The Springs Care Home

The Springs Care Home provides accommodation and nursing care for a maximum of 65 older people living with dementia. Care is provided to people over three separate floors, with the ground floor providing residential support and the two upper floors provide nursing support. At the time of our inspection there were 56 people living at the home.

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

The provider’s quality assurances systems although in place were not always effective as they had failed to identify the shortfalls in reviewing and up-dating people’s care plans to ensure they reflected people's current needs.

Improvements were required to ensure there was guidance for staff when applying medicines through transdermal patches.

Staff received training relevant to their roles and had regular supervision. People’s nutritional and health needs were promoted, and the home environment was maintained with ongoing redecoration taking place.

The home environment was clean and tidy, and staff worked to reduce the risk of infection. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again.

People were supported to have maximum choice and control of their lives and staff supported systems in the service supported this practice.

Staff were kind and caring. They respected people's privacy and dignity and supported people to be as independent as possible.

People's wishes at the end of their lives were respected and staff worked with healthcare professionals to ensure people were pain free and comfortable.

The provider had processes in place to deal with people’s complaints should they arise. People and relatives were aware of how to raise any concerns and felt comfortable in doing so should they need to.

Rating at last inspection

The last rating for this service was Good published (21 December 2017).

Why we inspected

The inspection was prompted in part due to concerns received about safe care and treatment of people. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Springs on our website at www.cqc.org.uk.

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.

At the last inspection in September 2016, the service was rated Good.

At this inspection we found the service remained Good.

Staff had a good understanding about recognising potential abuse and who to report it to. People had their risks assessed and staff had a good knowledge about how to support them to remain safe. The registered manager regularly reviewed staffing levels to ensure there were sufficient staff to meet people’s needs. Medicines were administered by trained staff. Medicines were regularly reviewed and monitored to ensure people had them when they needed them. There was a member of staff responsible for monitoring the risks from infection. Staff followed appropriate guidelines to reduce the risk of infection. Accidents and incidents were investigated and action taken to reduce the risk.

People had their care needs assessed and information about them as an individual recorded for staff guidance. Staff received regular training with some training lead by staff working at the home. People enjoyed their food and were supported by staff to maintain a healthy diet. People had access to health care professionals as they were needed. The environment was in the process of being adapted to effectively support people living at the home. Where it had been completed on the ground floor unit people had benefited for the adaptations in place. 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 support this practice.

People and their relative told us staff were kind and compassionate. Staff worked as a team to ensure people were supported with respect and their dignity maintained. People benefitted from the staff using different approaches and communication equipment to support them to make choices and be involved in their care decisions as much as possible.

People said their needs were met by staff that were knowledgeable about their rights and preferences. Where people or their families raised concerns these were investigated and actions taken to make improvements. People and their families were supported by staff that were compassionate and knowledgeable to meet their end of life needs.

At our last inspection the service required improvement in the well-led section. We found at this inspection there had been improvements made to the culture of the service and there was more effective monitoring in place to ensure people received quality care that was individual to their needs. The management team sought people and their family’s opinions to ensure people were satisfied with the quality of their care. The management team sought continuous learning through sharing innovative ideas with the wider care community to improve the quality of the care and people’s experience.

Further information is in the detailed findings below

The inspection took place on the 21 and 22 September 2016 and was unannounced.

The registered manager had left the service and the new manager was applying to be registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC to manage the service. Registered providers and registered managers 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 and their relatives told us that they felt safe and staff treated them well. However, because of staff sickness and some vacancies sometimes there was at times a lack of staff to meet people’s care needs in a timely way. The manager had identified the concerns and was taking appropriate action.

Staff we spoke with demonstrated an awareness and recognition of abuse and systems were in place to guide them in reporting to these. Staff were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them.

Staff had up to date knowledge and training to support people who lived at the home. People were able to make choices about their day to day care and staff provided the appropriate support when people needed it. People told us they had food and drink they enjoyed, and choices in what and where they ate. People said they had access to health professionals where needed. Relatives told us they were in regular contact with staff at the home and were kept updated when needed.

Staff knew people well, and took people’s preferences into account and respected them. People were able to see their friends and relatives as they wanted. There were no restrictions on when people could visit the home. People and relatives knew how to raise complaints and were confident action would be taken if needed. The registered manager had arrangements in place to ensure people were listened to.

People were involved in some pastimes they enjoyed. The manager was reviewing what interesting pastimes were available for people living at the home. They knew who to speak to if they needed to make a complaint and felt confident any issues raised would be resolved. People who lived at the home and staff were involved in meetings and were getting to know the new management team.

The new manager was working with the new unit manager on one unit at the home to improve the deployment and the attendance levels of staff. They were also working with staff to monitor their competencies and improve the effectiveness of staff to support people. The management team were working on an improvement plan which had identified concerns found during our inspection.

We considered all of the evidence that we had gathered under the outcomes that we inspected. We used that information to answer the five key questions that we always ask;

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The detailed evidence supporting our summary can be read in our full report.

Is the service safe?

