Springvale Court

We found the following examples of good practice.

¿ The home was clean and there was regular cleaning of all surfaces.

¿ The management team had worked with staff to keep the environment as homely as possible but still adhering to social distancing guidelines.

¿ Professional visitors and relatives were tested for COVID-19 at the service. Visiting professionals and staff provided evidence of their vaccination status to the registered manager before entering the service.

The registered manager had identified, assessed and mitigated all COVID-19 related risks to people, staff and visitors.

¿ Staff encouraged visiting between people and their relatives to allow for meaningful social interaction.

¿ Staff wore appropriate PPE and had access to this throughout the home. Staff had received additional training during the pandemic about correct PPE usage and infection prevention and control.

Springvale Court is a residential care home providing personal care to 29 people aged 65 and over at the time of the inspection. The service can support up to 40 people.

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

The provider now managed medicines safely. They had improved their systems to ensure accurate stock records were kept and better guidance was available to staff about when to give ‘when required medicines. People told us they received their medicines when they were due.

People, relatives and staff felt the home was safe. Staff were confident to raise safeguarding and whistle blowing concerns. Previous concerns had been thoroughly investigated. There were enough staff to meet people’s needs. Staff carried out risk assessments and health and safety checks to help keep people safe. Incidents and accidents were analysed to identify lessons and areas for improvement. The provider recruited new staff safely.

Staff had good support and received the training they needed. Staff supported people very well to have enough to eat and drink. They also supported people to access health care services. The provider had adapted the environment to suit the needs of people living with dementia. 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.

People received good care from a kind and considerate staff team. Staff treated people with respect and encouraged people to be as independent as possible.

People’s needs had been assessed and the information use to develop detailed care plans. We received mixed feedback about the current availability of activities. This was due to the activity co-ordinator recently leaving the role. The provider was recruiting for a new activity co-ordinator when we inspected. People knew how to complain if required. A previous complaint had been investigated and resolved.

People, relatives and staff gave very positive feedback about the management and culture of the home. They described the significant progress the provider had made to improve standards at the home. The provider had effective quality assurance processes which were used to drive improvement. People, relatives and staff had good opportunities to give feedback.

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 22 March 2019) and there was a breach 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

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.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question; is the service safe, to at least good.

During this inspection we noted that although improvements had been made, medicines management was still not safe.

Springvale Court 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 care home accommodates 40 people in one adapted building. There were 35 people living at the home when we inspected.

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.’

Medicines were not always managed safely for people and records had not been completed correctly. Arrangements were in place for recording the administration of oral medicines however some medicine stock did not balance with records. Further improvements were also needed in the records and guidance for topical preparations and medicines prescribed ‘when required’.

We noted the provider was still using a communal stairwell to store unused items, some of which could be classed as combustible.

You can see what action we are taking at the back of the full version of this report.

People, relatives and staff gave us consistently positive feedback about the care provided at Springvale Court. Throughout our visits to the home, we observed lots of positive interactions between people and staff.

People, relatives and staff told us Springvale Court was a safe place. Staff knew how to recognise and report concerns relating to safety. Previous safeguarding concerns had been dealt with effectively. There were sufficient staff deployed to meet people needs in a timely way. The provider now operated safe recruitment practices. Incidents and accidents were monitored to check robust action had been taken and to identify trends. Health and safety checks and risk assessments were carried out to maintain a safe environment.

Staff received good support and had access to the training they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff supported people to meet their nutritional and healthcare needs.

People's needs had been fully assessed to identify how they wanted their care provided. This included discussing any cultural, spiritual and end of life care needs people might have. The quality of care plans had improved so they now provided detailed and personalised information about the care people needed. People had plenty of opportunities to participate in activities. Previous complaints had been fully investigated and resolved.

People and relatives told us leadership and management of the home had improved significantly. There was a structured approach to quality assurance which was now more effective in identifying and addressing areas of concern. People and staff had good opportunities to provide feedback about the home.

The provider was continuing to make significant progress towards completing the actions contained within their ‘home improvement plan.’

Springvale Court 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 care home accommodates 40 people in one adapted building. There were 40 people living at the home when we inspected.

The home had a registered manager. They were not present during this inspection as they had been seconded to another home temporarily. An acting manager and deputy were present throughout the inspection, supported by a regional 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.’

