Spring Mount

Spring Mount is a residential care home providing personal care to 25 people living with dementia. The home supports younger adults and people over the age of 65. At the time of the inspection there were 22 people living at the home.

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

Improvements had been made to the quality assurance systems and the shortfalls identified at the last inspection had been addressed.

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 supported this practice. We have made a recommendation about updating people’s documentation to fully reflect their and/or their representatives’ involvement.

The home was clean and well maintained and surrounded by spacious gated grounds. The home had an open-door policy. This meant people were able to come and go freely from the house into the gardens.

People and relatives were happy with the care provided. People looked well cared for and comfortable. One person said, “It’s a great place to be.”

People’s medicines were managed safely. The service aimed to promote an environment where people living with dementia were supported without the use of sedating medication. The staff team were experienced and consistent and had a good understanding of how to care for people who lived at the home.

The registered manager provided people with leadership and was approachable.

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 16 July 2019) and there were 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.

Why we inspected

We undertook this targeted inspection to check whether the requirement notices we previously served in relation to Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Spring Mount 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 can accommodate up to 25 people and specialises in the care of people living with dementia. The home offers care to younger people living with dementia. At the time of our inspection there were 22 people using the service.

Following the last inspection in September 2016 the overall rating for the service was ‘good’. During this inspection we found improvements were needed and the overall rating has changed to ‘requires improvement’.

There was a registered manager in post. 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.

People told us they felt the service was safe. However, we found risks to people’s safety and welfare were not always managed effectively.

We found the home was clean and free of unpleasant odours. However, we found the registered providers quality monitoring systems had not been effective in identifying and dealing with risks such as those posed by radiators with hot surface temperatures.

There was an ongoing programme of refurbishment and some evidence the needs of people living with dementia had been taken into consideration. For example, the grounds were secure and people could go outside whenever they wanted. However, we found there was scope for improvement and made a recommendation about this.

People’s medicines were not always managed safely.

There were enough staff and safe recruitment procedures were followed. This helped to protect people from the risk of being supported by staff unsuitable to work in a care setting. Staff received training for their roles and told us they felt supported by the management team.

People told us the food was good.

People were not always supported effectively to access the full range of NHS services. We made a recommendation about this.

We found the service was acting in people’s best interests but this was not always reflected in their care records. Similarly, we found that although people’s relatives told us they were consulted about care this was not evidenced in the records. We found people’s care plans were not always up to date and accurate. However, staff could tell us about people’s current needs.

The service aimed to provide an enabling environment where people living with dementia were supported without the use of tranquilising or sedating medication. We observed many positive interactions between staff and people who used the service. However, we also saw examples of interactions which did not promote people’s privacy and dignity.

People were supported to take part in a range of activities inside and outside the home. However, some people felt this was an area which could be improved.

People spoke positively about the management team. They told us they felt confident any concerns they raised would be dealt with and said they would not hesitate to recommend the service to family or friends.

However, we found the registered providers systems for monitoring the quality and safety of the services provided were not always operated effectively. The management team acted quickly to address the concerns we identified during our inspection. From our discussions we were assured they were committed to making the required improvements to ensure people experienced consistently good outcomes.

We found the provider was in breach of two regulations. These were Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we told the provider to take at the back of the full version of the report.

Spring Mount provides accommodation and personal care for 25 people who have a dementia related condition. Spring Mount supports people of working and retirement ages. 25 people were living there at time of inspection.

The service had a registered manager. 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.

People were supported to have freedom of movement about the service and grounds, but staff had assessed any risk to their safety and wellbeing. Staff knew how to keep people safe and were aware of vulnerabilities people using the service may have had due to their dementia related condition or other individual needs. Any risks identified had clear plans drafted to ensure staff knew how to keep people safe, these plans afforded people as much freedom as possible and staff avoided unnecessary restrictions.

Any concerns or issues that arose were reviewed by the registered manager who took clear action to reduce future risk or adapted how the service was delivered to each individual to ensure that people were safe. Staff had been trained to support people with a dementia and felt able to raise any concerns and felt they would be acted upon. Relatives told us the service was a safe place and that staff supported people as distinct individuals, wrapping care around their needs. There was staffing deployed over the day and night to ensure that people’s needs were met in a timely fashion. Staff told us they felt they had the time, training, skills and knowledge to support people with a dementia related condition well.

The service was proactive in reviewing the use of sedative and anti-psychotic medicines to ensure they were effective, did not further disable people and were used only when required to support people’s wellbeing. Relatives told us this reduction in medicines had a positive impact on people and that the service adapted how it was delivered to meet people's individual behavioural needs rather than using “the chemical cosh” as relatives described it to us.

