Springfield House Residential Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

We found no evidence that themes or trends were monitored to reduce the likelihood of incidents recurring. We also identified incidents that met the threshold for statutory notification to CQC but had not been reported. We highlighted these specific incidents to the management team during the assessment. Following the assessment the provider submitted the relevant notifications to CQC.

Where incidents or accidents had occurred, staff documented and reported these in a timely manner. However, the reports were not reviewed or investigated in depth which meant care plans and risk assessments were not always up to date to inform staff of the actions they should take to mitigate the risk of further harm or injury.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Assessments were completed prior to people moving into the service. This ensured people’s needs were known and could be met.

The provider worked with external professionals such as GP’s and specialist nurses to support people’s care and help to keep them safe. One health care professional told us staff sought support as soon as possible and always listened to the advice and guidance given.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

The provider did not always escalate concerns promptly or appropriately to external agencies. During our review of care records, we identified potential safeguarding incidents. Whilst the service had taken actions to mitigate the risk of further occurrences, such as ensuring a person was supported continuously throughout the day, these incidents were not reported through safeguarding procedures, and the CQC had not been notified as required.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

We found there was not always sufficient understanding or application of the Mental Capacity Act (MCA) by staff undertaking mental capacity assessments. Assessments were not consistently decision-specific, and some lacked adequate information about the discussions held with people. For example, one person was at risk of falling and the provider had used a ‘crash’ mat next to their bed to reduce the risk of harm, a sensor to alert staff when the person was mobilising, and the person was constantly supported by a member of staff throughout the day to keep the person and others safe. The decisions to impose these restrictions were completed to keep the person safe, however formal mental capacity assessments had not been carried out. There was no evidence the decisions were proportionate, the least restrictive option and had been made in the person’s best interest.

We raised these concerns with the provider, who agreed to review and improve how mental capacity assessments were evidenced and recorded.

Applications had been made to the local authority Deprivation of Liberty Safeguards team. The applications contained information relating to people being restricted as they were unable to choose where they would live and were not safe to leave the home unsupported. Further restrictions such as alarm systems that were used to alert staff when the person moved to ensure people were safe, were not recorded on the application forms. This meant that not all restrictions had been reported and approved.

A list was held by the service to identify the date the application was sent, when it was authorised and when an approved authorisation was due to expire. The list was not up to date and did not contain information on an application that had been approved and the associated conditions that staff would have to meet. We spoke with the manager who told us they would address this and review the staff training.

Despite these concerns, people and their relatives told us they felt safe receiving support from the provider.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments and care plans were not always updated following incidents to guide staff on the actions they should take. Staff had reported 1 person had choked once whilst eating a crisp, the risk assessment had not been completed to reflect the incident, and the care plan did not inform staff of the potential choking risk. We did not find any evidence of harm; however, it is important care plans accurately reflect people’s needs.

We observed one person using a wheelchair throughout the day, we reviewed the care plan and risk assessment and found these were not up to date and did not direct staff to assist the person to safely mobilise around the home.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider had completed some refurbishment to the home. During the assessment we observed work was underway to the kitchen. This work was being completed at night to reduce the impact on people and staff. Further improvements had been planned included replacing carpets.

The provider had clear plans to support the safe evacuation of people in the event of an emergency. Fire drills were undertaken with all staff to ensure they had the practical skills and equipment needed to safely evacuate people in the event of a fire.

The environment was visibly clean, tidy and warm. Records showed health and safety checks were carried out frequently. Care equipment, such as moving and handling aids were serviced and maintenance records kept.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

The service was well staffed, and rotas showed planned staffing levels were routinely achieved. Staff told us, the deputy manager was “hands on” and helped to provide care for people.

Temporary agency staff were used to cover periods of staff sickness. The same agency staff worked regularly in the service to ensure consistency. The registered manager told us they had 1 vacancy which was covered by the manager.

Staff received support through formal and informal face to face meetings with their line manager. This gave them the opportunity to discuss their role, concerns and training needs as well as personal welfare. Staff told us they felt supported and the management team were approachable and “nice”.

Prospective staff went through a safe recruitment process which included their right to work in the UK and their fitness for the role. All staff had undergone a Disclosure and Barring Service (DBS) check to help ensure they were suitable to work in the care sector.

The induction process ensured new staff did not work alone and staff told us they were not allowed to work on their own until they felt confident. All staff completed training relevant to their role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The kitchen was being refurbished at night. The deputy manager explained the area was deep cleaned before use the following day.

The service employed housekeepers; cleaning schedules were used to ensure all areas of the service were regularly cleaned. Throughout the inspection, we observed housekeeping staff were busy, and communal areas were clean and tidy.

Clinical waste was managed safely. Personal protective equipment such as gloves and aprons was available throughout the service for staff to use.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff were observed assisting people with their medication and accurately completing the Medication Administration Records (MARs).

Medicines were stored securely. Medicines were managed by staff who had received training and had their competency assessed.

People’s medicines were regularly reviewed and care plans contained detailed information to support staff to meet people’s needs. Protocols for ‘as required’ medicines had been developed; these were reviewed monthly and usually contained detailed information to support staff. However, there was not enough detailed information on how staff should support people if they became agitated and distressed. We discussed this with a staff member who described how and when medication should be given during periods of distress and this aligned to the care plan. During the assessment a staff member responsible for medication updated the PRN protocols to include the additional information.

Medicine audits were completed and any discrepancies acted upon. Medicines that required additional storage security, such as controlled drugs, were audited to ensure the amount of stock was correct.