This inspection took place on 1 September 2015 and was unannounced.
Spencefield Grange is a care home that provides residential care for up to 60 people and specialises in caring for older people including those with physical disabilities, mental health needs and people living with dementia. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were 49 people in residence.
A registered manager was not in post. The service has been without a registered manager since December 2014 however there has been an acting manager in place since this date.
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.
People told us they felt safe at Spencefield Grange. Staff had a good understanding of safeguarding (protecting people from abuse) and knew how to keep people safe.
People’s care needs were assessed including risks to their health and safety when they started to use the service. However, risks to people’s health and wellbeing were not monitored or reviewed regularly. Care plans which staff referred to were not reflective of people’s current needs; therefore staff relied on any new information shared at the handover meetings. That meant people may at risk of receiving unsafe or inappropriate care.
The systems to store, manage and administer medicines safely were not followed correctly. Further action was needed to ensure the national guidance was followed in relation to safer management and administration of people’s medicines.
Staff were recruited in accordance with the provider’s recruitment procedures, which helped to ensure suitable staff were employed to look after people.
People lived in an environment that was kept clean. All the bedrooms had an ensuite facility and were personalised to reflect people’s interests and taste.
Staff received an induction when they commenced work and on-going training to support people safely. We saw staff used equipment to support people correctly. Staff received support through meetings and staff appraisals.
We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been followed. Further action was needed to ensure a mental capacity assessment was carried out to so that people’s wishes were known and kept under review. Where a person lacks capacity to make decisions or are unable to do so, then the provider must act in accordance with their legal responsibilities to ensure that any best interest decisions made involved the relevant people and health care professionals.
People were provided with a choice of meals that met their dietary needs. Drinks and snacks were readily available. People at risk of poor nutrition had assessments and plans of care in place for the promotion of their health.
People’s social needs were met. People received visitors and spent time with them as they chose. There were a range of opportunities for people to take part in hobbies and activities that were of interest to them.
People’s health needs were met by nurses and other health care professionals. Staff sought appropriate medical advice and support form health care professionals when people’s health was of concern and were supported to attend routine health checks.
People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance.
People were involved in making decisions about their care and in the development of their plans of care when they first started to use the service. Care plans were not up to date to reflect people’s current needs and how staff should support them. People were not always consulted or involved in the review of their care plan. Where appropriate the relatives or relevant health care professionals were not involved or consulted with regards to reviewing people’s needs to ensure staff provided the care that helped to maintain people’s safety and wellbeing.
People were confident to raise any issues, concerns or to make complaints, which would be listened to and acted on appropriately. Records showed complaints received had been documented.
Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.
The provider currently supports the manager to manage the service. The acting manager was in post over six months. However, they had not yet submitted an application successfully to become the registered manager
The provider’s quality governance and assurance systems were not used effectively and consistently to ensure people’s health, safety and welfare. We found gaps in the records for daily checks which the management team were not aware of. The internal audits were not always completed in full and actions to address any shortfalls were not monitored and sometimes not addressed. Therefore, the provider could not effectively monitor the improvements because the issues found were not always recorded and no plan of action developed.
We found breaches of 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 this report.