Springfield Grange

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At our last inspection we rated this key question inadequate. At this assessment, the provider had improved, and this key question is now rated good. However, there were some areas where improvements are still needed. Risks to people's health and welfare were not always assessed and managed safely or consistently. Medicines were not always managed safely. Safeguarding policies and procedures were in place and staff knew the correct reporting procedures. People told us they felt and had noted an improvement in the service since the new manager had been in post. There were sufficient staff available to meet people’s needs, who had been recruited safely. Systems and processes were in place to ensure the home was clean.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us that the service had improved recently, following the introduction of the new manager. People and relatives said that staff knew them well and supported them as required. A relative told us, “I do feel [my relative] is safe here now and it is because of the management.”

Staff told us they felt able to speak up and were confident any concerns they reported were followed up. They spoke positively of the changes in the service, since the manager came into post. The manager ensured there were records of incidents, which showed the actions being taken in response. The manager understood the importance of learning and identifying trends when reviewing incidents. However, further work was required to embed this into practice.

We found accidents and incidents were being recorded. However, appropriate and timely action was not always taken in response. For example, people’s care records were not always updated to reflect a change in their circumstances. The manager was aware of this and had recently begun to analyse records and share lessons learnt.

People and their relatives told us staff and management worked effectively with external professionals and were reactive to their needs.

The manager and staff told us they were building strong working relationships with external professionals, to ensure care for people was joined up and appropriate. This included communicating with occupational therapists, physiotherapists, community nurses and people’s GPs. Staff knew the importance of following professional advice regarding meeting people’s needs.

We received mixed responses from partner agencies. For example, the local authority was undertaking regular monitoring visits and had some concerns. However, at the time of our assessment they had not visited since the new manager had been in post. The local infection control team had visited recently and were happy with the progress being made in the service.

Safe systems were being implemented to ensure essential information was shared between staff and necessary health and social care professionals involved in people’s care. However, these had yet to be embedded into everyday practice within the home. For example, input from health professionals was cascaded to staff in handover, flash and team meetings, but this information was not always reflected in people’s care records.

People and their relatives told us they now felt safe with the care and support they received at Springfield Grange. For example, 1 relative told us, “We feel [our relative] is safe now, but before we had concerns and were looking to move them.” A person living at the service also told us, “I feel safe because I only have to press my buzzer, and somebody comes.”

Staff knew how to ensure people were protected from the risk of harm and abuse. They told us how they would raise concerns. Staff were confident the manager would follow up any concerns and make the necessary referrals. Staff understood how to ensure people’s rights were fully respected and had received training in safeguarding adults. The manager and provider were also clear about the process to follow, to ensure people were protected and concerns were reported without delay.

We observed people being supported with kindness. Appropriate equipment was in place and being used correctly. We did however find that staff did not use proactive strategies to deescalate the situation when 1 person showed signs of agitation. We also saw people having their needs met, without staff discussing with them what they were going to do.

Safeguarding policies and procedures were in place and staff knew the correct reporting procedures. Records showed all safeguarding concerns were logged and followed up.

People and their relatives told us the manager and staff worked to keep them safe and understood their needs.

Staff told us they had enough information about people’s risks to support them safely. However, staff and management confirmed that some care records did not give them the information required to involve people in managing risk.

We saw people being informed about risks. For example, 1 person was being advised to wear their slippers properly prior to walking around. People were generally observed being supported to eat in line with their assessed diets. However, clear instructions from the speech and language team regarding positioning had not been sought for 1 person. During our assessment, we observed this person was not eating in a position that was appropriate for a person who was at risk of choking.

The systems in place for ensuring risks to people’s health and welfare were assessed and managed were not always effective. For example, although staff had a good understanding of people’s needs and risks, people’s care records did not always reflect this information. We found not everyone had appropriate risk assessments in place and some records contained conflicting and contradictory information. This placed people at risk of harm.

People and their relatives told us staff worked in a safe way. People told us they were supported appropriately, by well trained staff.

Staff told us they had received moving and handling training and were confident in using mobility equipment. This was reflected in the service’s training compliance figures. Staff told us emergency equipment was also available to support people if they experienced a fall.

People moved freely around the home and the corridors were clear of obstruction and clutter. Doors that should be locked were locked and stair gates were secure. Cleaning items were stored securely in locked cupboards. However, we found not all call bells within people’s rooms were in place and not all rooms had people’s names or photographs on their doors to enable and assist the fire services in the event of a fire happening.

