Archived: Springfield Cottage Residential Home

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

We found significant shortfalls in the assessment, management and mitigation of risk in relation to people’s safety in the event of a fire.

We considered urgent enforcement action under our regulations, however, this was superseded by enforcement action taken by Lancashire Fire and Rescue Service. This ensured the safety of people living in the home while the provider undertakes the necessary action to mitigate the risks to people in the event of a fire. When the work is completed Lancashire Fire and Rescue will assess the works and review their enforcement action before people can be accommodated in the home.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns we had received from Lancashire Fire and Rescue Service. The inspection was prompted in response to concerns received about fire safety management. A decision was made for us to immediately inspect and examine those risks.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Springfield Cottage Residential Home on our website at www.cqc.org.uk.

Enforcement

We have identified a breach in relation to the assessment, management and mitigation of risk in the event of a fire.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Springfield Cottage Residential Home is a residential care home providing accommodation and personal care for up to a maximum of 26 people in one adapted building. The service specialises in providing care for older people and people with dementia. There were 25 people living in the home at the time of the inspection.

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

We found shortfalls across the operation of the home, including the management of risk and medicines, the environment, the application of the Mental Capacity Act, the quality of the service and care provided and the governance and record keeping systems.

Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. Staff raised concerns about the staffing levels and we noted there were times when the lounge area was unsupervised. We were assured the deployment of staff will be considered. There were appropriate arrangements for the recruitment of new staff. There were shortfalls in some people’s care plans and risks to people’s health safety and well-being had not always been assessed and recorded. Most areas of the home had a satisfactory standard of cleanliness; however, we observed some shortfalls in people’s bedrooms. Medicines were not always managed safely.

People were not always appropriately supported during mealtimes. We noted people were served meat which was very difficult to eat. We also observed the full meal service could not be completed because there was a shortage of plates. New auditing systems were introduced to minimise a reoccurrence of this situation. People were not always supported to have maximum choice and control of their lives and staff were not always aware of the least restrictive way of care; there were policies and systems in the service to support staff. We found there were no supporting care plans in relation to Deprivation of Liberty Safeguards (DoLS) and applications had not always been made when the DoLS authorisations had expired.

There were limited adaptations to the environment to support people’s needs. 11 people were unable to have a bath or shower due to the lack of suitable facilities. The provider assured us a new wet room would be installed. Staff had access to the provider’s online training which was refreshed at regular intervals. An agency worker new to the home had not had an induction or introduction to the home, so they may not have been aware of the safety procedures. People were supported to access healthcare services.

People told us the staff were caring and kind. However, people were provided with limited opportunities to express their views and there was no evidence of people being involved in the care planning process. People’s dignity was not always promoted and maintained. We observed people’s bedrooms were not always well presented and the laundry was disorganised. We received information following the inspection, to assure us this situation was being addressed and the laundry room had been tidied.

People’s care was not always planned to meet their needs and preferences. Many of the care plans had not been reviewed and updated and lacked important information about people’s care. The management team were in the process of updating all the care plans. There were limited opportunities for people to participate in activities.

Whilst the provider had a schedule of audits and auditing tools, most audits had not been completed since May 2022. This meant there had been no effective systems to monitor and improve the quality of the service and shortfalls identified during the inspection had not been identified and addressed. We also found there were no completed provider audits or oversight reports. People were given limited opportunities to express their views. Whilst a satisfaction survey had been carried out, there was no evidence of any residents’ meeting during 2022.

The manager and deputy manager were new to their roles. They were committed to making improvements to the service and had plans to improve people’s quality of life and the standards in the home. Following the inspection, the provider sent us an action plan in response to the findings along with additional supporting information. We will check any improvements on our next inspection of the home.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 5 March 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

The inspection was prompted in part due to concerns received about the management of staff, staff training, person centred care, the management of medicines, the environment and the management of the home. A decision was made for us to inspect and examine those risks.

We also followed up on the 4 recommendations made at the last inspection, in respect to the management of medicines, the application of the MCA, documentation in relation to end of life care and the development of the governance systems.

We have found evidence the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of risks and medicines, the facilities and equipment, the application of the Mental Capacity Act and the governance and record keeping systems. We also made recommendations about ensuring people are given opportunities to participate in activities. 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.

Springfield Cottage is a residential care home, providing accommodation and personal care

for up to 26 older people. Accommodation is provided over two floors. At the time of the inspection there were 21 people at the service.

