Archived: Spinneyfields Specialist Care Centre

nursing care for up to 51 people aged 65 and over. The service provides short stay, intermediate and respite care services. People usually stay in Spinneyfields Specialist Care Centre for a period of rehabilitation when they are discharged from hospital following surgery or illness, or to provide a break for carers.

We found the following examples of good practice.

¿ The service used innovative and effective use of cohorting and zoning in order to reduce the risk of infection spread. This meant people being admitted to the service, for example from hospital, were classed as high or medium risk and were isolated in a high risk ‘red’ zone or medium risk ‘amber’ zone before moving into a low risk ‘green’ zone following their period of isolation. Staff also worked in separate cohorts in the event of an outbreak of infection.

¿ Some people found it difficult to stay in their bedroom for 14 days following admission, perhaps because they felt isolated and this impacted their emotional health. The service considered ways of supporting people safely. For example, one person spent time in a lounge area with a staff member, and the room was then cleaned after each use.

¿ Key updates, particularly around Covid-19, were shared with staff through a text system directly to their mobile phones. This allowed management to give important information promptly to the whole staff team.

¿ Handwashing stations were clearly marked throughout the building and staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser.

¿ There were clear processes for any visitors entering the building to ensure they, and people using the service, remained safe. This included a temperature check, risk assessment form and use of PPE. The service had strong working relationships with their health professional network.

¿ Staff followed clear procedures to ensure good practice with infection prevention and control. They received additional training and competency checks. This reduced the risk of cross contamination.

¿ There was a regular programme of Covid-19 testing in place. This meant swift action could be taken if anyone received a positive test result.

¿ Staff used a large separate room for their breaks, which included a kitchen area and PPE station. This provided sufficient space for social distancing to be maintained. In the event of an outbreak of infection, kitchen staff were able to remain apart from the rest of the staff team including having a separate staff area and entry to the building.

¿ A robust audit system for infection prevention and control was in place which was regularly updated and reviewed. This included weekly audits with a walk around, monthly audits and additional audits from an external compliance manager. This ensured good practice was maintained.

Further information is in the detailed findings below.

Spinneyfields Specialist Care Centre is an intermediate and respite care service providing personal and nursing care for up to 51 people aged 65 and over.

The service provides short stay, intermediate and respite care services. To enable people recovering from surgery or illness to return to their own home or await a move to live at a more appropriate community setting, or to provide a break for carers. At the time of the inspection 29 people were using the service.

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

Staff supported people to maintain and regain their independence. To enable people to achieve the best possible outcomes.

People’s needs were assessed to ensure they received safe care. Staff knew how to raise any concerns regarding people's safety. The registered manager ensured any safeguarding concerns were raised with the local authority safeguarding body and the Care Quality Commission (CQC).

People were supported by staff that were safely recruited and had the right skills and knowledge to provide care to meet their assessed needs. Staff were alert and responsive to changes in people's needs. They liaised with relatives and health professionals in a timely manner.

Staff supported people to take their prescribed medicines safely. They followed good practice infection control guidelines to help prevent the spread of infection.

People’s health care and nutritional needs were carefully considered, and the relevant health care professionals were involved as required.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; the policies and systems in the service supported this practice. Information about the service was made available to people in formats that met their communication needs.

Systems were followed to monitor the quality of care and support people experienced. The registered manager and the staff team acted on people's feedback to drive continual improvement in the service.

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 28/02/2017).

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 reinspection programme. If we receive any concerning information we may inspect sooner.

The service is registered to provide accommodation for up to 51 older people who may require nursing care and rehabilitation. The people living in the specialist care centre have a range of needs including people living with dementia and people who have physical disabilities. The service provides rehabilitation for those people who may be recovering from surgery or illness, respite care and social rehabilitation. At the time of our inspection there were 31 people living there.

The service has 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 were cared for and supported by staff who were respectful of their dignity and who demonstrated an understanding of each person’s individual needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. Relatives spoke positively about the support their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

People received care from staff that knew them and were kind and compassionate. Their needs were assessed prior to coming to the Centre; individual care plans were in place and were kept under review.

Care plans detailed people’s needs, their likes and dislikes and preferences. The information gathered ensured that people were cared for safely. Staff understood their role and responsibility to keep people safe from harm.

Staff were supported through regular supervision and undertook training which helped them to understand the needs of the people they were supporting. There were sufficient staff to meet the needs of the people; staffing levels were kept under review. There were appropriate recruitment processes in place which protected people from being cared for by unsuitable staff and people felt safe in the Centre.

People were involved in decisions about the way in which their care and support was provided. Staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines. 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.

People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

There were a variety of audits in place and action was taken to address any shortfalls. The registered manager was visible and open to feedback, actively looking at ways to improve the service.

The service is registered to provide accommodation for up to 51 older people who may require nursing care and rehabilitation. The people living in the specialist care centre have a range of needs including people living with dementia and people who have physical disabilities. The service provides rehabilitation for those people who may be recovering from surgery or illness, respite care and also provides a hospital avoidance service for people to help prevent them from being admitted to hospital. At the time of our inspection there were 33 people living there.

The service has 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 were involved in decisions about the way in which their care and support was provided. Although staff understood the need to undertake specific assessments where people lacked capacity to consent to their care and / or their day to day routines records the application of The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards was not always being adhered to.

People were cared for by staff who were respectful of their dignity and who demonstrated an understanding of each person’s needs. This was evident in the way staff spoke to people and the activities they engaged in with individuals. However, there was an inconsistent approach as to how staff interacted with people in the dementia respite unit. Relatives spoke positively about the care their relative received and felt that they could approach management and staff to discuss any issues or concerns they had.

