Springfield Nursing and Residential Care Home

Springfield Nursing and Residential Home is a care home providing personal and nursing care to 42 people aged 65 and over at the time of the inspection. The service can accommodate up to 65 people across two buildings. One building provides residential support and the other building provides nursing support.

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

People and their relatives told us that they felt safe and happy with the provider. There were appropriate policies and systems in place to protect people from abuse. We saw clear records relating to the management of safeguarding incidents. Environmental risks were assessed, monitored and reviewed regularly and equipment was maintained to help ensure people were kept safe. A process was in place to review accidents and incidents on a regular basis. Any trends or lessons to be learned were discussed with staff.

There were sufficient staff deployed to meet people’s needs. Safe recruitment procedures were mostly followed. We have made a recommendation about the providers quality assurance process in relation to recruitment. Medicines were administered in line with people's preferences by staff who knew people well and systems were mostly in place to ensure people's medicines were managed safely.

We were somewhat assured that the provider was promoting safety through the layout and hygiene practices of the premises. However, the provider took prompt action to address the concerns during the inspection. We were assured that the provider was preventing visitors from catching and spreading infections. We were assured the provider was facilitating visits for people living in the home in accordance with the current guidance.

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. Staff asked for people's agreement before supporting them with personal care and other tasks. The policies and systems in the service supported this practice.

People's needs were assessed, regularly reviewed and included their physical, mental health and social needs. People's individual needs were met by the adaptation and design of the service. The layout of the home was suitable for people's needs. The provider was in the process of incorporating a dementia friendly environment within the décor of the home. People and their relatives felt staff were well trained.

People told us they enjoyed the food and we observed people being supported with regular fluid and nutrition throughout the inspection. Drinks and snacks were readily available to people at any time and we observed people’s comfort being checked consistently throughout the inspection.

People and their relatives were positive about the home and felt it was well managed. The registered manager promoted an inclusive, positive and open culture. The provider and registered manager had systems to gather the views of people, their relatives and staff. The provider had developed close links with external agencies, and we saw evidence of successful partnership working.

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 25 May 2019) and there were multiple 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 carried out an unannounced comprehensive inspection of this service on 20 and 21 March 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve consent to care and treatment, good governance and notifications of other incidents.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

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.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Springfield Nursing and Residential 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.

What life is like for people using this service:

•The provider lacked effective governance systems to identify concerns in the service and drive improvements. At times there was a lack of clear and accurate records regarding people’s medicines, mental capacity, support needs and any potential risks to them. The provider had not always notified CQC about incidents they are required to by law which meant these could not be monitored.

•People told us they were treated with dignity and respect, however we identified that improvements were required to ensure that there was a positive and person-centred approach to the language being used when staff were referring to people. We have made a recommendation about this.

•People were happy living at Springfield Nursing and Residential Home and people told us they felt safe. People were supported by staff who were kind, caring and who mostly understood their likes, dislikes and preferences. Where they needed external health input they were supported to receive this.

•People and their relatives knew the registered manager and felt able to speak to them if they had any concerns. Most staff told us they were well supported by the registered manager. Staff received training and people thought the staff were skilled and knowledgeable. The registered manager demonstrated a willingness to make improvements and during the inspection began reviewing their systems and process to ensure the service consistently provided good, safe, quality care and support.

Rating at last inspection:

Requires Improvement (Report published 5 January 2018)

Why we inspected: This was a planned inspection based on our last rating. At the last inspection the provider was rated as Requires Improvement.

Follow up: The overall rating of the service remains Requires Improvement. At the last inspection, the provider was found to be in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. At this inspection, we found that these breaches remained. An additional breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) 2014 was also identified at this inspection. This is the second consecutive time the service has been rated as Requires Improvement and we will request a clear action plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

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

Springfield Nursing and Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The home accommodates up to 65 older people and some who require nursing care, across two adapted buildings. House 72 accommodates up to 36 people and does not provide nursing care. House 74 accommodates up to 29 people and does provide nursing care. The registered manager confirmed that House 74 was only accommodating up to 26 people at the time of the inspection, in order that people could have single occupancy rooms. However, if the need arose and people wanted to share a room this could be accommodated. At the time of the inspection there were 32 people living in house 72 and 21 living in house 74.

A registered manager was in post during the 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.

Staff worked well as a team although they did not always feel supported by the day to day management team. The provider had investigated this and implemented an action plan with the management team. The registered manager expressed a willingness to ensure this improved. There were systems in place to monitor quality and safety of the home provided, however no overarching development or sustainability plan was in place. People and their families were encouraged to provide feedback on the service through residents meetings and an annual survey. They were also supported to raise complaints should they wish to.

Prior to people moving into the home, assessments were undertaken to ensure the home and staff could meet the person’s needs. Policies were in place for care planning which guided staff to ensure people’s diverse needs were considered and where needed support was planned. People told us that staff knew them well and this was apparent throughout our discussions with staff about people. Risks associated with people’s needs were assessed and actions were taken to reduce the risk. It was evident staff responded promptly to people’s change in needs and ensured they received a person centred service, although the records were not always updated to reflect this. Activities were delivered based on individual needs at the time of the inspection.

People and their relatives provided positive feedback about staff. Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. Their privacy and dignity was respected and they were encouraged to be involved in making decisions about their care.

People told us they were always asked for their permission before personal care was provided and where needed people’s ability to make decisions was assessed in line with the Mental Capacity Act, 2005 (MCA). Care staff and the registered manager had received training in respect of the MCA and were able to demonstrate an awareness of the principles.

