The Spinney Nursing Home

The Spinney Nursing Home is set across three floors and has a good amount of communal areas, garden and parking available.

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

People were kept safe by staff that had good knowledge about people’s needs and how to manage them. Staff understood their safeguarding responsibilities and people told us they felt safe living at the home. The manager made sure staff were recruited following safe processes and there were enough staff to keep people safe. We have made recommendations about the administration of some medicines and the management of infection and prevention control.

People benefitted from the fact that the home was run by a strong leadership team, meaning risks were assessed and mitigated. There was a positive culture at the home, we received positive feedback from people and their relatives. A relative said, “Everywhere is clean and tidy, the food is fine, and they offer alternatives if the menu options aren’t suitable.” Staff enjoyed their jobs and spoke highly of the manager.

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.

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 the service was requires improvement, (published 4 June 2021).

Why we inspected

The inspection was prompted in part due to concerns received about staffing numbers, maintenance of the home, and seeking timely medical input. A decision was made for us to inspect and examine those risks. We reviewed the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Although we found some areas that needed to be improved, we did not find evidence that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

The overall rating for the service has remained requires improvement.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Spinney Nursing Home (The Spinney) is a residential care home providing nursing and personal care for up to 35 adults, including those who have a physical disability. At the time of our inspection there were 26 people living at the home.

We found the following examples of good practice.

There were policies and procedures in place, which provided staff with clear guidance about good infection control practices, including the management of Covid-19 and visiting arrangements during the pandemic.

Government guidance was being followed in relation to isolation criteria and testing programmes for service users, staff, visitors and visiting professionals. All employees without exemption certification had received both Covid-19 vaccinations and all staff had completed specific training in relation to infection control and the management of Covid-19. The two staff members who had exemption certification had current risk assessments in place.

There were two domestic staff on duty at the time of our site visit and cleaning schedules were in place. The environment was clean and hygienic throughout and fully stocked PPE stations were provided in the entrance hall and on all floors of the home. We were told enough supplies of PPE were available and we saw staff wearing PPE correctly. The laundry department was well organised with separate areas for dirty and clean linen.

The Spinney Nursing Home (The Spinney) is a care home registered to provide accommodation for people who require assistance with personal or nursing care needs. It is registered for up to 35 people. At the time of the inspection 19 people were living in the service.

People's experience of using this service and what we found.

People told us they felt safe and staff were “kind” and “friendly." Our observations showed that people were treated with dignity and had their privacy preserved. Staff knew the people in the home well and supported them to be as independent as they could be.

People who lived at The Spinney and a relative who spoke with us told us they felt people living there were safe. Records showed that people received their medicines as prescribed and were detailed and person centred. Storage and disposal of medicines was appropriate and followed guidance. We have made a recommendation about recording and storage of powder to thicken drinks.

The provider had a staff training programme, competence assessments and supervision systems. Appropriate recruitment checks were followed to make sure staff recruited were safe to work with vulnerable people. Staffing levels were reviewed to make sure an adequate number of appropriately trained staff were available to meet people’s changing needs. We have made a recommendation about the accuracy of rota records.

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 on individualising all capacity assessments.

The provider had worked hard to develop a governance system and management framework with clear lines of accountability in place. There were systems in place to ask for the views of people living in the home and involve them in decisions about their home. The management team was committed to driving improvement and continuing to learn when things went wrong. However, new systems implemented by the provider needed time to be firmly and consistently embedded.

The provider had systems to identify risks and risk assessments were being done for people’s care and support. Safeguarding systems, policies and procedures were in place. Improvements had been made in decoration and maintenance and the provision of appropriate and properly maintained equipment.

The home was clean and hygienic and infection control procedures were in place. People told us the home environment was “greatly improved” and “more homely.”

Records showed that people received their medicines as prescribed and were detailed and person centred. Storage and disposal of medicines was appropriate and followed guidance.

We have made a recommendation about recording and storage of powder to thicken drinks.

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 on individualising all capacity assessments.

The manager used recognised clinical tools and followed good practice.

The provider has systems in place for making referrals to other professionals and specialist services. Staff were aware of people's dietary needs, preferences and any cultural requirements. The menus in use were varied to provide a range of choices. We saw lunch was a sociable and unhurried occasion and people told us they enjoyed their meals.

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 inadequate (published 13 May 2020) and there were multiple breaches of regulation. This service has been in Special Measures since May 2020. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned focused inspection based on the previous rating and was carried out to follow up on action we told the provider to take at the last inspection.

We carried out an announced comprehensive inspection of this service on 3 and 4 December 2019. Breaches of legal requirements were found.

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 Safe, Effective, Caring and Well-led which contain those requirements.

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 inadequate to requires improvement. This is based on the findings at this inspection.

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 Spinney Nursing Home (The Spinney) is a care home registered to provide accommodation for people who require assistance with personal or nursing care needs. It is registered for up to 35 people. At the time of the inspection 22 people were living in the service.

