Archived: Springfield House Care Home

This inspection took place on 5 and 6 June 2018 and was unannounced.

We carried out an unannounced, comprehensive inspection of Springfield House Care Home in March 2017. We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had not ensured there were robust procedures in place for the administration of medicines. During this inspection we found action had been taken and there was no longer a breach of the regulation.

Springfield House Care Home 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.

Springfield House Care Home offers accommodation and care for up to 23 people who may be living with dementia. At the time of the inspection there were 18 people living at the home. The service is a detached house with two floors. There is a passenger lift providing access to the upper floor. The communal area is on the ground floor and is divided into a sitting and dining area.

There was a registered manager at the service. 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 were supported to take their medicines as prescribed, by staff who were trained and assessed as being competent. The home was clean and benefitted from some new flooring. The provider had policies and procedures in place designed to protect people from abuse and staff had completed training in safeguarding people.

Risk assessments identified when people were at risk from every day activities, such as moving around the home or using equipment. Arrangements were in place to ensure people’s safety in the building. People’s needs were met by suitable numbers of staff and appropriate recruitment procedures were in place. The registered manager ensured that lessons were learnt and improvements made when necessary.

People were offered a choice of meals, drinks and snacks. People had access to healthcare services when necessary. People were able to walk around the building independently and sit in the garden if they wished.

People were supported by sufficient staff who had received relevant training to enable them to support people effectively. New staff completed a formal certificate of induction.

Staff developed caring relationships with people using the service. People were supported to express their views and be involved in making daily decisions about their care and support. Staff described how they supported people with personal care whilst being mindful of their dignity.

People received care and support which met their needs and was responsive to changes. There were detailed care plans were in place. The registered manager and staff organised and provided a range of different activities. People were supported to stay at Springfield House Care Home at the end of their lives if this was their wish and staff could meet their needs.

The provider had a complaints procedure in place which was displayed where people and visitors could see it. The registered manager promoted a positive culture that was open and inclusive. The registered manager had developed a system of seeking the views of people about the quality of the care provided. The service worked with other agencies to improve people’s health and wellbeing.

When we last inspected Springfield House Care Home on 26 April 2016, we found medicine records were not always accurate which meant it was not easy to establish from the records what prescribed medicines had been taken by people. We also identified concerns around some aspects of the environment and infection control.

During this inspection on 27 and 28 March 2017, which was unannounced, we found improvements had been made but we identified further concerns and areas for improvement.

Springfield House Care Home offers accommodation and care for up to 23 people who may be living with dementia. At the time of the inspection there were 22 people living at the home. The service is located in a detached house with two floors. There is a passenger lift providing access to the upper floor. The communal area is on the ground floor and is divided into a sitting and dining area.

There was a registered manager at the service. 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.

We found concerns with the systems around medicines. The numbers of tablets were not always correct against the records which meant tablets could be missing as staff did not know how many tablets there should be in the home. Some people were prescribed medicines “when required” but there was not a care plan in place for two of these people to guide staff in a consistent way when supporting people. The issues around medication had not been identified through the process of auditing.

Improvements could be made to the dining experience of people to ensure every meal time is a positive and enjoyable time. People were frequently offered a range of snacks and drinks, including fresh fruit and were offered choices to eat and drink.

Whilst auditing processes were in place, they had not been effective in identifying all the areas of concern we identified during our inspection.

People felt safe living at the home and were protected from avoidable harm through the use of equipment, such as special mattresses and walking frames. Risk assessments identified when people were at risk and the action taken to minimise the risks. The provider had policies and procedures in place designed to protect people from abuse. Staff had completed training in safeguarding adults and were aware of the different types of abuse and what they should do if they suspected or witnessed abuse.

People’s needs were met by suitable numbers of staff and appropriate recruitment procedures were in place. People were supported by staff who had received relevant training to enable them to support people. New staff had completed an initial induction to the home as wells as a formal certificate of induction.