People were protected against abuse. Policies and procedures were available to everyone who used the service. The registered manager and staff recognised their responsibilities and duty of care to raise safeguarding concerns when they suspected an incident or event that may constitute abuse.

No formal system was used by the provider to assess the level of staffing and skill mix needed and some staff expressed concerns about the staffing levels. However, our observations showed that staff responded promptly to call alarms and people’s requests and there were sufficient staff to meet people’s needs. The provider’s recruitment process ensured appropriate checks were undertaken to ensure staff suitability to work in the home. People told us they felt staff had the skills and knowledge to care for them. Staff received supervisions and training.

People and their relatives felt the home was always clean and well maintained. Equipment was managed in a way that supported people to stay safe and people were supported to maintain good health and had access to appropriate healthcare services.

In line with CQC's enforcement policy, the overall rating for a service cannot be better than requires improvement if there is a breach of regulations. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations. We also found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

This is a summary of what people told us and what we found.

Is the service safe?

People told us they felt safe and comfortable in the home. They said they had good relationships with staff. One person told us, 'I've never heard anyone being rude to anyone here.' A visitor said the staff were 'very kind'.

The provider had effective recruitment processes and undertook the necessary checks to ensure staff employed were suitable. At the time of our visit the provider was recruiting to maintain levels of staffing sufficient to support people safely. We have asked them to tell us how they will ensure they meet the requirements of the law in relation to staffing in future.

The provider had processes in place to ensure people's medicines were managed safely. The premises were maintained and adapted to take into account people's safety.

The provider understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). No DoLS applications were current at the time of our visit. Staff were aware of the circumstances when an application should be made, and were planning to review people's existing mental capacity assessments.

Is the service effective?

People told us that they were satisfied with the care and support they received. One person said, 'It is very good indeed, I have no grumbles.' Visitors we spoke with were satisfied with the care their loved ones received.

We found people's care and support were based on assessments of their needs. Care plans were detailed and personalised. Systems were in place to ensure care was delivered according to people's plans.

If people needed nursing treatment for a particular condition, this was provided and recorded. The service worked in co-operation with other healthcare providers where appropriate.

Is the service caring?

People using the service and their visitors told us they got on well with their care workers and other staff and had a good relationship with them.

Staff we spoke with were motivated to provide good care. They knew about people's needs and how they preferred to have their care delivered.

We observed positive, friendly interactions between staff and people who used the service. Staff took time to make sure people understood them, spoke clearly and made eye contact with the person they were talking to.

Is the service responsive?

People's care plans were individualised and person-centred. The plans were reviewed regularly and adapted in line with people's changing needs. People's individual risks were assessed and actions taken.

The service took advice from other specialist healthcare providers as appropriate.

Is the service well-led?

Staff told us they were supported to deliver quality care. People who used the service were satisfied with the care and support they received.

We found risks were assessed and appropriate action plans were in place in people's individual care plans. Effective systems were in place to regularly assess and monitor the quality of service provided. The provider sought the views of people using the service and others. Incidents, accidents and complaints were handled appropriately and lessons were learned.

We carried out an inspection in June 2013 when we identified concerns with record keeping. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and that they would be compliant by the 31 October 2013.

We inspected on 4 November 2013 to review the progress the provider had made. We found that the provider and registered manager had taken steps to improve care planning and record keeping and had worked on embedding the new systems.

We spoke with three members of staff and the manager who told us about the changes which had recently occurred in the home regarding records including the training that had been undertaken. Two nursing staff told us about the training and how beneficial they had found it they told us about new records that had been implemented and spoke very positively about the changes.

We carried out an inspection in April 2013 when we identified concerns with record keeping. We made a compliance action asking the provider to take action in order that we were reassured that people were in receipt of safe and adequate care. The provider wrote to us and told us what action they were going to take and that they would be compliant by the 19 June 2013.

We inspected on 28 June 2013 to review the progress the provider had made. We found that the provider had taken steps to improve record keeping however in five of the eight care plans we looked at there were still inconsistencies and care plans had not been updated as needs changed.

We spoke with four members of staff and the manager who told us about the changes which had recently occurred in the home regarding records including the training that had been undertaken. A nurse told us about the training and how beneficial they had found it they told us about new records that were to be implemented and spoke very positively about the changes

Staff told us that they said they were able to speak openly with senior staff about any concerns they had about the changes that were taking place and the training. We observed staff being respectful, asking people if they needed support and only assisting when asked.

We carried out an inspection on 29 April 2013 to review the progress the provider had made in taking action to be compliant in the areas where we had previously assessed them as non compliant. We found that improvements had been made to all the outcome areas where we had asked for action to be taken. However we did find that staff were not consistent in their record keeping.

There were 44 people living at the home on the day of our visit. We spoke with one relative, three people who use the service, the provider, manager and six staff.

Staff we spoke with told us about the changes that had happened since our last visit under the new manager and deputy. They explained to us what the expectations were regarding care planning and assessment of capacity to consent. Staff also told us about the training they had had in areas such as infection control and cleanliness and the records they kept to monitor cleaning in the home.

As not everyone was able to tell us what they thought about the care and support provided, we used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spent time in their company in the lounge dining area observing the support people received with their meal. We saw that the majority of staff were friendly and respectful and that they were quick to respond if anyone appeared unhappy or distressed. However we also observed two people not receiving assistance and support in a timely manner and one person was spoken to in a tone which was not respectful.

Relatives said that they had 'Good communication' with the staff at the service; they were told when their family member was unwell for example.

Staff said that the management of the home was 'settling down' under the new manager who had met with them and asked them about their experience at Springfield and their needs as employees.