People received care from staff that were kind and compassionate. Their needs were assessed prior to coming to Spinneyfields and person centred care plans were in place and were kept under review. Staff had taken care to understand people’s likes, dislikes and past life’s.

People’s health care and nutritional needs were carefully considered and relevant health care professionals were appropriately involved in people’s care.

There were appropriate recruitment processes in place and people felt safe in the home. Staff understood their responsibilities to safeguard people and knew how to respond if they had any concerns.

There were sufficient staff to meet the needs of the people living at the home; staffing levels were kept under review. Staff were supported through regular supervisions and undertook training which focussed on helping them to understand the needs of the people they were supporting.

There were a variety of audits in place and action was taken to address any shortfalls. Management was visible and open to feedback, actively looking at ways to improve the service.

Is the service safe?

When we inspected there were sufficient numbers of experienced and competent staff on duty to safely meet people's care needs. We saw that the equipment in place for staff to use was appropriately maintained. We saw that staff had been appropriately trained and received the managerial support they needed to do their job. This meant that people were protected from the risk of neglect or unsafe care.

We saw that people were cared for in an environment that was kept clean throughout. Staff wore appropriate protective clothing, such as gloves and aprons, when assisting people with intimate personal care, such as toileting or washing. This meant that people were protected from the risks associated with poor hygiene.

There were suitable arrangements in place to respond to emergencies. Senior staff were always available 'on call' to support staff if they needed guidance. This meant that appropriate action to protect people was taken in a timely way.

People's needs had been assessed before they were admitted to Spinneyfields Specialist Care Centre. After admission to the home we saw that their needs were regularly reassessed throughout their stay. This meant that staff had the information they needed to support people's changing needs. It also meant that people consistently received the safe care they needed.

Is the service effective?

We saw from looking at training records and from talking with individual staff that they had received the information, training and managerial support they needed to do their job effectively.

People said they received all the support they needed to enable them to do what they could for themselves. This meant that they were encouraged and supported to regain as much independence as their capabilities allowed.

We spoke with four staff and observed other staff going about their duties and we concluded that they had a good knowledge of each person's care needs and preferences.

Is the service responsive to people's needs?

We spoke with three people in the privacy or their own room and we met and talked with two visiting relatives. The people we spoke with were very pleased with the attention staff had given them. We also observed that staff responded in a timely way when people activated their 'call system' from their own bedroom.

One person said, "I can honestly say the staff here are marvellous. Nothing is too much trouble. They have really helped me."

Is the service caring?

We saw that staff were patient and never rushed people. Their manner was friendly, with of words of encouragement frequently used when assisting people. We saw that staff treated people kindly and with respect for their individuality and capabilities.

Is the service responsive to people's needs?

We saw that there was enough staff on duty to meet people's needs. This was confirmed by the people in residence we spoke with. One visitor said, "Whenever I come here the staff always make time for me even when they are busy. I can ask questions and I am never made to feel that I am holding them up. I find that reassuring.'

Is the service well-led?

The four staff we spoke with individually said they received a good level of practical day-to-day managerial support that enabled them to carry out their duties. We saw there were robust quality assurance processes in place. This meant that people were assured of receiving the care they needed in a way that suited them.

There was no registered manager in post when we inspected as the previous post holder had left and had voluntarily cancelled their registration. The new manager in post had yet to be formally registered with the Care Quality Commission (CQC) to manage the regulated activities at this location but an appropriate and timely application to register this person had been received by CQC for processing.

We considered all the evidence we had gathered under the outcomes we had inspected to answer questions we always ask; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well lead?

This is a summary of what we found:

Is the service safe?

Staff had identified where people had bruising or marks on their skin but there were no records to show that any assessment or investigation had taken place into the cause of these injuries. There was no record of any action being taken to safeguard the people from further harm.

Where risks to people had been identified there were not always care plans in place to ensure that these risks were managed.

People were not always receiving their medication as prescribed.

Is the service Effective?

People were not receiving appropriate care and were not being protected from the risks of developing pressure ulcers. People were not receiving safe and appropriate care for their assessed needs in relation to diabetes, constipation and pain management.

Is the service caring?

Two people who used the service during our visit told us that they were happy with the care that they received. We observed staff talking with people in a caring and respectful way.

Is the service responsive to people's needs?

Care plans did not contain adequate information about people's needs to ensure that they received safe and appropriate care.

Is the service well-led

At the time of our visit the service did not have a registered manager. The current manager has been in post since November 2013 and told us that he was waiting for his checks with the disclosure and barring service (DBS) and will then submit an application to register as the manager for the service.

Following our inspection on the 12 November 2013 the manager sent us an action plan which outlined the actions that the service would take to make the required improvements. The action plan stated that the service would be have made the necessary improvements by January 2014. When we visited on the 01 April 2014 we found that although some improvements had been made, there were still areas which we had identified at our previous visit which required improvement to make sure that the service was safe and met people's individual needs.

There were some systems in place to identify, assess and manage risks to people's health, welfare and safety but these had not been effective in ensuring people received safe and appropriate care.

We have asked the provider to tell us how they will make improvements and meet the requirements of the law in relation to safeguarding people from harm, ensuring care records are accurate and give staff relevant information and the managemet of medication. Where we have identified a breach of a regulation during inspection which is more serious, we will make sure action is taken. We will report on this when it is complete.

Although people spoke highly of the service we found some concerns with the way that care and treatment was planned and delivered. We looked at assessments and care plans for six people and found that care plans did not always contain sufficient detail to ensure staff knew how to care for people.

We found that medication was not being correctly accounted for or stored appropriately.

We saw there was a programme of audits and checks in place but these had not identified the issues that we found with care records or medication.