Springfield House Residential Care Home

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

People received their medicines safely in the way prescribed for them. Some improvements were being planned to make sure that best practice guidance was incorporated into the home’s medicines policies and practice. We have made a recommendation about this in the report.

When people were at risk of harm, assessments were in place alongside guidance for staff on how to mitigate the risk. Staff had completed safeguarding training and were confident any concerns would be dealt with.

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.

Staff received an induction when they first started working at the service. Training was updated regularly although we did identify gaps in training for the Mental Capacity Act (2005). The registered manager assured us they would make sure this was completed. Staff had received an annual appraisal since our previous inspection. Not all staff had completed a recent supervision meeting. We have made a recommendation about this in the report.

The atmosphere was relaxed and friendly. Staff spent time chatting to people and were enthusiastic about their role. There were enough staff to meet people's needs. People and relatives told us staff were quick to respond to requests for assistance and were kind and helpful.

People spent time taking part in activities that reflected their interests. Some people disliked group activities preferring to stay in their rooms. Staff checked on these people regularly.

The registered manager was highly visible in the service and staff told us they were approachable and would listen to any concerns they had. Daily handovers were held to enable staff to keep up to date with any changes in people’s needs. Staff meetings were not held and staff told us they felt this was an area for improvement.

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 (report published 30 October 2018) and there were breaches of the regulations. 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

This was a planned inspection based on the previous rating.

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.

The service is on two floors with access to the upper floor via a stair lift. Some rooms have en-suite facilities and there are shared bathrooms, and toilets. Shared living areas included a central lounge and sun lounge. There was also a dining room which had been extended to the side of the service. This led out onto an enclosed rear garden area which was suitable and safe to use for people living with dementia. The service is situated in its own grounds with a large side garden area.

The registered provider was also the registered as manager of the service and will be referred to as the registered manager throughout this report. 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 and associated Regulations about how the service is run.

At the last inspection in February 2016 we rated the service as overall Good. However, the safe domain of the report was rated Requires Improvement. This was because risk assessments contained limited or no information about measures staff should take to ensure people were safe in relation to specific risks. Where pressure relieving mattresses were in use the procedures to check them were not clear. The recording of people receiving repositioning was not always consistent.

There were no measures in place to reduce the risks of Legionella.

Medicines were not always stored and administered to people as prescribed. The temperature was not being monitored in the medicines room. Prescribed creams were not being managed and recorded appropriately. The registered manager gave us assurances the issues were being addressed.

At this inspection we found that issues identified as requiring action in February 2016 had not been addressed in full. Some people required management of specific risks and these had not been effectively managed using a risk assessment format, which would support staff to mitigate those risks.

Three people required pressure relieving mattresses. When we checked the settings, we found they did not correspond to their weight and therefore posed a potential risk for skin damage. There were no audits taking place to ensure the mattresses were operating at the correct pressure for the person. In one instance the equipment had been reported as faulty and therefore the service could not determine if the pressure was accurate. This meant peoples skin integrity could be at risk.

Some people required repositioning to reduce the risk of skin damage. The service had records in place monitoring the times people needed to be repositioned. The charts were up to date and response times were generally in line with the assessment. A visiting professional told us the staff were responsive to instruction from them and referred any concerns quickly.

The service had employed a contractor to monitor water in the service, including temperatures at various points so it met with current Legionella guidance.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely. The service had included body maps to identify areas where creams were to be applied and when. Creams were dated upon opening and kept in a locked wall facility in people’s rooms.

Care plans contained information about the person and what their individual needs were and how they would be met. Care planning was reviewed and people’s changing needs were recorded. Daily notes were completed by staff responsible for people’s care. However, the three care plans we reviewed were not written in a person-centred way which would ensure the person was at the centre of the information and described how they would want their care to be delivered. Some of the terminology used was not respectful, for example the use of ‘He’ and ‘She’.

There were formal systems in place to assess people's capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

People received enough to eat and drink and had a choice of meals and snacks. People were supported by staff to use and access a variety of other services and social care professionals. The staff had a good knowledge of other services available to people and we saw these had been involved with supporting people using the service.

People told us they were happy with the care they received and believed it was a safe environment. The atmosphere was calm and relaxed. People moved around the building choosing where to spend their time and who with. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner.

People had limited access to a range of meaningful activities which would support the social wellbeing. We have made a recommendation about this.

People were protected from abuse and staff understood how to protect people. The premises and equipment were maintained to minimise the risk of cross infection. People were supported by sufficient staff. Staff recruitments systems were in place and designed to ensure checks were made before a member of staff commenced working at the service. However, in one instance a staff member commenced work prior to satisfactory references being received. We have made a recommendation about the provision of end of life training and staff supervision.

Staff had access to a range of training opportunities which were monitored by administrative staff to ensure they were updated as required, however we identified there was no formal training delivered in relation to end of life provision. Staff were supported daily through handover meetings, however there were no formal systems for supporting care staff on a one to one basis. This meant individual performance issues were not shared and addressed and it did not give members of staff time to discuss any issues around their individual roles.

There were systems in place to update operational issues. People’s views were sought and listened to. However, there were no formal meetings with people using the service, relative’s and staff which would enable feedback to make improvements to the service.

