Springfield Nursing 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 assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

This service scored 54 (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 did not always ensure people’s needs were assessed and plans put in place to meet them.

People’s needs were assessed prior to moving to the home and where required the management team would contact outside health and social care professionals who knew the person to support with the pre assessment. This helped the manager and clinical team ensure they were able to meet the persons needs prior to them moving in.

However, we saw care plans were not always effectively updated and at times they contained conflicting or outdated information. This meant staff did not always have up to date and detailed information about people’s assessed needs. This placed people at risk of receiving inappropriate care and treatment.

Following the inspection the management team told us they had responded to our feedback by reviewing people’s needs and updating people’s care plans to address the outdated and conflicting information. We will check these changes have been effective at our next assessment.

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them. They did not always follow legislation and current evidence-based good practice and standards.

The provider used nationally recognised tools to assess people’s needs, and policies aligned with national guidance. However, these had not always been completed correctly. For example, the skin assessment tool. This increased the risk of people’s skin integrity needs not being met.

In addition, assessment findings were not effectively used to inform care planning and support with effective risk mitigation, and we found gaps were identified in applying guidance. This increased the risk of harm. As outlined in the ‘Involving people to manage risks’ section of this report, people were not provided with food in line with their assessed needs. This increased the risk of choking.

The provider did not always work well across teams and services to support people.

We received mixed views from external health and social care professionals in relation to joint working. One professional told us, “All the nursing staff I have interacted with have been well informed and helpful for both me and their service users.” However, others were less positive and commented, “When I arrive to the unit, I rely on 1 or 2 members of staff to orientate me, these tend to be the NHS staff rather than the [staff employed by the provider] who I do not know well at all” and “I have had some challenging conversations with [staff employed by the provider] when plans have not been followed and escalated to the management team to mediate the situations.”That said, all professionals were positive about the new manager, and one told us, “I do feel that [name of manager], has come into a very difficult and trying situation, they have done a brilliant job at bridging the gap between the rehabilitation team [NHS] and Springfield staff and trying to bring about change.”

Communication within the service was limited and some staff were unable to tell us about the people they were allocated to support. For example, some staff were unable to describe people’s, likes, dislikes, needs, abilities and what care was required to keep people safe. Staff attributed this lack of knowledge to not receiving formal face to face handovers, not having time to read records and gaps in internal communication and incomplete documentation. This meant staff did not always have the information needed to deliver safe and consistent care.

Records demonstrated should a person need to be moved between services, such as to hospital or a different care facility care plans and detailed specific information would be shared as needed to support joined up, person-centred care.

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.

Some people and relatives told us they had good access to healthcare professionals including weekly visits from the GP and regular appointments with chiropody, sight and dental checks. However, this was not always reflected from feedback we received from external professionals and other relatives. For example, a relative told us staff failed to act effectively on concerns about a person’s pain, saying “I told the staff, they just gave them pain killers for three weeks, I complain again, and they hadn’t referred them to anyone. They [person] had to go to hospital and have treatment.”

The provider did not always routinely monitor people’s care and treatment to continuously improve it. They did not always ensure that outcomes were positive and consistent, or that they met both clinical expectations and the expectations of people themselves.

We received mixed views from people and relatives about their clinical and personal outcomes. A relative told us, “When they [person] were admitted to the home staff were having to hoist them or they stayed in bed. Since being here, they have had physio and now mobilise independently with equipment.” Another relative said, “I think that it’s [service] lovely, I’ve seen such a difference in [person] – they are a changed person, they have people to talk to, the staff are kind and polite and there are people around them all the time. I can’t fault it.”

We also received reports of people’s healthcare needs not being effectively monitored or that people were not being supported to be independent as per treatment plans to allow them to regain independence. People’s health was not always effectively monitored and acted upon to improve their outcomes, such as with their nutrition, hydration, skin condition and physical health needs. This is further reflected on throughout this report.

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

Staff understood their responsibilities in relation to mental capacity and consent and people had the right to refuse care. Staff recognised the importance of people giving consent and supported people to make informed choices and respected these. We observed staff asking people’s permission prior to providing support throughout the assessment visits. People confirmed staff always asked their consent before providing any care or treatment.

Decision specific Mental Capacity Act (MCA) assessments and best interest decisions were in place where appropriate to support people who may be unable to make informed decisions.