The Care Quality Commission
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Archived: Spring Bank Nursing Home

Overall: Inadequate read more about inspection ratings

Howden Road, Silsden, Keighley, West Yorkshire, BD20 0JB

Provided and run by:
Mrs D Hudson

All Inspections

09 & 10 June 2015

During a routine inspection

The inspection took place over two days on 9 and 10 June 2015, the first day was unannounced.

Spring Bank Nursing Home provides accommodation for up to 31 people, predominantly older people. It is situated in the town of Silsden and is close to local shops and amenities. The accommodation is on two floors and is made up of single and shared rooms. There are two lounges and a dining room on the ground floor and there is a passenger lift. The home is set in its own grounds and there is parking by the side of the building.

The service has not had a registered manager since November 2013. 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 last inspection was in November 2014 and at that time we found there were ten breaches of the regulations. We issued warning notices for three of the breaches of regulations, there were in relation to nutrition, record keeping and monitoring the quality of the services provided. We told the provider they had to make improvements by 23 March 2015. The other breaches related to safeguarding, the safe management of medicines, the safety and suitability of the premises, consent to care and treatment, staff training and development and respect and involvement.

We told the provider they must submit an action plan with details of how they were going to make improvements in these areas. The provider sent us an action plan. During this inspection we followed up all these areas to check if the required improvements had been made.

We found the provider had not taken adequate measures to meet the requirements of the warning notices in relation to nutrition, record keeping and monitoring the quality of the service which meant there was a continued breach of regulation in these areas. In addition we found the provider was still in breach of the regulations relating to medicines, the safety and suitability of the premises, consent to care and treatment and staff training and development. In addition to the on-going breaches of regulation we identified new breaches of the regulations. They were in relation to staffing, staff recruitment, person centred care and safe care and treatment.

People who used the service and their relatives told us they felt safe. However, we identified a number of concerns which led us to conclude the service was not safe. We found people’s medicines were not managed properly and people did not always get their medicines in the way they were prescribed. This was an on-going breach of regulation. The home was not clean and there were unpleasant odours in some areas including people’s bedrooms. The home décor and furnishings were showing signs of wear and tear and the home was not well maintained. The standards of cleanliness had deteriorated since the last inspection.

There were usually enough staff on duty but the home did not have enough nurses and relied on a mixture of part time and agency nurses which risked a lack of continuity of care. This was a new area of concern.

We found people did not always receive care and treatment which was appropriate, met their needs and reflected their preferences. This was a new breach or regulation. People were supported to meet their health care needs and had access to NHS services via their GPs.

Some improvements had been made to the way people were supported to eat and drink however there were still areas of concern. For example, when people had food and fluid charts to monitor what they were eating and drinking there was no system in place for checking the charts to make sure they had in fact had enough to eat and drink.

People told us staff were kind and caring and we saw staff were respectful and attentive to people’s needs. However, there were some aspects of the service which could compromise people’s privacy and dignity, for example there was no lock on one of the communal toilet doors.

There were no restrictions on visiting and people were able to receive their visitors at times that suited them and in private. There was a programme of activities. Opportunities to take part in social activities outside of the home were limited and for the most part people relied on family and/or friends to take them out.

People told us they had no reason to complain. Information about how to make a complaint was displayed in the home.

The required recruitment checks were not always done before new staff started work. This meant people could be at risk of being supported by staff unsuitable to work in a care setting. This was a new breach of regulation. When new staff started work they did not always get any induction training to make sure they were competent to work safety and deliver appropriate care. Staff had received some training on safe working practices but it was difficult to get accurate information about what training staff had received. This risked people being cared for by staff who were not properly training to deliver appropriate and safe care. This was an on-going area of concern and had been identified as a breach of regulation at previous inspections.

Staff did not have a clear understanding of the principles of the Mental Capacity Act and the Deprivation of Liberty Safeguards which meant there was a risk they were not always acting within the law. This was an on-going breach of regulations.

