Archived: Springfields Care Home

We told the Registered Provider and Registered Manager that they had 28 days in order to address the concerns. The date by which this was to be addressed was the 9 May 2014.

We returned on the 12 May 2014 to ensure the concerns had been addressed.

Springfields Care Home is registered for 85 persons. It was split into four units Willow, that was dementia nursing; Maple, that was general nursing; Sycamore, that was dementia residential and Elburton that was general residential. On the day we inspected there were 63 people living in the home (The number of people residing in each unit were 17 in Willow; 21 in Maple; 16 in Sycamore and nine in Elburton).

One inspector carried out this inspection. They spoke with people living in the home, observed care and how this was given and reviewed care records. We spoke with 14 people, four staff and reviewed eight care plans. We spoke with people who had raised concerns with us last time we visited the home. We also spoke with the Registered Manager and Area Manager for the home.

When we inspect we review gather evidence to answer the below questions.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Below is a summary of the inspection and what we found.

Is the home safe?

We found care and treatment was planned and delivered in a way that ensured people's safety and welfare. We found that there were clear risk assessments and links to care planning. People's care was in line with the care plans. People, who were able to communicate with us, told us they felt their care was safe.

People told us 'The staff know what they are doing, they're as good as gold those girls.'

People had the correct equipment in place to meet their assessed needs. One person for whom a hoist was used to move from their bed to wheelchair, for example, told us that this was achieved safely and they felt safe when this was being carried out.

Is the home effective?

We saw that people had outside support from their GP and other services such as from physiotherapists as required. People who had a catheter fitted, for example, had regular reviews and the staff were trained to ensure their needs were met.

People told us 'You are asked what you would like' and 'I'm satisfied with my care'.

Is the home caring?

We saw that people responded positively to staff and the staff had the skills to communicate with people with a range of needs. We observed staff talking to people kindly and supporting people throughout the day. Care was given in an unrushed manner. On both Willow and Sycamore where people had a diagnosis of dementia we saw staff gently supporting people while delivering their day to day care. Care was given with respect and humour.

People told us 'It's brilliant here; it's absolutely brilliant', 'The carers are brilliant; the nurses are fantastic' and 'The ladies (staff) are very kind'.

Is the home responsive?

Springfields Care Home had undergone a lot of change since our initial inspection in September 2013. We found that they had addressed the concerns following our inspection in March 2014.

We were told by staff 'It's fantastic' now the extra staffing numbers had been addressed and investment had been made in the home. Staff also told us 'We have been able to talk to residents and spend time with people. We have been able to achieve more for our residents.'

Willow, where most of our concerns were, was seen to be a very different environment where people were being looked after and having their individual needs met. People's rooms were seen to reflect their individuality. One staff member summed it up when they stated 'People's rooms look more like their bedrooms at home; more friendly'. People were seen to be happy, smiling and having activity and care provided that stimulated their minds and reflect their likes and dislikes.

Is the service well led?

We spoke with the Registered Manger and Area Manager for the home. The showed us how they had worked to meet the needs expressed in the warning notice and the inspection carried out in March 2014. We found that at both the local level (the home) and provider level the concerns had been addressed and changes made that ensured people were being protected from unsafe and inappropriate care.

We were told that the Registered Manager 'makes sure you are happy; she goes the extra mile'. Staff also told us they were supportive and confirmed they had received recent supervision to ensure the concerns CQC had were addressed. They also stated their training had been updated and if they had missed any of these sessions this was sorted out quickly.

Staff told us that 'I would give the home eight out of 10 now. We could still improve, but it is much better'.

When we visited last time there was not a registered manager in place. We found that this was no longer the case and their details can be found in the early part of this report.

On the day we visited we were advised there were 63 people living at the home. The home is registered for 85 people. We found there were 16 people accommodated on the Dementia Nursing Unit (Willow), 21 people on the General Nursing Unit (Maple), 16 people on the Dementia Residential Unit (Sycamore) and 10 people on the General Residential Unit (Elburton).

We visited the home over two days. We spoke with a number of people, their families and staff. We also spoke with some people who had spoken with us the first time we visited. We also reviewed the records kept in respect of how people's care needs should be met as well as other information kept by the home.

People were very complimentary about the staff and used phrases such as, 'The staff have always been nice people here', 'Carers alright', 'Good crew here', 'I'm happy to be here', 'No complaints', 'Lovely home to be in, without doubt the best', 'My sister looked at five other places before fixing me up here ' she did well for me', and 'Staff always very busy and work hard to cover every contingency'.

We found that consent to care and treatment of people without the capacity to make their own choices continued to be a concern. The formal consent of some people with capacity had been sought by the second day of our visit however; in general this process had not been fully implemented.

We found that people continued to not be protected from receiving care that was inappropriate and unsafe.

We found that medication was being administered safely and by people who were suitably trained.

We had some concerns about the staffing levels on the first day of our visit but found these had been resolved before we completed our inspection on the second day.

We found there had been improvement in the quality auditing carried out by the home but some concerns remained.

When we visited this time we were concerned that the records used to ensure the care given was appropriate and safe were not of the standard expected.

When we visited the home we found the current manager is unregistered. We have requested the provider to ensure an application is submitted as a matter of urgency.

We spoke to people on their own and at meal times. We also spoke to their visitors, to staff, a mental health advocate and the manager. We have also communicated with staff within Four Seasons regionally and nationally.

We found that people who were able to communicate with us felt they always had their consent to care and treatment sought, felt they were in control of their care and were having their choices and preferences respected. For people whose communication needs were more complex and when they had advanced dementia it was not clear when people were having their consent to care and treatment sought. We found their care plans were on the whole detailed and meetings took place to establish what was in the person's best interest. We raised particular concerns about Willow Unit.

We found that people were not being protected from the unsafe administration of medicines on all occasions.

We found the staffing ratios to need in Elburton, Sycamore and in Willow were such that people's care was being compromised or people were being placed at potential risk of harm. People told us they felt there was not enough staff to see to their or their relatives needs and we observed that staff did not have time to spend with people.

We found the home had a quality assurance process in place and sought people's views within that process. However, we found the process was not robust enough to identify the concerns that resulted from our visit. We also found the provider had not picked up on all the concerns within the annual survey and ensured that changes had been made to the service to eradicate and remove those concerns.

During our observations we saw staff helped people to mobilise. We also saw staff conversed with people when they were laying up tables for lunch. We observed staff assisted people to eat their lunch. We saw people talked to each other at lunch.

We heard care workers ask people what they would like to do and they gave them ideas if people could not make a choice.