At this inspection we found the service to be in breach of regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

The home 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’s medicines records did not always give clear guidance to staff. Documentation regarding people’s creams was incomplete which meant it was not always clear where to administer the cream or whether people had received it. There was no clear protocol in place to inform staff when to administer, as required medicine to someone who experienced behaviour that may challenge others. This meant, if staff who knew them well weren’t available, they may receive it too soon or too late for their needs. Checks were not routinely done to ensure staff continued to be competent to administer medicines.

People were not always protected from risks associated with their care because staff did not have the correct guidance and direction about how to mitigate people’s individual risks. Risks relating to the environment were not always assessed meaning safety measures were not identified and put in place.

Care plans did not always reflect people’s up to date needs but the registered manager had committed to updating them and ensuring they contained more detail about people’s wishes and preferences.

People, their relatives and healthcare professionals spoke highly of the care and support people received. Comments included, “I think it’s excellent. Absolutely excellent.” Care and support focussed on the person, their individual needs, their likes, dislikes and the routines that were important to them. When people’s needs changed staff reacted promptly, involving other social and health care professionals if needed. People told us, “We receive very good care and attention if we’re not feeling well.” Care plans needed updating to ensure they reflected people’s current care needs and included advice from professionals.

People were provided with the right food and drink to maintain their nutritional health. Staff supported people according to their needs and where concerns were raised action was taken. People chose the meals they wished to eat and decided where to eat them. A relative told us, “Mum is very fussy but they always accommodate her.” Special diets were available for people with particular dietary needs. People who were at risk of choking had their meals prepared in line with their care plan to reduce the risk.

People told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. They demonstrated good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. There were sufficient staff to meet people’s needs.

Relatives and friends were always made to feel welcome by the staff and registered manager who treated them with respect. Comments included, “You won’t find better. There’s lovely staff here.” People and those who mattered to them knew how to raise concerns and make complaints.

New staff received an induction programme when they joined the organisation. Staff training was not all up to date. However, during our inspection the registered manager produced a plan of action to address this.

People, their relatives and healthcare professionals spoke positively about the registered manager. Comments included, “The manager does an excellent job. He’s an absolute work horse and his work ethic is amazing. He’s very committed.” Staff described the management as supportive and approachable and talked positively about their jobs. Comments included, “We always have a good day here.”

The registered manager and staff understood their role with regards to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. People’s care plans did not contain an assessment to show why they were deemed to lack capacity and their needs in relation to their mental capacity was not always detailed in their care plans. The registered manager was in the process of updating care plans and this intended to include more detail about people’s mental capacity.

For this inspection we spoke with the provider about their improvement plans, spoke with three people using the service, met other people using the service, spoke with two care workers and looked at records.

People told us that they were happy with the care they received. They said "The girls are lovely" and "The girls are very friendly". They said they liked their room, their bed was comfortable, they were always warm enough and they had no complaints. One person said "I would tell them, and the boss, if I was not happy, and he takes notice."

We found that assessment and care planning were very much improved. One person using the service fetched their 'Daily Living Plan' to show us and they said that the information within it was correct. The monitoring of care was better organised. Examples were pressure sore prevention, diet and personal care. Care workers were clear around people's right to determine their rising and retiring times, whilst protecting them from neglect. The correct equipment protected people from falls. Care was better organised and monitored.

The provider and care workers knew people's needs well. We saw them providing kind and thoughtful care. The environment was bright, enlivening and we found no hazards or concerns.

Some people's liberty was being restricted and they were at risk of harm because they were held in their bed by chairs or commodes. We were told that this was to stop them falling, but there was no risk assessment of the possibility of them falling and no plan as to how that risk should be reduced. We found that there were no risk assessments or care plans to protect people from pressure damage, weight loss or poor personal hygiene. There were no care plans of people's needs at night or instructions about the night workers role.

People were not receiving an acceptable standard of personal care and they lacked dignity.

One person's weight loss had not led to a plan to improve their weight. Of the care plans we saw none reflected the person's current needs. A care worker told us, "The care plans aren't really any use."

A district nurse told us that the home meets people's emotional needs very well.

We found worn and torn bedding and curtains loose. We found a fire exit which was locked and basins with no hot water. There was no formal method for recording and dealing with maintenance issues. People were living in a premises in need of refurbishment but there was a programme of refurbishment started.

We saw that care workers were attentive to people's needs and that people clearly enjoyed time with them. We observed care being delivered in a respectful and safe way. A district nurse and GP said that they had no concerns about the service. People had regular opportunity to have their views listened to and decisions were made in people's best interest and in a lawful way where they could not make those decisions for themselves.

People were better safeguarded from abuse due to good staff knowledge and medicines were handled appropriately and safely.

Staff were being supported through a training programme and this was delivered in ways which suited their learning best. Part of the programme was support and supervision. The owner/manager was very knowledgeable about people as individuals and supported staff to deliver good care.

Quality monitoring and management of the home had improved and there were plans for future and continuing improvements.

Record keeping was improved. Information was available to inform staff about people's needs and safe care delivery but care plans still lacked information about people's social needs. However, monitoring records were well completed.