About the service Springfield Grange is a residential care home providing personal and nursing care to 18 people at the time of inspection. The service can support up to 94 people. At the time of inspection two units in the home were open, the Rowan unit and the Willow unit. Three units were not in use.
People’s experience of using this service and what we found
People were put at risk because the provider did not appropriately assess risk and did not take reasonably practicable steps to mitigate risk. Records showed people were displaying regular behaviours which challenge, staff were not sufficiently trained to manage and de-escalate such behaviours, and there was a lack of person-centred guidance around how to support people.
We found incidents were not routinely being referred to the local authority safeguarding team or reported to the CQC. People’s medicines were not managed safely which put people at risk of not receiving their prescribed medicines. People did not receive appropriate dietary supplements when prescribed by a health care professional. Staff, people and relatives told us there were not enough staff to meet people’s needs.
Staff did not receive appropriate support, training and supervision to enable them to carry out their duties. There were no effective systems in place to monitor and record people's food and fluid intake. Reasonable adjustments had not been made to enable people with a disability to enter the building. The home had not been adapted for people living with dementia. There was a lack of appropriate signage to help orientate people with a memory impairment.
We found references in people’s care records which demonstrated they became distressed during care delivery. Best interest decisions were not appropriately documented. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
Staff interactions with people were mixed. We observed on the first day of inspection that staff ignored some people and although saying they would come back to them, they did not. On the second day of inspection we saw some positive interactions between staff and people. Staff were kind and caring when interacting with people.
People did not receive person centred care. We found care and support records did not contain enough information to ascertain whether people’s end of life wishes had been discussed with them. People and relatives told us they felt there were not enough activities to keep people occupied. We saw there was limited stimulation for service users and limited activities taking place. The provider did not demonstrate how they would meet people’s communication needs of people with a disability, impairment or sensory loss.
People told us the service was not well led. The provider had not established and did not operate effective systems to ensure the service adhered to relevant legislation. For example, the provider had not registered Springfield Grange as a food premise. There were many instances of physical altercations between people who used the service and against staff. There was no evidence this had been identified and appropriately addressed by the provider. The provider was unable to locate paperwork when requested during both days of the inspection. There was little evidence of learning, reflective practice and service improvement. Data was not shared as required and there was little evidence of partnership working.
Everyone thought the staff were good and worked very hard. On the second day of inspection, staff told us things were starting to improve. In the reception area we saw the provider had started an employee special mention board. This was for other staff members, people, visitors and relatives to express their appreciation and recognise positive staff contributions. The home was kept clean. We saw complaints were investigated and responded to appropriately.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
This service was registered with us on 25 October 2018 and this is the first inspection.
Why we inspected
The inspection was prompted in part due to concerns received about staffing, moving and handling, lack of stimulation and people not receiving appropriate care and treatment. A decision was made for us to inspect and examine those risks.
We have found evidence that the provider needs to make improvements. Please see all sections of this full report.
You can see what action we have asked the provider to take at the end of this full report.
Following the first day of inspection the provider sent us information to explain how they will mitigate risk. They sent information regarding, fire safety and staff receiving supervision in relation to this, induction sheets for agency staff, a statement to say they will review the training matrix, rotas and staff skills mix, a commitment to review the use of dietary supplements, review pre-admission assessments, review pressure mattresses, allocate senior staff to oversee Springfield Grange and increase the number of visits by the nominated individual.
Enforcement
We have identified breaches in relation to the following, the provider failed to appropriately assess risks, such as managing behaviour which challenges; the provider was not taking reasonably practicable steps to mitigate such risk; medicines were not managed safely; there were insufficient numbers of competent staff; staff were not receiving appropriate support, supervision or training; people did not receive appropriate dietary supplements, when prescribed by a health care professional; care and treatment was not provided with the consent of the person or relevant person; care provided was not person centred; the premises were not suitable to meet people’s needs; the provider did not have effective auditing processes to ensure the service provided safe and quality care; and, the provider did not assess, monitor and mitigate the risks relating to people’s health, safety and welfare.
Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.
We identified a large number of instances where matters had not been notified to us as required by regulation. This is a breach of regulation 18 of the CQC (Registration) Regulations 2009.This will be dealt with outside this inspection process.
Follow up
We will meet with the provider following this report being published to discuss 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.
Special Measures
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.
If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.
For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.