle and administer medicines safely.

Staff were supported to provide care to the required standard by appropriate training, supervision and appraisal. Staff sought people’s consent before they supported them with their care, and the service followed legal requirements where people did not have capacity to make a particular decision.

Where people needed support to maintain a healthy diet, this was provided. The food offered was prepared and presented in an appetising way. There was choice of meals and drinks, and people were encouraged to take sufficient fluids. People were supported to access other healthcare services when necessary.

Staff established friendly, caring relationships with people. People’s views were listened to and they were able to take part in decisions about their care and support. Their privacy, dignity and independence were respected. Staff received suitable guidance about equality and diversity.

The care and treatment people received was based on plans which focused on the person as an individual and contained information about their history, preferences and views. People’s rooms were decorated with personal belongings and photographs, and they were assisted to identify their own room by photographs and other personal details on the door. People were supported to take part in a variety of individual and group activities according to their choices and preferences.

There was a caring, friendly atmosphere in the home. People felt able to speak openly to both staff and the manager. The manager had identified actions to improve the quality of service provided and had established a management style which was appreciated by staff. There was a system of internal checks and audits, and quality surveys which were intended to let the manager monitor the quality of the service and identify improvements.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to 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 the report.

Inspection carried out on 14 August 2014

During a routine inspection

We carried out this inspection as part of our routine inspection programme to answer our five questions. Is the service safe, is it effective, is it caring, is it responsive and is it well led? The inspection was carried out by an inspector and an expert-by-experience. At the time of our inspection there were 61 people using the service. We spoke with 19 of them and three visitors in order to understand the service from their point of view. We observed the care and support people received in the shared areas of the home. We looked at records and files. We spoke with one of the registered providers, the deputy manager and six members of staff.

This is a summary of what people told us and what we found.

Is the service safe?

People told us they felt safe and comfortable in the home. They said they had good relationships with staff. One person told us, “I’ve never heard anyone being rude to anyone here.” A visitor said the staff were “very kind”.

The provider had effective recruitment processes and undertook the necessary checks to ensure staff employed were suitable. At the time of our visit the provider was recruiting to maintain levels of staffing sufficient to support people safely. We have asked them to tell us how they will ensure they meet the requirements of the law in relation to staffing in future.

The provider had processes in place to ensure people’s medicines were managed safely. The premises were maintained and adapted to take into account people’s safety.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No DoLS applications were current at the time of our visit. Staff were aware of the circumstances when an application should be made, and were planning to review people's existing mental capacity assessments.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person said, “It is very good indeed, I have no grumbles.” Visitors we spoke with were satisfied with the care their loved ones received.

We found people’s care and support were based on assessments of their needs. Care plans were detailed and personalised. Systems were in place to ensure care was delivered according to people’s plans.

If people needed nursing treatment for a particular condition, this was provided and recorded. The service worked in co-operation with other healthcare providers where appropriate.

Is the service caring?

People using the service and their visitors told us they got on well with their care workers and other staff and had a good relationship with them.

Staff we spoke with were motivated to provide good care. They knew about people’s needs and how they preferred to have their care delivered.

We observed positive, friendly interactions between staff and people who used the service. Staff took time to make sure people understood them, spoke clearly and made eye contact with the person they were talking to.

Is the service responsive?

People’s care plans were individualised and person-centred. The plans were reviewed regularly and adapted in line with people’s changing needs. People’s individual risks were assessed and actions taken.

The service took advice from other specialist healthcare providers as appropriate.

Is the service well-led?

Staff told us they were supported to deliver quality care. People who used the service were satisfied with the care and support they received.

We found risks were assessed and appropriate action plans were in place in people’s individual care plans. Effective systems were in place to regularly assess and monitor the quality of service provided. The provider sought the views of people using the service and others. Incidents, accidents and complaints were handled appropriately and lessons were learned.

Inspection carried out on 4 November 2013

During an inspection to make sure that the improvements required had been made

On the day we inspected there were 30 people living at the home. We observed a calm atmosphere where staff were able to offer support whilst respecting people’s dignity and independence. The manager has an ‘open door policy’ whereby family and visitors could easily approach her and ask questions about the care and welfare of the person they were visiting.

We carried out an inspection in June 2013 when we identified concerns with record keeping. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and that they would be compliant by the 31 October 2013.

