Springfield House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant the effectiveness of people’s care, treatment and support did not always achieve good outcomes or was inconsistent.

The service was in breach of legal regulation in relation to consent and safe care and treatment.

This service scored 54 (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 make sure people’s care and treatment were effective because they did not consistently check and discuss people’s health, care, wellbeing and communication needs with them.

The provider had recently introduced pre‑admission assessments to support safe and well-planned transitions for new people entering the service.

Although care plans were person centred‑ and included some information contributed by people, it was not always clear whether people or their relatives were actively involved in reviewing them. Some reviews had been recorded, but there was no record of family involvement or the involvement of people using the service, and several areas within the plans needed updating. For example, one person’s hospital passport had not been reviewed since 2019. In another case, the bedrail risk reduction measures set out in the person’s care plan were not being followed in practice. These gaps meant care plans did not always reflect people’s current needs or provide‑ consistent guidance for staff.

However, some care plans did contain helpful information about people’s care, health and wellbeing, which supported staff to understand individuals’ preferences and needs. When we asked how staff keep up to date when people’s needs change, one staff member told us, “When I go in, I look through the diary which [registered manager] writes on a daily basis. I also look through the care plans to see if they’ve been updated.”

The provider did not always plan and deliver people’s care and treatment with them, including what was important and mattered to them.

Although some clinical assessment tools had recently been introduced, these were not used consistently. Tools such as the Malnutrition Universal Screening Tool (MUST) and Waterlow score had been implemented, and some people’s weights were being recorded. Whilst staff understood when to escalate concerns and one staff member told us, “I help with people’s weight management. I calculate the weight management, and we escalate to the relevant health professionals where required”, we found there were gaps in weight records. The registered manager told us these were refusals, but this had not been documented. This meant it was not always possible to understand patterns or assess associated risks.

People’s nutrition and hydration needs had been considered, and one care plan referred to a daily fluid target, but the actual target amount was not recorded. This limited staff’s ability to monitor whether people were meeting their hydration needs.

However, one person’s epilepsy support plan, including guidance on the use of rescue medication, was clear and detailed. People also had care plans for specific healthcare needs, and these reflected recognised guidance, including National Institute for Health and Care Excellence (NICE) recommendations.

The provider worked well with other teams and services to support people’s care. Information was shared appropriately so people did not have to repeat their stories, and staff worked with external professionals to help ensure transitions were smooth and well planned.

People and relatives spoke positively about their experiences of moving into the service. Some appointment letters and correspondence from health professionals were kept in care files, showing communication and joint working with external agencies. One person described their transition warmly, telling us, “I came and visited for a weekend, and I didn’t want to go home. I moved in on the Wednesday.”

Relatives shared similar views. One relative said, “It went very smoothly…it was a difficult decision. The social worker was involved. [Person using the service] visited for the day, then the weekend, then for a few more days and settled very quickly…The transition went well.”

Health professionals we spoke with also commented positively on their interactions with the service and described communication as effective. One health professional said, “I would happily have a family member looked after there… They're proactive if they've got concerns. They refer to us through the GP or the hub quickly and they're very responsive.”

However, the provider did not record minutes of multi disciplinary team (MDT) discussions. The provider recognised this gap and told us they planned to introduce consistent recording to strengthen information sharing and accountability.
 

The provider did not always support people to manage their health and wellbeing in a way that helped them maximise their independence, choice and control. Staff did not consistently help people to live healthier lives or, where possible, reduce their future need for care and support.

There was no evidence that staff held regular, person centred conversations with people (and, where appropriate, relatives) about their health goals, how they might live more healthily, or how they could build their independence. Care records did not show agreed goals, actions or follow up, so it was not clear how people were being encouraged to make informed choices or track progress over time.

People’s health needs had been assessed, and some were reviewed regularly. For example, one person’s healthcare needs were overseen through Continuing Healthcare (CHC) reviews, providing ongoing clinical oversight. Health Action Plans were in place, but some needed updating. One person’s plan was updated and focussed mainly on one specific health condition, so did not reflect their wider health needs or support a proactive, preventative approach to wellbeing. Although daily notes were used to monitor this specific health condition, the service would benefit from a dedicated tracker to produce clear, accurate information for professionals.

Referrals to external health professionals were made when concerns were identified, including a referral for dietary advice for one person.

We observed staff offering choices about meals throughout the day, and people were supported to decide what they wanted to eat in line with their preferences. One person told us, “I like the food here and I am trying things that I said I don’t like, like vegetables, my favourite is mashed swede and carrots. [Registered manager] encourages me to eat more veg.”

The provider did not always monitor people’s care and treatment in a way that helped them improve their outcomes over time. They did not consistently ensure that outcomes were positive, meaningful or aligned with both clinical expectations and what mattered to people.

People did not have recorded outcomes, goals or aspirations in their care plans. There was no clear evidence that people were consulted about how they might maintain or improve access to social opportunities, develop new skills or build their independence. When we assessed people’s quality of life using the Quality of Life Tool, we did not see recorded evidence that the service had a structured approach to improving or maintaining people’s quality of life.

However, people appeared happy and content during our visit. One person told us, “My favourite thing about living here is mixing with the group and having a talk… I absolutely love it and I like the [people using the service], I love them and they love me as well.”

People had oral health care plans in place, which included details of their dentist and guidance for staff on how to support oral hygiene. However, it was not always clear when people were last seen by a dental professional, so the provider could not demonstrate ongoing monitoring of oral health. Some people had future dental visits booked in.

Some care plans did contain helpful, person specific guidance. For example, one person’s plan clearly described how they expressed anxiety and set out how staff should respond. This supported staff to recognise early signs of distress and take consistent action.

The provider did not tell people about their rights around consent or consistently respect these when delivering care and treatment.

There were inconsistencies in how the service assessed and recorded people’s capacity to consent. One person the provider told us lacked capacity to consent had unsigned consent forms and no Mental Capacity Assessment (MCA) or Best Interest (BI) decisions in place. Another person had a health and welfare consent form completed by a relative, but there was no evidence the relative held a relevant Power of Attorney or that the provider had carried out an MCA or BI decision. For people who did not use words to communicate, the provider did not have communication systems in place to support decision making and consent. This meant the provider could not demonstrate that consent for care was obtained in line with the Mental Capacity Act 2005.

Some Mental Capacity Assessments and Best Interest decisions were present in care files, however in several cases where we were told people lacked capacity, these were incomplete or missing. As a result, the provider could not show that decisions made on behalf of people lacking capacity were lawful, necessary or the least restrictive option. This placed people at risk of receiving care that did not reflect their rights or wishes.

There was no system in place to ensure consent to care was revisited with people. However, staff were observed interacting kindly and respectfully with people. We saw staff explain what they were doing, seek agreement before offering support, and look for non‑verbal cues to gauge whether the person was comfortable.