There was no registered manager and there was a lack of consistency and leadership. There were some systems in place to monitor the quality of the services provided but there were not working well. This meant that potential problems or shortfalls in the service were not always identified and acted on which in turn could have a negative impact on the experiences of people who lived in the home.

People who lived in the home and others were potentially at risk because the provider did not have effective systems in place to identify, assess and manage risks to their safety and welfare.

We found the provider was not meeting nine regulations and many of these were on-going. CQC is considering the appropriate regulatory response to resolve the problems we found.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

On 07 September 2015 we issued a Notice of Proposal to cancel the provider’s registration to carry on the regulated activities accommodation for persons who require nursing or personal care, treatment of disease disorder or injury and diagnostic and screening procedures at the location Spring Bank Nursing Home.  The provider took the decision to close the home.

11 November 2014

During a routine inspection

We inspected Spring Bank Nursing Home on 11 November 2014. The inspection was unannounced. There were 17 people living in the home at the time of the inspection.

Spring Bank Nursing Home provides accommodation for up to 31 people, predominantly older people. It is situated in the area of Silsden, which is on the outskirts of Keighley. The accommodation is on two floors and there is a passenger lift. The home is set in its own grounds and there is parking by the side of the building. There are single and shared bedrooms.

The last inspection was on 12 June 2014 and at that time we found the provider was not meeting a number of the regulations. We told the provider they must take action to make improvements in care and welfare, nutrition and assessing and monitoring the quality of the service. We also gave them a warning notice telling them they must take action to improve the training and support provided to staff. We followed up all those areas during this inspection.

The service has not had a registered manager since November 2013. 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.

We found the service was lacking consistency and clear leadership. There was a lack of a structured approach to the management of the service. There were some systems in place to monitor the quality of the services provided but these were not working well.

The provider did not have effective systems in place to identify, assess and manage risks to the safety and welfare of people who used the service and others. The provider did not always take appropriate action when, other agencies such as the Commission, told them about risks to people’s safety and welfare. This was a breach of Regulation 10 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People told us they felt safe and secure at the home. However, we found the provider did not always follow the correct procedures for reporting allegations or suspicions of abuse. This was a breach of Regulation 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Medicines were not managed safely. People did not always receive their medicines in the way they had been prescribed. This was a breach of Regulation 13 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

The home was clean and decorated and furnished to an acceptable standard. People’s bedrooms were warm and comfortable. However, the building did not always meet the standards of safety and suitability set down in law. For example, a recent environmental health inspection had identified structural problems with the kitchen windows and the provider had failed to take action in a timely way to deal with this. This was a breach of Regulation 15 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found the numbers of staff on duty were adequate to ensure people’s needs were met.

We saw that some staff training had taken place. However, there was no evidence of a planned and structured approach to providing staff with the training and support they needed to deliver safe and appropriate care. This was a breach of Regulation 23 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People living in the home told us they had enough to eat and drink and said they enjoyed the food. The records which related to supporting people to meet their dietary needs were not always available and/or accurate. This created a risk that people would not receive the right support. This was a breach of Regulation 20 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

People who lacked capacity were not always protected under the Mental Capacity Act 2005 and the service was not meeting Deprivation of Liberty Safeguards (DoLS). For example, one person’s records stated they must not be allowed to go out of the home alone. There was no evidence to show the best interest decision making process had been followed and a DoLS application had not been made. This was a breach of Regulation 18 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found people had access to the full range of NHS services. However, on occasions we found there had been delays in referring people to other health care professionals. This could result in delays in people receiving appropriate care or treatment.

The home had a warm and homely atmosphere. We saw staff were kind, caring and compassionate in their interactions with people. People looked clean and well cared for and were wearing appropriate clothing and footwear.

The majority of people we spoke with told us the staff were caring and looked after them well. However, two people told us some staff, and in particular the night staff, were not always kind and compassionate. We discussed this with the provider and manager. We spoke with two people’s visitors and they told us they had no concerns about the care provided and confirmed they could visit at any time.