We inspected on 4 November 2013 to review the progress the provider had made. We found that the provider and registered manager had taken steps to improve care planning and record keeping and had worked on embedding the new systems.

We spoke with three members of staff and the manager who told us about the changes which had recently occurred in the home regarding records including the training that had been undertaken. Two nursing staff told us about the training and how beneficial they had found it they told us about new records that had been implemented and spoke very positively about the changes.

Inspection carried out on 28 June 2013

During an inspection to make sure that the improvements required had been made

We spoke with three people and a relative who said that they felt their loved one was “safe” at Springfield and that the care provided was good.

We carried out an inspection in April 2013 when we identified concerns with record keeping. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and that they would be compliant by the 19 June 2013.

We inspected on 28 June 2013 to review the progress the provider had made. We found that the provider had taken steps to improve record keeping however in five of the eight care plans we looked at there were still inconsistencies and care plans had not been updated as needs changed.

We spoke with four members of staff and the manager who told us about the changes which had recently occurred in the home regarding records including the training that had been undertaken. A nurse told us about the training and how beneficial they had found it they told us about new records that were to be implemented and spoke very positively about the changes

Staff told us that they said they were able to speak openly with senior staff about any concerns they had about the changes that were taking place and the training. We observed staff being respectful, asking people if they needed support and only assisting when asked.

Inspection carried out on 29 April 2013

During an inspection to make sure that the improvements required had been made

We carried out an inspection in November 2012 when we identified concerns with consent to care and treatment, care and welfare, safeguarding, cleanliness and infection control and supporting workers. We made five compliance actions asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take. The action plan stated that all areas would be compliant by 31 March 2013.

We carried out an inspection on 29 April 2013 to review the progress the provider had made in taking action to be compliant in the areas where we had previously assessed them as non compliant. We found that improvements had been made to all the outcome areas where we had asked for action to be taken. However we did find that staff were not consistent in their record keeping.

There were 44 people living at the home on the day of our visit. We spoke with one relative, three people who use the service, the provider, manager and six staff.

Staff we spoke with told us about the changes that had happened since our last visit under the new manager and deputy. They explained to us what the expectations were regarding care planning and assessment of capacity to consent. Staff also told us about the training they had had in areas such as infection control and cleanliness and the records they kept to monitor cleaning in the home.

Inspection carried out on 1 November 2012

During a routine inspection

Springfield is registered for up to 62 people. On the day we inspected there were 40 people living at the home. The home is divided into two houses, one offers support with personal care the other offers nursing support. Some people who needed nursing support also had difficulties with communication due to either a physical illness or dementia. During our inspection we spoke with two relatives, seven staff and five people who use the service.

As not everyone was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spent time in their company in the lounge dining area observing the support people received with their meal. We saw that the majority of staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or distressed. However we also observed two people not receiving assistance and support in a timely manner and one person was spoken to in a tone which was not respectful.

Relatives said that they had “Good communication” with the staff at the service; they were told when their family member was unwell for example.

Staff said that the management of the home was “settling down” under the new manager who had met with them and asked them about their experience at Springfield and their needs as employees.

Inspection carried out on 30 January 2012

During a routine inspection

The people that live at Springfield Nursing and Residential Care Home had varying needs and abilities. To help us to understand the experiences people had we arranged for an expert by experience to spend time at the home. An expert by experience has personal experience of using or caring for someone who uses a health, mental health and/or social care service. Experts by experience come from varied backgrounds. They include people with physical impairments, learning disabilities, mental health needs, who are older or who care or have cared for family members or friends who have dementia or complex needs.

The expert by experience spent time talking to people and watching what was going on in the home. They found that overall people had positive experiences. The staff caring for people knew what support they needed and they respected their wishes if they wanted to manage on their own.

Everyone said that they were treated with respect and that their views were listened to and acted upon. They also told us that they felt safe living at the home.

All people who we were able to have a conversation with said they were happy with the care they received.

Some people expressed the view that at times the home was short staffed.

Everyone said they were happy with the staff and that they treated them with kindness.

People told us that their views were sought on a daily basis when care and support was given. They also said that views were obtained via residents’ meetings.

Reports under our old system of regulation (including those from before CQC was created)