During this inspection we found medicines administration was not safe. We found gaps in medicine administration records which meant it was not always possible to be sure people had received the medicines they needed. Records for medicines in stock were also inaccurate. Where people had been prescribed ‘when required’ medicines there was no up to date guidance for staff to help them decide whether thee medicines should be given. We observed some agency nurses did not follow best practice when administering medicines. The provider was acting to reduce the risk to people’s safety. This included retraining for senior care staff and increased checks of medicines.

When we inspected the provider had already started making improvements with the management of medicines to ensure people received their medicines safely. Following our visits to the service we wrote to the provider to outline our concerns from the inspection and to request a robust action plan to address the concerns. The provider submitted a detailed action plan to the CQC which reflected the concerns we found during the inspection, as well as the concerns of local commissioners. The provider agreed to submit a monthly progress update. This will enable the CQC to closely monitor progress against actions identified in the improvement plan and in meeting the requirements of the regulations.

Staff told us staffing levels were not suitable to enable them to meet people’s needs effectively. The dependency tool used to monitor staffing levels had not been updated regularly. Recruitment was not carried out in a safe way or in line with company policy. References lacked detail and were not received from staff member’s last employer or the referees declared on application forms.

Incidents and accidents were not fully investigated to ensure appropriate action was taken and lessons learnt to keep people safe. Local safeguarding procedures had not always been followed as some incidents had not been referred to the local authority safeguarding team to be investigated. Statutory notification had also not been submitted to the CQC for reportable incidents.

Staff told us the registered manager had provided good support. Records showed supervision and appraisals were not carried out in line with the provider’s expectations.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service did not support this practice. The provider held contradictory information about the number of people requiring a Deprivation of Liberty Safeguards (DoLS) authorisation. Some DoLS had expired and no renewal application submitted. Mental Capacity Act (MCA) assessments and best interests decisions were not recorded where people had restrictions on their liberty.

We found some people assessed as being at risk did not have care plans to help maintain their safety. For example, where people were potentially a risk to others due to aggression or were at risk of falling and injuring themselves. Other care plans were not up to date, lacked detail and were not person-centred. Evaluations were not carried out consistently and lacked meaningful information about people’s current needs.

Actions identified in the Fire Risk Assessments had not been completed within the recommended timescales. We observed a potential fire hazard as the stairwell was used to store equipment. Although dealt with on the day of inspection, staff told us the equipment had been there for a long time.

Staff and relatives gave negative feedback about management and leadership of the home. Quality assurance was ineffective as the issues we found had not previously been identified and addressed through the provider’s internal quality assurance systems.

You can see what action we are taking at the back of the full version of this report.

People and relatives gave positive feedback about the caring nature of staff. Although we observed interactions between people and staff were kind, people did not always have their needs met in a timely way.

The provider carried out a range of health and safety checks. We noted the home was clean, well decorated and well maintained.

Staff had competed training relevant to their role.

People were supported well to meet their nutritional needs. Where people required support, this was provided straightaway. Staff supported people to access health care services when needed.

Previous complaints had been dealt with appropriately in line with the provider’s complaint procedure. People did not raise any complaints directly with us.

To address the concerns identified at the home, the provider had developed a ‘home improvement plan.’ When we visited the home, we found they were making progress with this plan.

The service was last inspected in January 2016 and the service was rated as requires improvement. Breaches of the Health and Social Care Act 2008 (Regulated activities) regulations 2014 were identified in relation to safe care and treatment, staffing and governance of the service. Requirement notices were issued to the provider.

Following the January 2016 inspection the provider sent us an action plan detailing how the breaches would be addressed. At this inspection we found that the provider and staff had taken action to ensure the service became compliant with the regulations.

Springvale Court is a care home providing accommodation and personal care to 40 older people, including people with a dementia diagnosis. There were 32 people living at the service at day one of the inspection.

The service 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.

Systems were in place to protect people from avoidable harm or risk. Staff received safeguarding training and understood their role in ensuring people’s safety. Risks to people, staff and visitors were assessed and regularly reviewed. The service took action to minimise risks where appropriate in order to keep people safe from avoidable harm. Some improvement to the recording of post incident improvements were identified during the inspection and action taken by the registered manager to improve this process.

Robust recruitment processes were in place to ensure staff members were suitable to work with vulnerable people. Staffing levels were based on the dependency levels of people living at the home and were reviewed on a regular basis.

Appropriate systems were in place for the management of people’s medicines. Medicines were stored and managed correctly by staff who were trained and monitored to manage this safely.

