Springfield Grange

Updated 28 March 2024

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

As part of this inspection, we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practise we can share with other services.

Inspection team

The inspection team consisted of 3 inspectors, one of which was a medicines inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Service and service type

Springfield Grange is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Springfield Grange is a care home with nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was not a registered manager in post. A manager was in place who had been in day to day control of the home since July 2023. Following our inspection, the provider told us the manager had applied to become registered with us.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from partner agencies and professionals who work with the service. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection We spoke with 10 people who used the service and 11 relatives about their experience of the care provided. We spoke with 6 members of staff including the manager, senior care worker, and 4 care staff.

We observed staff interacting with people in all areas of the home and reviewed a range of records. This included 4 people’s risk assessments, care plans and care records. We saw 6 people’s care records and multiple medication records. We looked at 3 staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.

After the Inspection

We continued to speak with the manager and regional manager. We reviewed further records remotely to validate evidence found. This included information regarding safeguarding people from abuse, records relating to consent, activities, quality and safety records, policies, and procedures. We looked at training and quality assurance records.

Updated 28 March 2024

About the service

Springfield Grange is a care home providing personal and nursing care. The service can support up to 80 people. Care was provided over 4 units, this included nursing needs and people living with dementia. At the time of the inspection 49 people were using the service.

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

We found care and treatment of people was not always appropriate and did not meet their needs or reflect their preferences.

We found people were not supported to have maximum choice and control of their lives and staff supported them in a restrictive way and not always in their best interests. There was no information recorded on care records as to when people preferred to be supported to go to bed or get up.

We observed a lack of engagement and activities in communal areas and for people who were cared for in bed. The provider had 2 activity co-ordinator posts, but these were both vacant at the time of the inspection.

We found shortfalls in the safe management of medicines. Medicines administration was not safely recorded, and medicines were not always stored safely. The balance of some medicines was incorrect, the provider could not explain why the count of medicines was not correct.

Risk assessments for people were not up to date, incorrectly completed or blank. We found information recorded on a person’s personal emergency evacuation plan (PEEP) did not match the information in the person’s care plan.

Complaints received were not always investigated, and the necessary and proportionate action was not taken in response to any failure. There were no established, effective, or accessible system for identifying, receiving, recording, handling, and responding to complaints made by people who used the service.

We found systems or processes were not in place and operated effectively to monitor and improve the quality and safety of the services provided. Risks were not always assessed, monitored, and mitigated.

Mental Capacity Assessments (MCA), Best interest decisions (BID) and Deprivation of Liberty applications (DoLS) was not consistently in place for people who required them. DoLS conditions were unclear, and the provider was unsure whether DoLS had been applied for. Two care plans, which should have had a DoLS applied for or in place and neither one did.

We found staff had not had regular supervisions and appraisals had not been completed in 2023. Not all staff had completed all mandatory training.

We received mixed feedback about the quality of care provided from both people who lived at the service and relatives.

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

Rating at the last inspection

The last rating for this service was requires improvement (published 2 March 2023). The provider completed an action plan after the last inspection to show what they would do and by when to improve.

Enforcement

At this inspection we found breaches of regulations concerning safe care and treatment for people, person centred care, receiving and acting upon complaints, staffing, need for consent and good governance.

Why we inspected

The inspection was prompted due to concerns received regarding the quality of care for people. Concerns included quality of care, medicines administration and leadership of the service. A decision was made for us to inspect.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

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.