People’s needs were assessed and the information was used to develop plans of care. We found the provider did not always support people to be involved in making decisions about the planning and delivery of care. This was a breach of Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Information about people’s past lives, interests and preferences was recorded and we found staff knew about people’s needs and preferences.

Information about planned activities was not displayed in the home which meant people might miss out because they were not aware of what was going on.

The majority of people told us they had no reason to complain but would not hesitate to talk to the management or staff if they had any concerns. We found some of the information in the complaints procedure was not correct. This could make it difficult for people to know what to do if they were not satisfied with the way the provider had dealt with their concerns. This was a breach of Regulation 19 Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

You can see what action we told the provider to take at the back of the full version of the report.

12 June 2014

During an inspection looking at part of the service

The inspection was carried out by two inspectors. We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

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

Is the service safe?

We found the home was clean and looked well maintained. However, we were unable to confirm that the required checks on gas, electricity and the lifts and hoists were carried out because the records were not available in the home at the time of the inspection.

The service had been served with an enforcement notice by West Yorkshire Fire & Rescue Service for shortfalls in training, the fire risk assessment and the evacuation plan. The manager told us they were addressing the concerns which had to be dealt with by 15 July 2014.

We have asked the provider to make the required documents available for inspection and to tell us what they are doing to comply with the fire safety requirements.

People had care plans in place however the majority of the care plans we looked at had been developed in 2012 and 2013 and although they had been evaluated every month we found they had not always been updated to reflect changes in people's needs and/or the care and treatment provided. The manager told us they had already identified this as an area that required improvement and were planning to introduce a new care planning system.

At the last inspection in March 2014 we were concerned the service did not have enough staff to meet people's needs. During this inspection we found the provider had addressed these concerns and there were enough staff to meet people's needs.

The manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) and was aware of the recent Supreme Court judgment on the Deprivation of Liberty Safeguards.

Is the service caring?

One relative said 'I stood outside my relatives bedroom door without the care staff knowing I was there and I and could hear them being patient and offering reassurance to my relative while assisting with personal care. This proved to me I had chosen the right home for my relative.'

During the inspection we observed staff were busy but also had time to spend with people, for example supporting and encouraging people to eat and drink. We observed staff were kind and respectful in their interactions with people.

Is the service effective?

We found improvements were needed to the way the service managed the care of people who were at risk of malnutrition.

The provider did not have suitable arrangements in place to ensure that staff were appropriately trained and supported in relation to their responsibilities. This meant there was a risk people would not receive safe and appropriate care.

We have asked the provider to tell us what they are going to do to make improvements to these aspects of the service.

Is the service responsive?

We saw people had access to a range of NHS services. Visits from health care professionals such as GPs, tissue viability nurse specialists and speech and language therapists were recorded in people's records.

We spoke with the relatives (two) of one person who used the service. They told us they were very pleased with the standard of the care and treatment provided and were always kept informed of any changes in their relative's physical or mental health.

At the last inspection in March 2014 we found the provider did not have an effective system in place for dealing with concerns and complaints from people who use the service or those acting on their behalf. During this inspection we found the provider had taken action to improve this aspect of the service and had provided people with information about the complaints procedure. We were unable to test the effectiveness of this because the service had not received any complaints since March 2014.

Is the service well led?

The provider appointed a new manager for the service in April 2014. The manager had not applied for registration with the Commission at the time of the inspection. However, they told us they would make an application at the end of their probationary period. Following the inspection the manager told us they had started the registration process with the Commission. People who manage care services are required by law to be registered. The service has not had a Registered Manager since November 2013. The provider is required by law to have a Registered Manager in place.

The home was providing care to a number of people living with dementia but there were no environmental risk assessments in place which addressed the potential risks to people living with dementia. For example, there was no risk assessment in place for the main staircase which people had unrestricted access and therefore were potentially at risk of falling or for the lack of appropriate locks on the sluice room doors which meant people could have access to potentially harmful substances.

At the time of the inspection there was no effective system in place to identify any shortfalls in the service or non-compliance with the essential standards of quality and safety. The manager told us they were addressing this but it would take time to implement an effective quality assurance system.