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

Overall, progress had been made to develop the service. However, some matters needed further attention and action was ongoing to make improvements. There were some shortfalls with the provider's systems to monitor and review the quality of care people experienced. We have made a recommendation about further improving quality monitoring processes. Springfield Cottage had a welcoming, friendly and inclusive atmosphere. Management and leadership arrangements supported the effective day to day running of the service. People were consulted about their experiences and could make suggestions for improvements.

People were satisfied with the support they received with medicines. Progress had been to manage medicines safely, but we found some shortfalls. We have made a recommendation about medicines management. People told us they felt safe at the service. Improved processes for safe staff recruitment had been introduced. Improvements had been made with managing risks to individuals. Staff were aware of safeguarding and protection matters. They had received appropriate training and their conduct was supervised. Processes were in place to maintain a safe and hygienic environment.

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 had not always supported this practice. We have made a recommendation to ensure continued best practice. People's needs and preferences were assessed before they moved to the service.

People were satisfied with the variety and quality of the meals provided at the service. The provider offered staff training, development and supervision. People were supported with their healthcare needs, medical appointments and general well-being. Furnishings and décor responded to people's needs and comfort, progress was ongoing.

People received personalised care and support, their needs and choices were reviewed and updated regularly. Progress could made with supporting people to plan in advance, for their end of life needs. We have made a recommendation about end of life care. There were opportunities for people to engage in a wide range of activities. People were supported to have contact with families and friends. Processes were in place to support people with making complaints.

People said their privacy and dignity was respected. They made positive comments about the caring attitude of staff. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 28 January 2019) There were four breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations. However, the service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections. We will ask the provider to let us know how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Why we inspected

This was a planned inspection based on the previous rating.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of is the service safe and is the service well-led to at least good. The provider submitted the requested action plan which showed they would complete all required actions by January 2018.

Springfield Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Springfield Cottage is registered to provide accommodation and personal care for up to 26 older people; there were 25 people living in the home at the time of the inspection. The home is situated in a residential area in Blackburn. Accommodation is provided over two floors in 24 single and one double room, a number of which have en-suite facilities. There is both a passenger lift and stairlift to provide access to the first-floor rooms. Communal space is provided in two lounges and a dining room.

The service was managed by a registered manager who had been appointed since the last inspection. 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.

During this inspection, we identified four breaches of the regulations. This was because people were not provided with the equipment required to support them to mobilise safely in the home, medicines were not always safely managed, staff were not always safely recruited and governance systems were not always effective. This has led to the service again being rated as required improvement. This is the second consecutive time the service has been rated as required improvement since December 2017. You can see what action we told the provider to take at the back of the full version of the report.

Our observations during the inspection showed that staff did not always ensure people had the appropriate equipment necessary for them to mobilise safely in the home. We saw that people were transferred in wheelchairs which did not belong to them. In addition, we saw staff support an individual to walk using a frame which was inappropriate for their height. One person had to ask the inspection team to find their walking frame to enable them to mobilise safely. We found this equipment had been placed behind another person in the communal dining room.

Staff had not always been safely recruited. Checks were not always made to ensure applicants had documented a full employment history on their application form or CV. One person had started employment prior to any references being received. The registered manager told us this was standard practice in the home but recognised this meant they could not be certain employees were of good character and suitable to work with vulnerable people before they started work. They told us they would cease this practice with immediate effect and ensure references were always received before people commenced employment.

Medicines were not always safely managed. Records we reviewed showed that on one occasion, a person had received a dose of a medicine which was four times the prescribed dose. Although the person did not appear to have suffered any ill effects from this error, the registered manager was unable to provide us with evidence that appropriate advice had been sought from health professionals and any advice given was followed. In addition, weekly stock checks of medicines were ineffective in identifying if any errors had occurred.

The provider had quality assurance systems in place which included the completion of audits relating to medicines, equipment and staff recruitment records. However, these had not been effective enough to identify the shortfalls we found during this inspection.

The provider had failed to ensure a statutory notification was submitted to CQC after a person suffered a serious injury in the home. The registered manager told us this had been an oversight on their part and confirmed they were aware of the events which needed to be notified to the commission. We saw that all other notifications had been submitted as necessary.

People told us they felt safe in Springfield Cottage and that staff were kind and caring towards them. Care plans and risk assessments provided guidance for staff on how to safely meet people’s needs. Our observations during the inspection showed there were enough staff on duty to meet people’s needs in a timely way.

