Archived: Spring Cottage

Spring Cottage is a residential care home providing personal care for up to 16 older people. 16 people were living at the service at the time of our inspection. The care home consists of one adapted building and a bungalow, providing accommodation for two people.

People’s experience of using this service and what we found

The provider had not always made improvements and applied learning following the last inspection to address previous breaches in regulation. The provider’s systems and policies were not always followed to identify areas for improvement and take action accordingly. There was a risk of people being put at risk of avoidable harm due to shortfalls in the governance arrangements.

The provider had not always followed its own policy and procedure to ensure staff were always recruited safely and to ensure health and safety checks were robustly completed to keep the service safe.

Staff were aware of risks to people. People felt safe living at the service.

People received effective care following a period of assessment at the service. They were supported by consistent members of staff who knew their wishes, needs and preferences. People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People felt at home at the service. Relatives felt welcome when they visited. People shared bonds with staff who were kind and respectful towards them and respected their privacy.

Care was person-centred and focused on the needs and wishes of each person. People continued to remain part of their local communities.

People and their relatives felt able to speak openly with the registered manager about any issues and that these would be addressed.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 December 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to staffing, fit and proper persons employed and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spring Cottage provides residential care for to 16 older people. People live in two adapted buildings; most people live in the main home, with a separate bungalow providing accommodation for up to two people that are more independent. 13 people were living at the service during our inspection. Most people living at Spring Cottage had strong connections to the surrounding local area, having grown up and lived their working lives there.

People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Since our last inspection the local authority had identified some concerns with the provider following a visit from their quality assurance and contracting team. The provider was pro-actively working with the local authority and following an action plan to remedy these issues and improve their practice.

There was a registered manager in place, who was also one of the partners in the business. 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 registered manager was supported with the day to day running of the service by a manager and a deputy manager.

At the last inspection in April 2016 the home was rated good. At this inspection we found the home required improvement. This is the first time it has been rated requires improvement.

Recruitment processes were not applied robustly to ensure all appropriate checks were completed for staff prior to them commencing work at the service. This included Disclosure and Barring Service (DBS) checks, written references and health questionnaires.

Quality and safety was not being consistently monitored by the provider. Health and safety checks were not always being completed to ensure the premises were maintained and to minimise risks to people and staff at the home. The provider took immediate action on window security based on the issues we identified.

Staff received supervisions but these did not follow a set format and the frequency of these taking place varied. Staff had completed training, many of their training certificates had expired. The provider had recently introduced a new e-learning system and was working to improve the monitoring of staff training.

Roles and responsibilities within the management team were not always clear. The registered manager was not always monitoring the home and had not identified issues we found on inspection.

A system of audits was being developed within the home. At the time of inspection medicines was the only area being audited. This meant the provider did not have a system for identifying and addressing issues within the home.

The provider had a clear value basis, with people living together in a homely environment, where they were treated with dignity and respect. The home had links to the local community.

Mealtimes were a positive experience, which people and their relatives shared with staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems were being updated to support this practice. Consent was sought prior to people receiving any care interventions.

Staff knew people’s histories and provided personalised care. People received emotional support, which helped improve their wellbeing.

People, their relatives and staff were able to speak with managers and were involved in the running of the home. The registered manager made themselves available to people and their families.

We found the provider was in breach of three of the regulations 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 the report.

The last inspection was completed on 21 May 2014 and was found to be compliant with the regulations inspected at that time. This unannounced inspection took place on 13 March 2016.

The registered manager had been in post for over 30 years. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had completed safeguarding training and understood their responsibilities to report any abuse or episodes of poor care they witnessed or became aware of. This helped to ensure the people who used the service were protected from the risk of harm and abuse. Staff had been recruited safely and were deployed in suitable numbers to meet the needs of the people who used the service. Medicines were ordered, stored and administered safely. People were supported to self-medicate when possible and people received their medicines as prescribed from staff who had completed safe handling of medicines training.

Staff had completed a range of training which enabled them to meet the assessed needs of the people who used the service. Records indicated and staff confirmed they received regular supervision and support. People provided their consent before care and support was delivered and best interest meetings were held when people lacked the capacity to make important decisions themselves. The service operated in line with the principles of the Mental Capacity Act. People were supported to maintain a healthy and balanced diet of their choosing. Relevant professionals were contacted for advice and guidance as required.

People told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. People were treated with dignity and respect throughout our inspection. It was clear staff were aware of people’s preferences for how care and support should be provided. Staff understood their responsibility to ensure people’s private and sensitive information was treated confidentially.

People or those acting on their behalf were involved with the planning and on-going assessments of their care when possible. We saw records confirming that reviews took place periodically. People participated in a range of different activities; photo collages of different events and outings were displayed within the service. There was a complaints policy in place at the time of our inspection which was displayed at the entrance of the service. This helped to ensure people could raise concerns about the service or the individual care and support as required.

The registered manager understood the requirements to report accidents, incidents and other notifiable incidents to the CQC. Audits were completed regularly and we saw when shortfalls were highlighted action was taken to improve the service. Questionnaires were completed by people who used the service, their relatives and professionals periodically to enable the service to receive feedback about the care and support provided.

Below is a summary of what we found. The summary describes what people using the service told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People were seen to be treated with respect and dignity by the staff. People we spoke with told us they had felt valued and listened too by the provider and staff.

The service had policies and procedures in place in relation to the mental capacity Act and Deprivation of Liberty Safeguards (DOLS). There was no one currently using the service who had a DOLS in place. The provider knew how to request an assessment if this was required. Staff received safeguarding and Mental Capacity training. This helped to protect people.

The provider had effective systems in place to deal with any emergencies.

Is the service effective?

People's health and care needs were assessed and detailed care plans and risk assessments were in place. This helped to ensure that people's needs were met. A person we spoke with said 'The staff are wonderful, they care for people. They look after me well. They are there when I need them.' We observed that the provider and staff spent quality time with people and knew people's individual needs well. Continuity of staff was provided. Staff received training to develop their skills.

People's nutritional likes, dislikes and preferences were well known by all the staff. People were supported to remain as independent as possible with eating and drinking, staff assisted people where necessary. Special diets were catered for. Food provided was home cooked and appeared to be nutritious. People we spoke with said 'The food is good.' And 'The food is excellent. I cannot fault it there is always plenty on offer.' This helped to ensure people's nutritional needs were being met.

Systems were in place for the provider to monitor if the service being provided was effective to meet people's needs. Action was taken to ensure people remained happy with all aspects of the service they received.

The recruitment and induction process had been fully revised and updated and all necessary documentation had been collected and recorded. Where this had not been in place previously it was recorded in an alternative way. Supervisions and appraisals had been implemented on a regular basis. There had been a large investment in training which covered both induction and mandatory/refresher training. Staff had completed a variety of training since our last visit.

We found that the home was well maintained and infection control procedures were being followed although recording of tasks carried out was not in place. Staff checks were not always evidenced as carried out for suitability of employment. Staff felt well supported but supervision and staff meetings were not always appropriately recorded or carried out consistently.

There were some quality assurance checks in place and people who used the service and their relatives were given opportunities to feedback about the service. There was a lack of audits and monitoring being carried out in the home at the time of our visit. Complaint information was available and appropriate procedures were in place for responding to these.

One person told us "It's a home from home"

We saw records about the people who used the service. These were up to date and provided the information needed to ensure people who used the service received the correct care and support. We also saw records about staff and the management of the service. Staff told us that records were stored securely in the office and we saw evidence of this during our visit.