Staff were supported through the provision of training, formal supervision and annual appraisals. Staff confirmed they felt well supported in their roles and spoke positively about the registered manager and their leadership and management of the home.

The service worked within the principles of the Mental Capacity Act 2005. People’s capacity to make decisions about their care and treatment was assessed and where appropriate, “best interest” decisions were made on people’s behalf. These involved relevant healthcare professionals as well as people’s friends and family members as appropriate.

People were complimentary about the kind and caring nature of the staff team. Staff had developed relationships with the people they supported and were knowledgeable about their individual needs, likes and dislikes.

People’s needs were assessed prior to them joining the service. Care plans were produced which guided staff on how to care for people. These included details of any preferences people may have. People and their representatives were actively involved in their care planning and were also encouraged to voice their opinions about the service in general.

The services activities co-coordinator was noted for their energetic approach. Some areas for further improvement, to involve more care staff in providing activities, had been identified by an external agency and the registered manager agreed to review these further.

People’s needs were reviewed on an on-going basis and action taken to obtain the input of external professionals where appropriate. Recording systems were not consistently used by all staff to ensure people had sufficient to eat and drink and to access other healthcare professionals in order to maintain good health. The registered manager took action and by the third day of inspection improvements had been made.

A range of systems were in place to monitor and review the quality and effectiveness of the service. Action was taken to address what areas for improvement were identified. For example changes to the environment. Complaints were taken seriously and records maintained of the action taken by the service in response to any form of dissatisfaction or concern.

Springvale Court is a care home providing accommodation and personal care to 40 older people, including people with a dementia diagnosis. There were 38 people living at the service at the time of the inspection.

The registered manager post had been vacant since September 2015. The former deputy was acting as manager and was in the process of applying to become 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.

We found that the service and staff knew how to keep people safe and reported any concerns to the appropriate agencies. Staff could tell us how they would keep people safe from possible harm that may occur.

Medicines records were not being completed correctly by all staff. Some records had gaps or had not been checked by other staff. ’when required' medicines were not being managed effectively.

The home was well furnished, clean and well maintained. People told us they liked the environment and we found no malodours or areas for repair.

There were enough staff and we observed that staff were able to respond to peoples’ requests for assistance throughout our visit. Some staff told us and feedback from the provider’s last survey of people in 2015 told us that sometimes staff did not have enough time to talk to people.

Processes were in place to recruit staff safely and ensure they had the skills and knowledge to support people. However, supervisions and appraisals of staff had not been happening as frequently as the provider’s policy stated.

People were identified who needed support to eat and drink to maintain their well-being. However some of the records kept of people’s food and fluid intake were being completed inconsistently so people were at risk of not maintaining their well- being.

The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw that people were subject to DoLS as appropriate and that staff we spoke with were aware of the process to identify people subject to a DoL.

Staff were observed to be caring and to respond quickly to people’s need for support. People and their relatives told us that staff treated people well and spent time getting to know them and their families.

Care plans were in place to support consistent care; however the evaluations carried out were inconsistent and lacked the details needed to ensure that care was provided in a personalised way. The care records did not always document where people or their relatives had been involved in the creation of care plans and whether consent had always been obtained.

Some staff and people told us that activities could be limited at times. A part time member of staff was now leading on activities as the regular staff member was absent. The last survey also identified that activities could be further improved.

The service did not have a registered manager in place, but the former deputy had been appointed to manage the service and was in process of registering with us. We saw that they had responded positively to complaints made about the service and had taken steps to act on feedback from the last survey of people to improve the service further. The service had a low staff turnover and staff told us they had a positive ethos in the service, of looking after people the way they would like to be cared for themselves.

At the time of the inspection there were 36 people living at the home. Due to their health conditions and complex needs not all people were able to share their views about the service they received, but we did speak with nine people. We observed their experiences to support our inspection. We spoke with the deputy manager, five staff, six relatives and two district nurses.

Is the service safe?

All the people we spoke with told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. One person told us, 'I definitely feel safe and protected from any abuse. We can speak to the manager at any time.' A relative we spoke with said, 'My relative is absolutely safe, I have no concerns whatsoever. If I did I would speak with the manager.'

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager understood the home's responsibilities under the Mental Capacity Act 2005 and DoLS. No deprivation of liberty application had been submitted to the local authority. Following a recent court ruling regarding DoLS in care settings, the provider may wish to review people's living arrangements to check whether their circumstances amount to a deprivation of liberty, according to the revised definition.