When we reviewed the accident and incident records we found accidents and incidents were not always investigated and/or reported to the Commission and other relevant agencies. This meant that potential risks to people's safety and welfare may not be identified and managed appropriately.

People who used the service had been asked to share their views of the service by completing survey questionnaires. The manager told us staff had helped people to complete the surveys. We looked at a number of the surveys, which were not dated, and saw that people were generally satisfied with the care and support provided. However, we saw the survey did not ask people about the staffing levels or if they felt staff were available to meet their needs in a timely way. Staffing was identified as an area of concern during the last inspection in March 2014 and therefore people using the service should have been given the opportunity to comment on this aspect of the service.

We have asked the provider to tell us what actions they are taking to address these shortfalls in the service.

11 March 2014

During an inspection looking at part of the service

We spoke with seven people who used the service and three visitors. People said they felt safe and overall they were satisfied that their needs were met. They said the staff were kind and respectful and asked for permission before doing anything. Comments included 'I find it ok', 'I am highly satisfied' and 'Care good, looked after well'. We observed staff knocking on people's doors before entering their rooms and people said this happened all the time. One person said staff did not always close the curtains when supporting them with personal care. However, we found some improvements were needed to the way people's care was planned and delivered to ensure their safety and welfare.

People told us they had enough to eat and overall they were satisfied with the standard of food. Comments included the 'Meals are fine', 'Food is good and we get enough', 'Meals vary, some days they are very good, some days I don't care for them".

Most people said they felt there were not always enough staff, they said the staff were very busy and always had something to do. We found the provider did not have suitable arrangements in place to make sure there were always enough staff on duty to meet people's needs.

The people we spoke with were not aware of the complaints procedures although they said they would feel comfortable talking to the staff or the provider if they had any concerns. We found the provider did not have an effective system for dealing with complaints.

6 September 2013

During a routine inspection

We spoke with five people who used the service. They told us they were very happy with the care they received. One person told us 'we are well looked after' another person told us 'it is lovely here'.

The people who used the service had known each other for a long time and we saw how people had developed friendships and looked after each other. When one person became upset during lunch, other people around the table offered them comfort and support. During lunch we saw one person using a knife to eat their food. The other people around the table then supported them to start using a fork to eat their lunch.

We saw that interaction between staff and the people who used the service was warm and friendly. We spoke with four care assistants. One care assistant us 'I have known some of the people here for a long time, we have got to know each other very well.' All the care assistants we spoke with told us that the home had a friendly atmosphere and one staff member told us 'it is like a family here.'

We saw that activities took place each week. The activities were varied and included; a quiz, an entertainer and gardening. During the inspection, an entertainer had been booked and they played songs in the lounge. We saw that people in the lounge sang along and appeared to enjoy themselves.

We looked at the care plans of four people who used the service. We saw that they were detailed and comprehensive. We saw that the care plans were tailored to meet the needs of the individual and each plan had an associated risk assessment. In each of the plans we looked at we saw that regular reviews of the care plans had taken place and were up to date. One member of staff we spoke with told us that people who used the service were asked their opinion regarding their care. We saw in the care plans that preferences, such as likes and dislikes of certain foods had been recorded.

The care assistants we spoke with told us that they had received training in safeguarding and would know what to do if they had any concerns. One of the people who used the service told us they would talk to the senior nurse if they had any concerns about the way they were being treated.

16 October 2012

During a themed inspection looking at Dignity and Nutrition

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector and joined by a practising professional and an Expert by Experience, who has personal experience of using or caring for someone who uses this type of service.

We also spent a period of time observing staff delivering care to people who used the service. This method of observation is called the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We observed three people who used the service for a period of 30 minutes during lunchtime. We recorded their experiences at regular intervals. This included people's mood, and how they interacted with staff members, other people who used the services, and the environment.

People told us that the staff were kind and friendly and they always were respectful. People said they liked to maintain their independence. One person said 'I have a key to my bedroom door so that I can come and go as I please.' Other people told us that they had been able to visit the home before moving in and then they could choose their bedroom.