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

We found the provider had not implemented systems to ensure people were adequately safeguarded and serious risks to people's health and safety were not promoted. The management of medicines was unsafe and infection control practices did not support good hygiene or reduce the risk of cross infection. There was no evidence of lessons being learnt by the staff team when things went wrong. However, people we spoke with said they or their relative felt safe living at The Spinney. One family member told us, “[Relative] loves it here; they are safe.” Another person told us: “I’m quite content.”

People were not always supported to have maximum 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. The service was not working within the principles of the Mental Capacity Act (MCA) in relation to Deprivation of Liberty Safeguard (DoLS) applications and consent was not always obtained from people before care and treatment was delivered.

People’s needs had not been thoroughly assessed and care plans did not reflect people’s assessed needs or identified risks. The planning of people’s care was poor and people were not always provided with good nutritional support. At our last inspection we recommended the provider offered people a wider variety of meal choices.

Routine appointments and visits by community professionals had been arranged. However, people were not always supported to access emergency health care services in accordance with their needs, particularly in relation to accidents resulting in potential head injuries.

The governance of the service was not effective, as the internal auditing systems had not recognised issues identified by the inspection team. Therefore, the assessing and monitoring of the service was not robust.

People were not always supported to be involved in the care planning process or to make decisions about their care and treatment. At our last inspection we recommended the provider involved people in planning their own care and support. At this inspection we have made a repeat recommendation about supporting people to make decisions about how their care and support is delivered.

We noted on one occasion a person’s privacy and dignity was compromised, as care staff did not recognise when assistance with personal care needs were required. At our last inspection we recommended the provider improved practices around promoting privacy and dignity. At this inspection we have made a repeat recommendation about respecting people's privacy and dignity.

Feedback from people was not regularly sought and meetings were not being held. We made a recommendation about this.

Parts of the environment were in need of updating and modernising, so the home is brought up to an acceptable standard for people to live in. We made a recommendation about this.

There were some gaps in training schedules and formal supervision was not consistent. A high percentage of agency workers were utilised and induction programmes for new employees and agency staff were not thorough. We made recommendations in these areas.

The management of complaints could have been better. We made a recommendation about this.

Recruitment practices adopted by the home were robust. This helped to ensure new employees were suitable to work with vulnerable people.

People told us they felt safe living at The Spinney. They were well-presented and looked relaxed in the company of staff. Staff members approached people in a pleasant manner and were supportive when assisting them with daily activities. We saw some lovely interactions and staff members were chatting with people in a friendly way.

Staff communicated with people in a way in which they preferred and relevant information was accessible. People were supported to maintain their interests whilst living at the home and activities within the home and within the wider community were provided to avoid isolation.

Rating at last inspection and update

The last rating for this service was requires improvement (published 7 December 2018) 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 not been made and the provider was still in breach of regulations. The service has deteriorated to inadequate.

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

Why we inspected: This was a scheduled inspection based on the previous ratings.

Enforcement: We have identified breaches in relation to person-centred care, safe care and treatment, safeguarding people, nutrition and hydration and good governance.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up: 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.

At our last inspection on the 9 June 2016 the location was rated 'good' overall, with all key questions being rated as ‘good’, except for ‘safe’, which was rated as, ‘requires improvement.’ At that time, we identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of safe to at least good.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed.

We discussed our concerns with the registered manager at the time of our inspection and requested an action plan was submitted to the Care Quality Commission within 24 hours of the first day of our inspection, to show how improvements were going to be made in order to protect people’s safety. The action plan was received within the time frame agreed and was found to be satisfactory. The registered manager provided us with an updated action plan on the second day of our inspection and we saw some improvements had been made, However, further improvements were still needed.

The Spinney Nursing Home (The Spinney) 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 Spinney is located in the village of Upholland. It provides accommodation for up to 35 people requiring help with nursing or personal care needs. The home is situated in its own grounds on a main road position with onsite car parking available. There are three floors served by a passenger lift. Most bedrooms are of single occupancy, although facilities are available for those who prefer to share. A variety of amenities are nearby and public transport is easily accessible.

At the time of our inspection there were 29 people who lived at The Spinney.

The service had a registered manager in post. A registered manager is a person who is 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. The registered manager was on duty at the time of our inspection and she was co-operative and helpful throughout.

We found those who lived at The Spinney were not protected by the recruitment practices adopted by the home, as these were not sufficient to ensure all staff were fit to work with vulnerable people. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found concerns around fire safety and the general safety of some areas of the home. The management of risks within the environment was insufficient and therefore people were potentially at risk of harm. Some parts of the premises were dirty, which did not promote good infection control practices. The management of medicines was poor. These findings constituted a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that a system had been implemented for assessing and monitoring the quality of service provided. However, this was ineffective, as concerns identified during our inspection had not been recognised by the internal auditing system. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found a complaint made to the home should have been reported under safeguarding procedures and a statutory notification should have been submitted to CQC, in accordance with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to do so. This was a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found some improvements had been made in relation to analysing trends and patterns for accidents and incidents, in order to minimise the risk of harm to people. However, further improvements could be made. We made a recommendation about this.