We saw that the service was safe, clean and hygienic. The home had an effective infection control system. Equipment was well maintained and serviced regularly, so preventing any unnecessary risks. All the staff told us how they worked to prevent infection and told us how they would manage an outbreak at the home so that the risk of infection spreading could be reduced.

Is the service effective?

Comments from people included, 'I think it is fine here. The staff will help me if I ask them. I feel quite well looked after here.' Another person told us, 'I have no problems here. The staff will always ask me if I want anything.' A relative told us, 'I am very happy with the service at the home.'

People explained how their care and welfare needs were met. People told us they had support with health appointments and felt that the service was flexible. One person told us, 'When I am not feeling well I ask the staff to call my doctor.' All the relatives we spoke with told us they were all kept informed about people's care and they felt the service was good. One person told us, 'It's like having my own apartment. I have everything I need in my room. The staff will always come and do whatever you ask.' All the people we spoke with told us staff always asked them if they needed help or assistance and provided it when necessary.

Is the service caring?

We saw staff communicated well with people and were able to explain things in a way that could be easily understood. People were not rushed when care was delivered and we saw that staff interactions with people were caring. All the people we spoke with said they felt the care was very good. People we spoke with told us, 'I like it here. I think the staff are very good with you.' One relative said, 'The care is absolutely brilliant.'

We saw that staff treated people with respect and dignity. One person told us, 'The staff respect my dignity. They always ask me about what I like too.' We saw that people were given choices in relation to their care. Both people and their relatives told us they were very happy with the care they received.

Is the service responsive?

All the people we spoke with told us staff would respond to any of their requests for support. One person told us, 'I like to do activities. I like to play bingo and I will ask the staff. There are times when I just want to relax and watch my television in my room.'

All the relatives told us that they were very happy with the service.

All people we spoke with told us they were involved in decisions about their care. They said that staff were flexible and responded to their requests promptly. We saw staff responded to people's requests for help in a timely manner.

We saw that there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaints.

People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded appropriately and altered the care and support they delivered in line with these changes. Care records had been updated to reflect the person's current needs.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service well-led?

We spoke with the deputy manager. They showed us there was an effective system to regularly assess the quality of service people received. We found the views and opinions of people, relatives and staff had been regularly gathered, recorded, analysed and responded to.

We saw the home had systems in place that ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

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

We found staff had completed appropriate training and were receiving regular supervision with their line manager.

The provider had undertaken a review of the audit systems in place at the home to make them more effective in order to identify gaps in service delivery. The provider analysed information it held to identify areas for improvement.

People, and their relatives, told us they knew how to complain and were confident their views would be listened to. One person said, 'The manager would listen to me", and, "I am happy to be here." One relative commented, 'I have no complaints at all', and, "This place is marvellous, the staff are so patient."

During this inspection we carried out two visits. A pharmacist inspector from the Care Quality Commission visited the home on 27 March 2013 and spoke with two people who used the service. People told us they were happy with the way their medicines were handled and administered. One person said, 'I get all my medicines and they never run out'. Another person said, 'Staff are good and I like it here."

Overall we found improvements had been made and people were given their medicines safely.

We also visited the home on 2 April 2013 at 10pm to check whether overnight staffing arrangements were sufficient to meet people's needs. At the time of our visit most of the people who used the service were in bed. We saw staff met people's requests quickly, both in the lounge and when people pressed call bells in their rooms. Staff checked people's bedrooms to see if people needed assistance.

We spoke with two members of staff who told us that staffing levels had improved since our last inspection. We found that there were enough staff to meet people's needs.

During our observations we saw people were treated with consideration and respect. People and their relatives told us they were involved in how their care was delivered. One relative said, "They keep me updated and I'm involved in any decisions. I visit a few times a week, but if anything happens when I'm not here they'll give me a ring. We come in two or three times a year to sit down discuss how everything is going. They check if we are happy with the care and are very interested in our feedback."

There were systems in place to monitor the quality of the service provided and to protect people from the risk of abuse.

People and their relatives said they were happy with the care which was provided. One person said, "This is the best you could ask for. I'm quite content. I'm well looked after. I can't think of one thing they could do better."

However, we found care was not always delivered in a way which ensured people's safety and appropriate arrangements were not in place to protect people against the risks associated with medicines. There were not always enough staff to meet people's needs, and some staff training was out of date.