This inspection took place on the 6 February 2017 and was unannounced.

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.

This inspection took place on the 2 February 2016 and was unannounced.

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.

During this inspection, we gathered evidence against the outcomes we inspected to help answer our five key questions; 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?

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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records. The detailed evidence supporting our summary please can be read in our full report.

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.

We spoke with four people who used the service. All were positive about the care they received. One person told us that “the staff are polite and helpful” saying that they gave explanations about the care and treatment provided. Another person told us “The staff are very helpful indeed, very good – all of them”. We saw that staff spoke to people in a kind and respectful manner and gave people choices.

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.

We spoke with two people about the service they received. They were happy with their care. One person told us that staff were always polite and told us that staff asked them how they would like to be assisted. Another person told us “all the staff are good, some are better than others – but I’ve no complaints.” We found that people's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

All of the people we spoke with during our visit said they felt safe, and satisfied with the care and support they received. They said they were able to choose whether they wished to spend time in their own rooms or in the company of other people using the service within the communal areas.

People told us they had been involved in making decisions about their rehabilitation programmes and the support arrangements for when they were discharged home.