Springfield Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

People’s needs were assessed face to face prior to moving to the service. Some people moved to the service long term, while others stayed for respite. A relative said, “Initially [person] camefor two weeks respite care, and after that just stayed.” The manager told us they had some people who came for respite several times a year and were well known to staff. The manager told us, “If people make an enquiry about moving here, I will invite them to look around, then if they do want to come here, they have a home assessment. I will do everything I can to find a solution to help people."

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

The provider used nationally recognised tools to assess and monitor people’s needs and risks, including the risk of malnutrition and skin damage. However, care plans did not consistently provide clear information for staff on the best practise steps to take to support people effectively, particularly in relation to managing skin integrity and wounds. For example, care plans did not include information for staff such as the importance of a nutritionally balanced diet to aid healing. Plans for people with specific dietary needs, such as a textured diet, did not consistently include information for staff such as which size cutlery or type of drinking utensil was required.

Kitchen staff knew people’s dietary needs and preferences and were trained to carry out their roles. They told us how they were kept informed about people’s changing needs. A staff member said, “Lots of the food is fortified. [The manager] or senior staff tell us if someone loses weight and we then make fortified milkshakes with added cream for them.”

We observed lunch during the inspection. In both houses many people chose to eat at tables, laid up for lunch, with condiments available for people to help themselves. There was a choice of drinks available, and staff were seen supporting those people who needed assistance.

People spoke highly of the food. They told us meals were, “Wonderful”, “incredible” and “really tasty.” One person said, “I’m looking forward to my carbonara later. There’s always something good to choose from.” Another person’s relative said, “[Person] does eat well which surprises us as [they] used to be pernickety. [Person] is now eating properly, eating a balanced diet and is a healthy weight.” The relative told us the person had been “very thin” when they moved to the service.

The provider did not always work well across teams and services to support people. They did not always share their assessment of people’s needs when people moved between different services.

We spoke with several health professionals and received mixed feedback. Some professionals felt communication between themselves and staff at the service was not always as good as it could be. Concerns were raised the service did not always accept help and advice, including additional support and training for staff. Health professionals told us they did not feel staff always understood advice that was given and therefore felt their professional advice was not always being followed. During the inspection staff told us they felt they sometimes received conflicting advice from professionals, but it was unclear how they attempted to resolve this. After the inspection we were told a regular multi-disciplinary team meeting was being held to address these concerns.

Other health professionals told us they felt they had a good working relationship and the management team communicated well with them. One health professional told us “I feel confident staff will be in contact when concerned. If [the manager] or their team request a visit, then it is always appropriate. I receive weekly contact from [the manager] informing me of planned updates and any new issues/concerns. [The manager] and their team know the residents very well, are caring, thorough and have a careful but pragmatic approach. I get given all appropriate information prior to visits.”

The provider did not always support people to manage their health and wellbeing, so people could not always maximise their independence, choice and control. Staff did not always support people to live healthier lives, or where possible, reduce their future needs for care and support.

The management team did not always have oversight of people’s wellbeing. Although clinical governance meetings took place there was limited information recorded in records which meant it would be difficult to assess how staff could support people to be healthier and reduce future needs.

People told us staff contacted the GP for advice if they were unwell and supported them to attend healthcare appointments. A relative said, “A chiropodist comes to do [person’s] nails, and the GP sees [person] if they are unwell.”

The management team told us they were able to refer people for additional advice and support when required. For example, if people had lost weight, the GP was informed, and people were supported with food supplements and a fortified diet.

The provider did not always routinely monitor people’s care and treatment to continuously improve it.

Although records showed people were reviewed by the GP and had some aspects of their healthcare needs monitored and reviewed, this was inconsistent. For example, people’s needs in relations to skin integrity was poorly monitored and there was limited oversight. Records showed people’s wounds had deteriorated, despite health professional intervention and advice. Records in relation to skin care showed advice had not always been followed. Care plans did not detail comprehensive guidance for staff, and staff daily records did not always show steps were taken to improve people’s skin integrity outcomes. This meant outcomes for some people were not always positive and placed people at risk of avoidable harm.

Despite this, we also saw that some aspects of people’s care did show positive outcomes. For example, when people’s health deteriorated, we reviewed records that showed staff had taken immediate steps to seek medical advice and arranged hospital review when necessary.

The provider told people about their rights around consent and respected these when delivering person-centred care and treatment.

In the main, mental capacity assessments had been carried out in line with legislation. However, some people had sensor mats in use. These are mats that alert staff when people stand up and are used to reduce the risk of people falling. In some of the plans we looked at, people had consented to their use, but this was inconsistent. When people had been assessed as not having mental capacity to make a decision, best interest decisions had been made. However, records of decision making did not always include information about what, if any, less restrictive options had been considered.

We observed people being offered choice throughout the inspection. A relative said, “I have heard them [staff] say ‘I’m going to do this, is that all right?’”

We saw and heard staff ask people for their consent. For example, we heard staff ask, “Here's your breakfast [name]. Would you like a clothes protector on?”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager kept a record and tracker of DoLS applications and authorisations. None of the authorised DoLS had any conditions attached.