The staff team had been trained to meet the needs of people living with a dementia related condition and they were supervised and appraised regularly to ensure their skills were current and they shared good practice. Staff supported people who lacked capacity to be as involved in their care as much as possible. Staff had the skills and knowledge to communicate with each person as an individual, staff learnt new skills such as sign language when this was needed. Where necessary the service sought family and external professional advice and support when making decisions about peoples care. People’s rights and choices were respected and staff always sought the least restrictive intervention when making decisions. People were encouraged to live as they wished with as much freedom and choice as possible.

People were supported to eat a healthy and nutritious diet. Staff supported people to eat well and they were able to evidence where interventions around weight loss had led to improved health outcomes for people. We saw that staff had developed personalised menus to suit people’s needs for finger food, or support was in place where required. Staff support at mealtimes was discreet and sought to support people’s dignity, whilst ensuring they ate and drank enough to maintain their wellbeing.

Relative’s feedback, our observations and discussion with staff showed us that the staff team truly cared for people using the service as distinct individuals. Staff knew people very well and there was consistent evidence from all the relatives we spoke with that they also felt the service supported them to maintain their familial relationships. Staff had the skills and practical knowledge to communicate with people using the service, and staff learnt new skills, or tried new way to communicate as required to meet individual’s communication needs. Relative’s felt informed and updated on their family members lives at Spring Mount and felt able to raise any queries and that they would be responded to positively and quickly. Relatives told us they felt the staff team were caring and compassionate in their work.

Care records described how best to support each person and staff notes were used to check on people’s wellbeing and make changes to any future care interventions. The staff and registered manager regularly changed how care was delivered as people’s needs changed, and in response to planned changes in care. Reviews of care involved people and relatives as much as possible and always sought the least restrictive option when making decisions in people’s best interests.

The service had a number of communal areas where people could access music, television or quiet relaxation. We saw that staff encouraged people to take part in any activity in the service, or spent time with them one to one throughout the day. The service had secure, accessible grounds which people could enjoy safely. We saw this had a positive impact on people’s emotional and physical wellbeing. We did not observe any negative interactions between staff and people.

Relatives and external professionals told us the registered manager and owners were hands on in the service and were approachable, knowledgeable and empathic about the needs of people using the service. We saw they led by example and reflected the philosophy of the service in their actions and approach to people. The service had productive relationships with local and national external professionals, and accessed good practice via these relationships and through questioning their own practice. The service had a culture of continuous improvement, learning and change, recognising new ways of working and used practical changes or innovation to keep people safe.

The registered manager and senior staff undertook regular checks and audits of the service and its quality, seeking feedback at all times. If these led to any areas for improvement, action was taken quickly to improve the quality of the service offered to people. The service sought feedback and input from people, relatives and external professionals. The service used this to constantly adjust how the service was delivered to ensure that care was bespoke to the person.

' 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 the records we looked at, our observations and what people who used the service and the staff told us.

Is the service safe?

The six people we spoke with raised no concerns about their safety with us during our visit and said if they had concerns they would discuss them with the manager.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to keep them safe.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

Safeguarding procedures were in place to protect people from the risk of abuse and we found staff understood their roles and responsibilities in safeguarding the people they supported.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well.

Is the service caring?

We found the care staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was calm, relaxed and friendly and we saw that staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

People told us they were happy with the care and support they received. One person told us 'I am very happy, what an amazing place it is here.' Another person said 'We can have what we want to eat and drink, staff are really good.'

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

Care records were reviewed and any changes made either when people's needs changed or as part of the monthly review process. We saw evidence of this within the care records we reviewed.

Where people's needs changed and additional staff support was required we saw evidence the service put additional staff on duty to ensure people were kept safe.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service. All the staff we spoke with said the organisation was well led and praised the manager and provider. They said they were both 'lovely people', who were open, approachable and they felt able to talk to them about anything.

The care records reviewed were relevant, complete and up to date; they were also stored securely to ensure confidentiality. We saw appropriate records were maintained in relation to the management of the service. All records were located promptly when requested.

We found staff sought the consent of people who used the service before assisting with care tasks. The provider had systems in place to obtain the consent of those who did not have capacity to make decisions .

The premises were suitably designed, laid out and maintained.

We found the provider had appropriate recruitment procedures in place which ensured staff were suitable for their role.

However the provider did not have robust systems in place to monitor the quality of its service provision or seek the feedback of people who used the service.

We found the provider did not maintain appropriate records as key care plan documentation was missing and it was difficult to find some information using the electronic care plan system.