Springfield Lodge Care Home

Springfield Lodge Care Home is a residential care home providing accommodation and personal care to up to 40 older people, people with physical disabilities and people living with a dementia. People are supported in 1 adapted building. At the time of our inspection there were 39 people using the service.

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

Medicines and risk were not always managed safely. The provider had not ensured staff had received the training needed for their roles. Eating and drinking support was not always effective. Care records did not always reflect people’s care choices and needs. The provider’s governance processes had not always identified or addressed issues at the service.

A number of staff had recently left the service, meaning agency staff were regularly used until new staff could be recruited. Staff were safely recruited. Effective infection prevention and control systems were in place.

People’s needs were assessed but were not always subject to effective ongoing review. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. The policies and systems in the service supported this practice. The premises were adapted to suit people’s choices and support needs.

People spoke positively about staff at the service, who they said were caring and kind. People and relatives said people were treated with dignity and respect.

People were supported to access activities they enjoyed and to avoid social isolation. The provider had a clear complaints process in place.

We received mixed feedback on how people’s views and opinions were sought and acted on, and how the provider worked in partnership with others. People and relatives said staff helped people to achieve the outcomes they wanted.

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

Rating at last inspection

The last rating for this service was good (published 11 December 2018).

Why we inspected

The inspection was prompted in part due to concerns received about medicines management. A decision was made for us to inspect and examine those risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to medicines and risk management, training, eating and drinking support, care records and governance processes.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

• The service was clean, tidy and odour free.

• Staff were observed wearing personal protective equipment (PPE) appropriately. Staff were knowledgeable about when to change their PPE and disposed of it in clinical waste bins.

• The service was booking visitors in at a time that suited people and was spaced out to avoid potential infection transmission with other visitors. Visits were currently limited to reduce the risk of infection transmission; this was in line with national guidance and visitors had been informed.

• The staff team had worked together to cover increased staff sickness during an outbreak to minimise the use of agency staff and potential to increase transmission of infection.

At this inspection we found the evidence continued to support the rating of 'Good' and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risk or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Springfield Lodge 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.

Springfield Lodge Care Home accommodates up to 40 older people who require personal care. On the day of our inspection there were 38 people using the service. People who used the service and their relatives were complimentary about the standard of care at Springfield Lodge Care Home.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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 home was clean, spacious and suitable for the people who used the service. The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out. Accidents and incidents were appropriately recorded and risk assessments were in place where required. The registered manager understood their responsibilities about safeguarding and staff had been trained in safeguarding vulnerable adults. Appropriate arrangements were in place for the safe management and administration of medicines.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. Staff were suitably trained and supported to provide care to people who used the service through regular supervision and appraisal. Staff said they felt supported by the registered manager.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community.

Care records showed people’s needs were assessed before they started using the service. Care plans were written in a person-centred way and were reviewed regularly. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account. Care plans were in place that recorded people’s plans and wishes for their end of life care.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People had access to healthcare services and received ongoing healthcare support.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint. The provider had a quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

Springfield Lodge Nursing Home provides care and accommodation for up to 37 people with personal care and nursing needs. On the day of our inspection there were 34 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Springfield Lodge Nursing Home was last inspected by CQC on 31 July 2014 and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. Staff had been trained in how to safeguard vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act (MCA) 2005 and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service were complimentary about the standard of care at Springfield Lodge Nursing Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Springfield Lodge Nursing Home and care plans were written in a person centred way.

The home employed an activities co-ordinator and activities were arranged for people to help meet their social needs and protect people from social isolation.

People who used the service were aware of how to make a complaint. There had been only one formal complaint recorded at the service in the previous 12 months.

The service had links with the local community. Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service.

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

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

Is the service safe?

People told us they felt safe and 'in good hands'. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.

The service was clean and hygienic. Appropriate guidance, equipment and facilities were in place for staff so people were safe and protected from the risks associated with cross infection. We found improvements had been made since our inspection in November 2013.

Is the service effective?

People's health and welfare was protected and promoted and we recognised the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People received appropriate care and support because there was effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Is the service caring?

We saw that staff had a good awareness of individual's needs and treated people in a warm and respectful manner. We saw people were receiving care and support in a sensitive way during our visit and staff were able to manage behaviours that were complex or challenging.

The manager and staff were knowledgeable about people's lives before they moved into the home. There was interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.

People were positive about their experiences. Comments included "They are all lovely and very kind", "It's not like being at home but it will do" and "The home is wonderful, I am very well looked after".

Is the service responsive?

Systems were in place to make sure that the manager, deputy manager and staff learnt from significant events including accidents and incidents. Audits helped determine why a particular incident may have happened and what further action was required to help prevent reoccurrence.

Is the service well-led?

The manager, deputy manager and staff continued to look at the needs of people who used the service and ways to improve these for people. It was evident the manger was committed to ensuring people received care which was safe and effective because a number of audits such as care planning had been introduced which meant people's needs were met in a safe and effective way.

We also spoke with three health professionals who were visiting the service during our inspection who told us they did not have any concerns relating to how people were cared for and found the level of care to be "very good".

We looked at people's records in relation to consent to their care and treatment and also care planning and risk assessment and the care people received. We found improvements were required for example in relation to decisions about end of life care because important principles of involving people had not been followed.

Care plans we looked at did not contain sufficient information to ensure people's needs were fully met and when we observed how people were care for we found staff did not always have the right skills and there was an insufficient number of staff to ensure people were cared for appropriately.

We did find that people were protected from the risks of unsafe medication practices. We found the service carried out monthly audits and where concerns had been identified these were rectified immediately.

We observed the cleanliness of the home and found improvements were required. The service had recently appointed two infection control leads but they were still awaiting training, the physical state of bathrooms and toilets needed improving we found many areas to pose a risk of infection because of a lack of cleanliness.

We looked at the quality and monitoring system for the service and found although the service did do regular audits in relation to the care people received and the environment issues identified were not often addressed promptly and there was no information available about how improvements would be made.