Staff developed caring relationships with people using the service. People were supported to express their views and be involved in making daily decisions about their care and support. Staff described how they supported people with personal care whilst being mindful of their dignity.

Staff knew people well and met their assessed needs. Staff provided a range of activities for people and took time to encourage them to join. People could move around the home and spend time as they wished. Complaints were recorded, investigated and responded to and appropriate action taken, including additional training, to reduce the risk of a similar occurrence happening again.

There was a clear management structure, which consisted of the registered manager, deputy manager and senior care staff. The registered manager responded to, followed up on and shared learning from incidents which had occurred in the home. Visitors and staff were positive about the registered manager who they felt was approachable.

We identified a breach of a regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This unannounced comprehensive inspection took place on 26 April 2016. The last inspection took place on 24 September 2014. At this time the service was meeting the requirements of the regulations.

Springfield House is a care home which offers care and support for up to 23 predominantly older people. At the time of the inspection there were 20 people living at the service. Some of these people were living with dementia. The service is located in a detached house with two floors. There is a passenger lift providing access to the upper floor.

The service had a registered manager in post. 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 were some malodours throughout the service and the communal areas were in need of some refurbishment. Carpets and floors were not being effectively cleaned regularly. Soiled laundry was sorted on the floor of the laundry room. We saw soiled incontinence pads wrapped up in soiled laundry had been sent to the laundry room. This posed an infection risk. Some people’s bedroom doors slammed shut loudly. This posed a risk of injury to people using these doors regularly.

We looked at how medicines were managed and administered. We found it was not always possible to establish if people had received their medicine as prescribed. We found medicines remained in packs when records showed the person had had the medicine given to them. Medicine audits were not consistently identifying when errors occurred. We found several full sharps bins stored at the service. The service did not have a system for the safe collection and destruction of sharps. Some people’s risk assessments had not been reviewed regularly according to the records. The registered manager told us these had been done but not recorded in a timely manner.

The service held personal money for people living at the service. We checked the money held against the records kept at the service. The records were not accurate. The registered manager was able to explain the discrepancies and told us that some transactions were not always recorded at the time they were done.

The service had identified the minimum numbers of staff required to meet people’s needs and these were being met. People were treated with kindness, compassion and respect. People’s bedrooms were comfortable and personalised to reflect people’s individual tastes.

Staff were supported by a system of induction training, supervision and appraisals. Staff knew how to recognise and report the signs of abuse. Staff received training relevant for their role and there were good opportunities for on-going training and support and development. More specialised training specific to the needs of people using the service was being planned. For example, dementia care training. Staff meetings were held regularly. These allowed staff to air any concerns or suggestions they had regarding the running of the service.

Meals were appetising and people were offered a choice in line with their dietary requirements and preferences. Where necessary staff monitored what people ate to help ensure they stayed healthy.

Care plans were well organised and contained detailed information about each person’s individual needs. People’s care needs were reviewed regularly. Care records detailed people’s preferences and dislikes and past life history. Where appropriate, relatives were included in the reviews of the care plans.

Activities were provided. Care staff planned activities for people. The management team were aware of the need to provide meaningful activities for people and were planning on providing more relevant programme of activities particularly for the men living at the service.

The registered manager was supported by a deputy manager and senior care staff. Staff and relatives of people living at the service were positive about the registered manager and told us they were approachable and friendly.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see what action we have told the provider to take to address these concerns at the end of this report.

Is the service responsive?

We found the home was responsive because there were systems in place to enable people to complain if they were unhappy about aspects of their care. The provider had displayed the complaints procedure where people or the visitors could see it. Staff knew what to do if a person made a complaint to them and were clear of people's rights to complain. The manager was developing systems to monitor whether people and their representatives were aware of the procedure and how to use it.

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

We found the service was safe because people were cared for by staff who were knowledgeable about their needs and had the skills to provide the support people required. People were assessed prior to receiving care and support plans were developed to show how their needs would be met. Risk assessments were completed and measures to reduce risks were put in place.