We looked at how the service provided person centred care. Records showed that people’s needs had been properly assessed and the plans of care we saw were well written and person centred. The service demonstrated appropriate systems to assess health care risks for people who lived at The Spinney and robust systems were in place for the formulation of individuals care plans. However, records we saw did not demonstrate people had been involved in planning their own care and support. We made a recommendation about this.

Records showed staff had received supervision and appraisals. However, these were sporadic and were not always formally structured. The staff team had received training in safeguarding adults and whistle-blowing procedures. Personnel records showed that new employees had been guided through an induction programme when they first started to work at the home.

The lunch time meal service was a pleasant experience. However, menu planning could have been better to ensure people were provided with more choices, varied and nutritious options. We made a recommendation about this.

The service demonstrated appropriate use of the Mental Capacity Act and people were supported to make decisions about their care. Consent was obtained from people before any care intervention or treatment was delivered.

Complaints were being well managed and people who lived at The Spinney were being protected from discrimination. People told us staff were responsive to their needs and staff members were seen to be kind and caring. However, we made a recommendation about maintaining the privacy of two people in their bedrooms.

Records showed that a wide range of community professionals were involved in the care and treatment of those who lived at The Spinney. Records showed that surveys had been conducted for those who lived at the home, their relatives and staff members. This enabled any interested parties to provide some feedback about the quality of service provided.

There were sufficient staff on duty on the days of our inspection and we saw staff were always present in the communal areas of the home. We found that disciplinary procedures were followed in response to incidents of misconduct or bad practice.

You can see what action we have asked the provider to take at the end of this report.

This inspection took place on the 9 June 2016 and was unannounced.

We last inspected this service on 3 June 2014. At that time, the service was judged to be compliant in all the areas we looked at.

The registered manager of the service was present throughout our 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.

Safeguarding procedures were in place and we felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

Staff were kind and respectful towards people ensuring privacy and independence was promoted. Staff understood their roles and people were supported in a person centred way.

People's rights were protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Management applied these measures appropriately and staff understood their responsibilities and how to keep people safe.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process.

People's views had been gathered using effective systems These included regular surveys and staff Meetings.

The service had a registered manager who was available to people who used the service, relatives and staff. People we spoke with told us the manager was approachable.

We found the manager receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We reviewed accident and incident records and found shortfalls in the recording of unwitnessed falls.

We have made a recommendation with regards to following NICE guidelines for documentation around ‘as required’ medicines and ensuring the cleanliness of the property at all times.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment.

You can see what action we have asked the provider to take at the back of this report.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, a relative, the staff on duty and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The care and welfare of people living at the home was well planned. Any areas of potential risk were identified and strategies were implemented, in order to reduce the possibility of harm.

People told us they felt safe living at the home. Safeguarding procedures were robust and staff understood how to protect people they supported from abusive situations.

People told us they felt their needs were being met by a kind and caring team of staff, who were competent to deliver a safe service. Systems were in place to make sure managers and staff learned from events, such as accidents and incidents. This helped to reduce the risks to people and helped the service to continually improve.

People had access to choice and remained, where possible in control of decisions about their care without being put at unnecessary risk. People’s care needs were taken into account when making decisions about the deployment of staff. This helped to make sure people were kept safe and protected from harm. Recruitment practices were safe and thorough. Policies and procedures were in place to make sure unsafe practices were identified and people were appropriately safeguarded.

Is the service effective?

People’s health and personal care needs were assessed with them or their relative and they were involved in planning their own care, in accordance with their individual preferences. Specialist dietary needs had been identified where required. System were in place for people to access the local advocacy service, should they wish to appoint someone to act on their behalf.

Evidence was available to show that a wide range of external professionals and other providers were involved in the care and support of those living at The Spinney. This helped to ensure people received effective health, personal and social care.

The home had adopted effective recruitment practices, which helped to ensure only suitable people were appointed to work with this vulnerable client group. Those working at the home were well supported to deliver effective care and support.

Is the service caring?

We spoke with five people using the service. We asked them for their opinions about the staff that assisted them. Feedback was consistently positive. When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their relatives were asked to complete an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately. People’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

One person living at the home commented. "I think it is nice here. It is very comfortable and the staff are very caring. I have no complaints thankyou."

Is the service responsive?

People knew what to do if they were not satisfied with any aspect of the service. The service worked well with other agencies and services to make sure people received care in a coherent way. The home was responsive to people's nutritional needs so that they received a well balanced diet in accordance with their preferred choice of meals.

Is the service well-led?

The manager of The Spinney had been in post for one week only and therefore was not registered with the Care Quality Commission. However, he had submitted his application,which was being processed at the time of our inspection. The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure people received a good quality service at all times.

The relatives we spoke with gave positive feedback about the care provided. Comments included; “Everything is fine. The staff are very kind.”

However some information was difficult to find and could lead to people not having their needs met appropriately or in a timely manner. Care plans addressing challenging behaviour did not provide clear information for staff to follow and did not promote a consistent approach.