The Spinney Care Home

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

Medicines were not always safely managed. Systems in place were not robust enough to identify errors or issues with the storage of medication. People felt safe living at The Spinney Care Home and staff understood their responsibility to keep people safe. Risks associated with people’s care were identified, assessed and well managed.

Some checks on the environment were not always effective, as they failed to identify issues we found, for example issues around infection prevention and control. People and relatives were happy with the care they received; staff felt supported by the management team. The manager was committed to addressing shortfalls identified during the inspection visit to improve the safety of the environment.

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

Rating at last inspection

The last rating for this service was good (published 18 January 2018).

Why we inspected

We inspected and found there was a concern with infection, prevention and control, so we widened the scope of the inspection to become a focused inspection which included the key questions safe and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 provider had taken action to mitigate the risks identified during the first day of inspection and had an action plan in place to continue to make the improvements needed.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

The overall rating for the service has changed from good to requires improvement. 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 The Spinney Care Home on our website at www.cqc.org.uk.

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 Spinney 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 Spinney Care Home provides accommodation for up to 26 older adults who require personal care for

physical health needs or dementia. 26 people were living at the home at the time of our inspection.

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.

At our previous inspection in October 2016, we rated the home as Requires Improvement. At this inspection, we found improvements had been made as required, and the rating has changed to Good.

People were comfortable with the care staff who supported them and felt safe. Staff received training in how to safeguard people from abuse and were supported by the provider’s safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified, minimised and responsive towards individual needs so people could be supported in the least restrictive way possible and build their independence.

People were supported with their medicines by staff that were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any potential issues were identified and action could be taken as a result.

There were enough staff to meet people’s needs. Staffing was tailored to support people to maintain hobbies, interests and activities they enjoyed. The provider conducted pre-employment checks prior to staff starting work to ensure their suitability to support people who lived in the home. Staff told us they had not been able to start work until these checks had been completed.

The provider assessed people’s capacity to make their own decisions if it was identified people might lack the capacity to do this. Staff and the registered manager had a good understanding of the Mental Capacity Act and the need to seek consent from people before delivering care and support wherever possible. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure the restrictions were in people’s ‘best interests’. Applications for legal authorisation to restrict people’s liberty had been sent to the relevant authorities in a timely way.

People told us staff were respectful and treated them with dignity. We observed interactions between people which confirmed this. Records also showed people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. People were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals whenever necessary, and we saw the care and support people received was in line with what had been recommended by health professionals. People’s care records were written in a way which helped staff to deliver care that was based on each person’s needs. People were involved in how their care and support was delivered, as were their relatives if people needed support from a representative to plan their care.

People were able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager was approachable and responsive to their ideas and suggestions. There were systems to monitor the quality of the support provided in the home. The provider ensured that recommended actions from quality assurance checks were clearly documented and acted upon by the registered manager as they undertook regular unannounced visits to the home.

The Spinney Care Home provides accommodation for up to 26 older adults who require personal care for physical health needs or dementia. 24 people were living at the home at the time of our inspection.

We last inspected the home in June 2015 and found improvements needed to be made to the number of staff on shift at night and that risks were not always managed effectively in regards to people’s nutritional needs. At this inspection we found some improvements had been made but further improvements were still required.

There was a registered manager in post however they were absent from the home due to extended leave. 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. There was an interim manager in post who was overseeing the day to day running of the home.

People told us they received their medicines when they needed them. However we saw that medicines were not always stored safely and it was not always recorded when people had received their medicines.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care.

Care workers understood how to protect people from the risk of abuse and keep people safe.

Care workers’ suitability and character was checked during the recruitment process to make sure they were suitable to work with people who used the service.

Environmental checks were completed to ensure that the home was safe for people who lived there, however we found that some areas were not always locked securely and could pose a risk to people.

Analysis of incidents and accidents were carried out to minimise the likelihood of them happening again.

Care workers received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care workers had the right skills to provide the care and support they required.

The provider and interim manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Staff were kind and caring when providing personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff and people at any other time of the day.

People were supported in a way that promoted their privacy and dignity.

Group activities were offered by care staff however activities did not reflect people’s individual preferences.

Care plans and assessments contained information that supported staff to meet people's needs; however some had not been updated when there had been a change in people's condition. People and their relatives were not consistently involved in the planning of care being provided.

People received food and drink that met their nutritional needs however people were not always aware that alternative meals were available if they did not want a meal that had been offered.

The interim manager completed quality checks of the care provided however these checks had not identified some of the issues we had raised.

People we spoke with who lived at the home were very complimentary about the care and the staff. 'A lovely place' and 'I wouldn't live anywhere else' were amongst the comments people made to us. Throughout the home there was a lively good natured atmosphere, with much joking and jollity between experienced staff and residents. Staff ensured that the needs of the less vocal and frailer residents were also met. Staff were very busy throughout our visit but did not rush people. One person told us, 'They don't rush you getting up and about.'

We looked at the care of two people who were less able to speak up for themselves. We saw that their needs were effectively recorded and monitored. Staff understood their needs and tended to these regularly.

We looked at medication and saw that this was being administered effectively. We saw staff were well supported and the manager and the wider organisation audited and monitored the service being provided. During our visit the hall was being redecorated. The manager told us of proposed environmental improvements.

The current manager told us they were in the process of applying to register as the manager. The name of the previous manager appears on this report as their registration had not yet been cancelled.

People who lived at the home were very complimentary about the home and the staff. We spoke with a person who spent much of their time in bed. They told us staff were 'very friendly' and were always 'bobbing in and out to see if I'm alright.' They told us 'food is good' and that they were 'very happy.'

One visitor we spoke with told us they were very happy with the care provided and that the home had responded when they had raised issues. Another visitor commented favourably on the 'homely' nature of the home. They said their family member had been 'calm and relaxed since coming here.' They added 'we are very satisfied.' Another visitor noted that people were happy, clean and staff were 'usefully employed.'

We heard one dissenting view to these favourable comments from a visitor who felt the home had 'gone downhill'. Her concerns were being addressed by the manager.

The current manager told us they were in the process of registering as manager.