Systems and processes were in place to ensure the environment was safe, but they were not always effective. For example, the manager had requested for a fence to be put up around a ditch in the grounds, but this has not been actioned in a timely manner and placed people at risk.

People and their relatives told us there were enough staff, who were well trained and knew them well, to support them safely. Comments included, “Staff come quickly if I press the buzzer”, “There are plenty of staff, the staff help me when I ask them” and “The staff are very good, there are enough of them.”

The manager told us they used a dependency tool to calculate staff numbers and adapted and increased staffing numbers when needed. The manager told us they had sufficient staff and were not currently using agency staff. Staff told us they had received training and felt competent in supporting people safely. Staff told us they had not had regular supervision; however, this had improved since the new manager started. The manager acknowledged staff supervisions and competency checks had not always been carried out as frequently as they should have. However, a rota had been put in place to ensure a schedule for supervision was in place moving forward.

We observed staff responding promptly to people and taking time to sit and talk to them. People did not have to wait long for their care and staff were present in communal areas. We observed staff treat people with kindness and respect and staff knew them well.

Processes were in place to ensure there were safe staffing levels. We found there were enough staff on duty to keep people safe and the training matrix showed most staff were up to date with training. The manager had audited previous recruitment and found significant gaps. However, this was in the process of being rectified and new staff had since been recruited safely.

People and relatives spoke positively of the cleanliness of the service. Feedback included, “The staff help me when I ask them, they come in and clean my room all the time. I'm happy”, "The home is clean, that's improved now with the new manager, they have started to redecorate" and “The cleanliness here is good and the crockery and cutlery are clean.”

Staff had access to Personal Protective Equipment (PPE). Staff told us they were aware of their responsibilities in relation to infection prevention and control (IPC). One staff member told us there were 3 cleaners that were split across different areas of the home, so they all had their own responsibilities.

The home was clean and tidy throughout. This had recently been actioned following a visit from infection control. We saw evidence of cleaning being undertaken throughout both of our visits to the service. Staff were observed wearing PPE in line with current guidance.

Systems and processes were in place to ensure the home was clean. For example, cleaning schedules were in place and complied with. IPC audits were now being completed monthly, and where actions were identified they were addressed.

People and their relatives were happy with the report they received with medication. However, people that were prescribed ‘as and when required’ medicines (PRN), did not always have detailed guidelines to show how and when to give these appropriately. Some records we saw had follow up plans of what to do if PRN medicines were being administered frequently within a certain timeframe, however these weren’t always actioned with a GP. This could lead to people having medicines unnecessarily or unsafely. We also found people that had their medicines given ‘covertly’, hidden in food or drink, did not always have detailed guidelines in place explaining how to give these medicines safely. Letters from GPs were seen, but they didn’t have in-depth instructions from a pharmacist to ensure medicines could be given safely in food or drink.

Staff told us there had been recent improvements within the team which seemed to be going well. They also said they had good relationships with the GP, who came to do weekly reviews of residents. However, the manager said the relationship with their pharmacy supplier could be better. There had been two recent incidents relating to medicines which were being investigated. Staff also said the online system they use to document care plans was outdated and wasn’t the easiest to navigate. During the inspection, we also found care plans around people’s specific needs, e.g. diabetes, Parkinson’s disease, were not in-depth or easy to find in people’s records. The provider agreed with this and told us they were going to make the care plans more user friendly.

Systems and processes were in place to ensure people received their medicines safely. However, they were not always effective. During the assessment, stock levels that were checked seemed appropriate and medicines were stored safely and securely. The treatment rooms were tidy and organised, and each person’s medicines were clearly separated from one another. Creams were kept separate from regular medicines and extra stock was kept in a locked cupboard. When medicine patches were applied, documentation was seen to show where on the body the patch had been placed. The online system showed the last application sites to ensure the following patch would be placed in a different location. However, stock checks of Controlled drugs were not carried out in accordance with the organisation’s medicines policy. Controlled drugs are at higher risk of being misused, daily stock counts should be carried out, to account for all administered doses. We also found that 1 person who had Parkinson’s Disease was routinely given their medicines late, which could be detrimental to their condition. We informed the home that this needed to be looked at as a matter of urgency. Management told us they were going to investigate why this had happened and how to improve this in the future.