Springfield Grange

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

At our last inspection we rated this key question requires improvement. At this assessment the rating remains unchanged. We identified breaches of the legal regulation in relation to person centred care and safe care and treatment. The provider had processes in place to monitor and assess people’s needs, but they were not always used effectively. People's care plans did not always contain clear information about what was important for people or what mattered to them. Systems to record information from health and social care professionals were in place but were not used effectively to support the safe delivery of care. Systems were not always effective to monitor and improve people’s outcomes. People were supported to access health services when necessary.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed feedback from people regarding their involvement in how the service assessed their needs. For example, some people told us they were not always involved in their care planning, including when their care was reviewed, but others stated they had recently been involved. Relatives told us staff knew their relative well and how to support them. For example, 1 relative stated, “Now they do discuss [relative’s] plan of care. I have one hundred percent confidence in here now.”

The manager and staff told us people’s care plans could be improved upon, as they did not always contain key personalised information relating to the person. For example, their likes, dislikes and preferences. The manager acknowledged that care plans required reviewing, to be more person centred and capture more information relating to the person. This was an action already identified on their service improvement plan.

The provider had processes in place to monitor and assess people’s needs, but they were not always used effectively. For example, resident of the day was in place, which meant that every day 1 person’s care records should be reviewed and updated. However, this did not always take place and when this did, the changes were not always reflected consistently within their care plans and risk assessments.

Overall, people received the care and support they needed. However, we found the support people received with nutrition was not always in line with their assessed needs.

Staff understood people’s needs and knew them well. Staff could tell you specific details about people and their preferences, however this was not always reflected in care records. Staff understood the importance of considering people’s holistic needs, which included their physical and mental wellbeing. Feedback included, “We ensure people have what they need when they need it. People are offered choices regarding their daily lives including what they wear, what they eat, activities.”

We found that people's care plans did not always contain clear information about what was important for people and what mattered to them. Care plans we reviewed also lacked detailed information including, for some people, how to support people with nutrition. The manager had begun auditing care plans and had highlighted missing information, but this was an ongoing process.

People told us staff liaised with other health and social care professionals, should this be required.

The manager told us they were building relationships with health and social care professionals and aimed to share key information appropriately, to benefit people who use the service. Staff and management told us they followed advice and information given by professionals. This information was discussed and cascaded during handover meetings. However, it required further embedding into practice within the home.

We received feedback from the local authority regarding concerns they found during their visits. However, since then, improvements had been. The manager and staff acknowledged that there was still work to be done.

Systems to record information from health and social care professionals were in place but were not used effectively to support the safe delivery of care. For example, we found care records lacked detail and, at times, were contradictory to other documents. This included risk assessments and guidance from speech and language. The manager had identified this during an audit they had undertaken, but work was still required to ensure people’s records were accurate.

People were supported to access health services when necessary. Feedback from people and their relatives included, “[Staff] would get a doctor and I have met him. [Relative] can have a hairdresser and a chiropodist” and “I am sure they would get a doctor and respond quick. I like it that I have the time to do things in my own time and in my own way. If you have a problem, you can talk to them about it.”

Staff demonstrated a good understanding of people’s health, care and support needs. They provided a clear account of the support they gave people to access health care services. Staff were also aware of when to raise concerns regarding people’s health. They listened to people and acted when required.

We saw evidence of partnership working with a range of health and social care professionals. For example, speech and language assessments were in place for some people. However, these were not always clear and had been written on in pen, with no evidence of who had amended them. We raised this with the manager, who urgently sought clarity of people’s needs.

We received mixed feedback from people and their relatives about their involvement in care planning. For example, comments included, “[Staff] do understand [relative’s] needs. They do review the care plan” and “[Staff] do not discuss my medication or my care plan with me.”

Staff told us they knew people well and we found this was generally the case. However, care plans did not always reflect people’s needs. This meant staff did not always have the most up to date information regarding how that person required supporting. For example, staff were not aware of how to support 1 person who showed signs of agitation.

Systems were not always effective to monitor and improve people’s outcomes. For example, daily notes for people were completed. However, we found these were task orientated and did not allow for staff to record what was going well, or not well, for people. Audits of daily notes were also not being completed, which meant there was a missed opportunity to monitor outcomes for people.

Most people we spoke with felt their consent was gained prior to staff supporting them. However, during our visit, we observed mixed practice. We found some staff asked for consent and explained what was happening, but occasionally some staff did an activity without gaining consent. For example, 1 person was supported to wear an apron prior to eating, but the staff member placed this on them without asking permission or informing the person.

Staff and the management team showed an understanding of mental capacity and how to support people in their best interests. The manager told us how they worked with people to recognise their ways of communicating, including nonverbal cues. However, we found people’s capacity was not always fully considered in practice.

People’s care files contained mental capacity assessments for specific decisions relating to their care. These showed how the provider had taken steps to support people’s understanding in the process. Although these assessments did demonstrate involvement of the person, there was no indication that people’s relatives or representatives were involved. We also found a best interest decision had been made, without considering whether this was the least restrictive option for the person. We raised this with the manager who took immediate action.