People who use services were only deprived of their liberty when this had been authorised by the Court of Protection, or by a Supervisory Body under the Deprivation of Liberty Safeguards. At the time of the inspection, one person was protected appropriately by the safeguards.

The home was kept clean and cleaning schedules were maintained. Staff were clear about how to launder linen to ensure the risks of infection were minimised.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs which they knew well. One person told us, 'It is fantastic here'they help you with your make up and personal care. I thoroughly enjoy it here.'

Is the service caring?

People who used the service felt the staff cared about them. One told us, 'Yes, they're there [for us].' Another person said it was 'lovely here, very nice people, all of them.' A visitor said staff were, 'kind and caring. They spend time with [their relative] when she is down.'

We observed staff as they spoke with people or supported them to move around the home. We saw they were kind, calm, un-rushed, respectful and considerate. We saw staff putting a hand gently on people's backs when they were walking, which was showing the person they were there to support them.

Is the service responsive?

The service was not responsive across all aspects of its service. People's needs had been assessed before they moved into the home. Records confirmed people's preferences were noted and formed part of the care plan. People were supported to maintain relationships with their friends and relatives.

Whilst one complaint had been made and addressed appropriately, the provider had not made people aware of the complaints procedure. This meant people did not know how to complain if they wished to.

Is the service well-led?

The provider had a system in place to regularly assess and monitor the quality of service people receive. The provider had sought relative's views but did not have a formal system in place to seek the views of people living in the home.

The provider had audit systems in place to people were well cared for and risks to their safety managed. Audits included medication, health and safety, record keeping and cleaning. Audits showed areas which needed action to improve and records showed these had been addressed. The audits were then reviewed by a senior manager to ensure appropriate action had been taken. This meant the manager and provider had an overall view of the service and how people's needs were being met.

We spoke with two people who used the service and they were positive about living there. One person told us, 'whatever I want, I get it' and that staff were, 'very polite, helpful'. Another said the home was, 'very good'. Staff were, 'very attentive' and would stop and talk, often asking 'is there anything I can do for you?' We also spoke with two visitors, who were both positive about the care provided. One said, 'it's fabulous. I don't know what we would have done without them. You just couldn't ask for a better place.' The other told us about an incident involving their relative and said the service's response had been positive.

We looked at the care plans for three people who used the service and whose needs were considered complex. Their needs had been assessed and regularly reviewed to ensure any changes were identified and responded to. Care plans were detailed and personalised to individuals and included risk assessments. Daily records showed the care plans were being followed which meant people's assessed needs were being met. Staff received appropriate professional development and annual appraisal to support them in their work.

The home appeared clean but the home did not have a policy and procedure regarding infection control and did not have a named staff member responsible for ensuring risks were minimised. We saw five beds which were stained and a bath which was damaged and posed a risk to people using the service.

One person told us: "I got lonely living on my own, now I live here I have my friends." Another person told us: "It's what I expected in a care home. I can choose how much I join in and find I get on with most people." Where people were able to discuss their care needs they were involved in their care planning. The manager told us mental capacity act assessments were used to support those people who were unable to consent.

People were safe and staff were trained in identifying abuse and knew how to respond to safeguarding concerns. One person told us they would talk to the manager if they felt they were not being treated well by staff.

Our last inspection found staff were not being adequately supported and were not receiving regular supervision. We found staff had received supervision in January of this year however this had not occurred since. therefore staff were still not being adequately supported as they were not receiving regular supervision.

The service had received comments from people who used it and had prepared an action plan accordingly. This showed they responded to feedback received.

We found that people did have choice on a daily basis and that staff knew them and their needs well. Staff respected people's privacy and dignity when they supported them with personal care. Staff spoke to people respectfully and acknowledged their wishes. There was a complaints procedure in place which was given to people when they moved into the home. Staff were trained to give medication and medication records were maintained accurately. Staff were trained in the other aspects of their work but were not fully supported through the use of supervision and appraisal.