We saw that a comprehensive risk assessment had taken place before people had gone to live at the home. Care plans reflected assessed risks. We saw that when a person had been assessed as having a swallowing risk, appropriate diet and fluids had been provided. Some people had been assessed as having actual or potential risks of malnutrition and, following referral to a dietician, received nutritional supplements. Where equipment was used to care for people, this had been serviced regularly and staff knew how to use it. There were enough hoist slings of the appropriate size but they were not allocated for individual use. This can lead to a risk of cross infection.

All staff had received the appropriate training to meet people's needs, which included training about safeguarding people. Measures were in place to safeguarded people from abuse. We saw that an application to the court of protection had recently been made on behalf of a person in relation to deprivation of liberty. The decision to make the application had been made following a best interest meeting which involved the appropriate people, and was recorded.

Is the service effective?

One relative told us, 'This is a nice place for people to live.' Another said, 'I'm happy and (they) are too.' And 'You'd go a long way to find a better home.'

We saw that care and support had been carefully planned to meet people's needs and included personal preferences. We saw that the service had been supported by a specialist nurse over an 18 month period to improve the safety and quality of care. Forging stronger links to primary care and improving the involvement of relatives in decision making had helped trained staff at the home to become more confident in managing health needs for people. This meant that fewer people attended the hospital accident and emergency department (A&E) than in the previous year. It is beneficial for people to be able to remain in familiar surroundings, cared for by familiar staff who understand their needs. Staff told us the process had improved their understanding of the Mental Capacity Act 2005 and that when helping people to make decisions and choices, they paid more attention to the preferences and choices that individuals had made when they had capacity than they had previously done.

Is the service caring?

Relatives that we spoke with told us that some staff were particularly caring and that they all, 'Do a good job.' A member of staff was described as, 'Brilliant, very caring.' Another relative told us that staff had time to stop and talk to people which they felt showed that they cared about them. A member of staff told us that the care staff tried their best to help people and that, 'People surprise you, sometimes we laugh a lot.' This was said in a way that showed us that they cared about the people that they cared for. We spoke with the manager of the service who was enthusiastic about plans to improve people's lives by increasing the involvement of relatives and volunteers so as to offer more outdoor activities and social interaction. We observed that when staff interacted with, or helped people they were kind, patient and cheerful.

Is the service responsive?

The service was responsive to the changing needs of people using the service and to suggestions and comments made by relatives. We saw that care plans were regularly updated and were changed when people's needs changed. A relative who often helped a person at mealtimes told us that staff had listened to them about how to help the person to eat and drink and had learnt to do it the same way. Another relative told us that they had complained about a carpet in a person's bedroom which had become soiled. They told us that the service had replaced it with laminate flooring which was easier to clean. They also told us of the close relationship that they had with staff at the home and that, 'They always phone me if there are any problems.'

We saw records, and staff told us that changes had been made in response to suggestions, incidents and preferences of people using the service. The manager told us that any concerns or complaints were discussed in a meeting every Monday. We saw a recent letter inviting relatives to join in a consultation about planned refurbishment of the home. We saw many examples of responses to relatives' concerns or suggestions and the results of the annual satisfaction survey was followed up with an action plan.

Is the service well led?

We spoke at some length with the manager. They told us about many changes that had taken place during the last year to improve the quality of care for people and the experience of staff. The manager had identified the need for all staff to have a greater understanding about caring for people with dementia, and appropriate training had begun. The service had an effective system to monitor the quality of the service they provided. This included independent and local authority quality assessments, an annual satisfaction survey to monitor what relatives thought about the quality of the service and regular meetings with relatives. We saw that action plans had been formed and implemented to address any shortfalls in performance. Staff told us that the manager and deputy were approachable and responsive. A member of staff told us that a lot of changes had taken place in the last few years and that some staff had not been happy. Some staff no longer worked at the home. They also said, ' There is a great difference, its more stable and much better (than before)' and 'I'm happy working here.' This all showed us that the service was well led.

We spoke with a registered nurse, an activities coordinator, three care staff and the registered manager. We also spoke with a visiting relative. We were unable to hold conversations with the people who lived at the home due to their communication difficulties. We spent time and observed the care and support people received.

We read care records for three people and other supporting documents for the service. Staff asked people if they were happy with them giving care before they gave it.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan. Staff were aware of each person's needs and how to give care and support to meet those needs. We saw that staff were kind and caring in their approach to people who lived at the home.

People were supported with access to additional medical services as necessary which made sure their health and social welfare was protected at all times.

There was a complaints procedure in place at the home. The registered manager told us this procedure would be followed in the event people had any comments or complaints. A relative we spoke with told us: 'I don't have any complaints, they give great care here'.

Due to the nature of nature of people's conditions we were not able to ask people about their experiences of the home. We therefore observed how care was provided for the people who lived at the home. We spoke with the manager and four members of staff.

We saw that staff treated people with dignity and respect. We saw that staff were friendly and supportive to people who lived at the home and helped them to make everyday decisions. Staff showed they knew how to care for people and they told us they had access to the information they needed to meet people's needs.

People's needs had been assessed and care and treatment was planned and delivered in line with their individual care plan.

Recruitment procedures made sure that suitable staff were employed to work in the home. The manager had applied to the Care Quality Commission to become the registered manager for this service.