There were policies and procedures in place regarding safeguarding adults. Staff were able to tell us the correct action to take should they witness or suspect abuse. They told us they were confident managers in the service would listen if they raised any concerns.

The registered manager and staff understood the principles associated with the Mental Capacity Act 2005 (MCA) and acted according to this legislation. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People's consent to various aspects of their care was considered and was clearly documented in their care records.

Staff had completed an induction when they started work and completed regular training to keep their knowledge and skills updated. Staff received regular supervision and an annual appraisal of their performance.

People told us they generally enjoyed the food provided in Springfield Cottage. Improvements had been made to the systems in place to assess and monitor people’s nutritional needs.

A range of activities were provided to help maintain people’s sense of well-being. The provider’s website and quarterly newsletter provided evidence of the activities in which people had participated.

Systems were in place to gather feedback from people who lived in the home, relatives, staff and visiting professionals. People were aware of how they could raise a complaint or concern if they needed to and had access to a complaints procedure.

We received positive feedback about the new registered manager and their impact on the running of the home. Staff told us they were fairly treated and were able to make suggestions about how the service could be improved.

Springfield Cottage is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home is a detached property and accommodates up to 26 older people on two floors. At the time of the inspection there were 23 people accommodated in the home.

The home had a registered manager in place. 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. At the time of this inspection the registered manager was on maternity leave. The provider had arranged for a relief manager to be appointed until the registered manager’s return; they had only been in post for three days at the time of this inspection. Prior to this arrangement the provider had organised for the registered manager from another of their services to oversee the running of the home.

During this inspection we found two breaches of the regulations. This was because some people’s care records contained contradictory information which could lead to a risk of them receiving unsafe care or treatment. In addition, the provider had failed to ensure that people’s nutritional needs were properly assessed, monitored and met. You can see what action we told the provider to take at the back of the full version of the report.

This is the first time the service has been rated Requires Improvement.

Although people told us they felt safe in the home, care records did not always consistently record the care people required. This meant there was a risk people might receive unsafe or inappropriate care. In addition the systems in place to assess, monitor and meet people’s nutritional risks were not sufficiently robust. People gave us mixed feedback about the quality of the food.

Staff had been safely recruited. They had received training in safeguarding adults and understood their responsibilities to protect people from the risk of harm. Records showed staff were provided with the induction, training and support required to help ensure they were able to deliver safe and effective care. People who used the service were generally complimentary about staff. Although two people told us they felt new, younger staff needed more training, one person with particular medical needs told us they felt all staff were competent to care for them.

We received mixed feedback about staffing levels in the home. While some people who lived in the home felt there were sufficient staff to meet their needs, a number of people felt staffing levels were not sufficient to respond to people’s needs in a timely manner. On the first day of the site visit, the inspection team had to intervene on five occasions to ensure people received the care they needed; this was mainly due to a member of domestic staff being off sick. A full complement of staff was in place on the second day of the inspection; this meant staff were more visible and therefore better able to respond to people’s needs.

People told us they had no concerns about the way their medicines were administered by staff. However, we noted that improvements needed to be made to the systems for monitoring and recording when prescribed topical creams had been administered.

People were cared for in a safe and clean environment. On-going plans were in place to improve the décor of the home. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

People who used the service told us they were able to make choices about their daily life and the care they received. Staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The relief manager in post was aware of their responsibility under the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people's rights were considered and protected.

Care records we reviewed were personalised and provided a good level of detail for staff to follow. The initial assessment, completed before people were admitted to Springfield Cottage, was used to formulate care plans and risk assessments. People’s communication needs were clearly documented as well as how staff should support them to express their views and wishes. Staff demonstrated a good understanding of people’s diverse needs and preferences.

People were encouraged to consider what care they would want to receive at the end of their life, including issues such as whether they would wish their organs to be used for transplant purposes. Where completed, end of life care plans contained detailed information about people’s wishes and preferences for the care and treatment they would want to receive at this difficult time.

There were regular opportunities for people to provide feedback on the care they received. Where possible, people were involved in the regular reviews of their care needs.

A number of activities were provided within the home to help promote people’s sense of wellbeing.

Staff told us they enjoyed working in the service and found the managers to be supportive and approachable. Regular staff meetings took place and were used as a forum to discuss how the service could be improved.

Although systems were in place to monitor the quality of the service, these had not been sufficiently robust to identify the shortfalls we found during this inspection.