Spring Grove is a residential care home providing accommodation for up to 46 older people. The home forms part of the Springdene Nursing and Care Homes group and is located in North Central London. There were 36 people in residence at the time of our inspection.

This inspection took place on the 5 and 7 October 2016 and was unannounced. At the time of our previous inspection in June 2014 the home had been in breach of Regulation 9 of the HSCA 2008 (Regulated Activities) Regulations 2010 in so far as arrangements and procedures for dealing with foreseeable emergencies was not clear. Staff had been unable to enter people’s locked bedroom doors in an emergency. We carried out a follow up focused inspection on 19 August 2014 and found that the issue had been resolved.

At the time of our inspection a registered manager was employed at the service. 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.

The staff of the service had access to the organisational policy and procedure for safeguarding people from abuse. They also had the contact details of the London Borough of Camden which is the authority in which the service is located and the details of other authorities who place people at the home. However, most people paid for their own care. The members of staff we spoke with said that they had training about protecting vulnerable adults from abuse, which we verified on training records and the staff we spoke with were able to describe the action they would take if a concern arose.

We saw that risks to people using the service were considered and common risks such as the risk of falls and those associated with people’s healthcare needs were included. Any risks associated with people’s individual circumstances were also given attention and responded to. The instructions for staff about how to minimise risks were clear.

We saw there were policies, procedures and information available in relation to the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure that people who could not make decisions for themselves were protected. The service was applying MCA and DoLS safeguards appropriately in every case where people were thought to require assessment.

People were supported to maintain good health. Staff were on duty at the service 24 hours and people’s own GP’s visited to attend to their medical needs. Where nursing care was required the home obtained this from the local community nursing service. Staff told us they felt that healthcare needs were met effectively and records showed that people were referred to and seen by appropriate healthcare professionals.

Everyone we spoke with who used the service praised staff for their caring attitudes. The care plans we looked at showed that attention was given to how staff could ascertain each person’s wishes, even in situations where people were suffering with dementia, to maximise opportunities for people to make choices that they were able to make.

Communication between people using the service, relatives, visitors and staff was open and respectful. Staff talked about the people they cared for with dignity and respect and knew their responsibilities in providing effective care.

The staff team communicated effectively and there was trust in approaching senior staff and the registered manager to raise anything of concern and to discuss care practices. The views of staff were respected as was evident from conversations that we had with staff and that we observed.

At this inspection we found that the home was meeting all of the regulations that we looked at.

At this responsive inspection we sought to answer one of our five questions; Is the service safe? This was due to a compliance action that was imposed following our previous inspection on 10th June 2014.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with three people using the service, two of the management staff at the service and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Three people using the service spoke with us during this visit. Two people asked us about what CQC did and we told them. The other person told us about their role as chair of the resident’s house meetings which they found to be very positive. We spoke with the manager and the deputy manager who each told us about the action the service had taken in response to the outcome of the previous inspection. We were also shown documentary evidence about the actions that the home had taken regarding these improvements.

From these discussions and the information we were shown we judged that the service had taken the necessary remedial steps to keep people safe.

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, response and well-led?

As part of this inspection we spoke with nine people who used the service, four relatives or friends of people living there, nine staff including four night staff. We also spoke with the manager, the area manager and the owners of the home. We were able to speak with the General Practitioner who cared for people’s medical needs. Records relating to the management of the home were reviewed, which included four care plans, daily care records, records about the management of medicines and records about how the home monitored its own performance and the quality of care.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed during the visit and what we saw in the records we looked at.

Is the service safe?

There were enough staff on duty to meet the needs of people living at the home on the day of our visit. The training records we looked at showed that people were cared for by staff who had received training in subjects that supported them in carrying out their roles.

CQC monitors the operation of the Deprivation of Liberty Safeguards. No applications had been made for permission to deprive people of their liberty although a significant number of people living at the home lacked capacity to make an informed decision about living there. Although we saw that relatives were involved with the care of people living at the home and that staff obtained verbal permission from people before giving care where people could give this, it is possible that decisions about the provision of people’s care were outside the current legal framework for people who are not able to make their own decisions.

Most people required their medicines to be kept for them and given to them daily. We saw that medicines were managed safely and given to people as required and in accordance with their individual prescriptions.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. Many people were able to retain links with the local community and were supported in being active whilst in the home. Everyone was well dressed and looked well cared for. One person told us how they liked living at the home. They said ‘it’s very good here. You can come and go and there are things to do in the day time. The food is good and staff are lovely.’ Another person said ‘I am really pleased my sister in law is here, I can’t think of a better place for her. Her hair and nails are always done nicely. They keep me informed about what’s going on and ensure she has all she needs.’

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers and other support staff were respectful and courteous in their communication with people and were welcoming and supportive of relatives and friends of people living there. Everyone we spoke with told us that the staff were very good at the home and very helpful.

Is the service responsive?

People’s needs had been assessed and care plans drawn up on the basis of these needs. Care and support plans were modified when people’s needs changed and the home sought to arrange for additional care for people as their dependency levels increased over time.

Is the service well lead?

The manager in post had joined the organisation five months previously. The home had not informed CQC of the change and the current manager was not registered with CQC at the time of our visit. Improved processes and systems had recently been introduced in order to monitor and maintain the quality of care. These were welcomed by external professionals.

During this follow-up inspection we spoke with four people who used the service, two care workers, the maintenance officer and the acting manager. A new manager, who had just been employed and yet to be registered by the Care Quality commission, was also present during most part of the inspection. We observed people during lunch and reviewed supervision notes, staff rota and the home’s health and safety records and risk assessment.

We noted that the service had taken action and made improvements on three areas we looked at. Staff were now receiving supervision and arrangements were put in place for this to continue. Staff told us they had supervision and people who used felt they received care that met their needs and staff “could not have been more careful and caring”.

The staff rota and people who used the service indicated that there were sufficient staff on duty to provide care and support. We observed that staff were present to provide care as required at lunch time.

The provider had reviewed the home’s health and safety risk assessment and people who used the service indicated that the home was clean and bright. We noted that the facilities and equipment were regularly monitored and tested to ensure that they were safe and effective to use.

We spoke with five people who used the service, four members of staff, two relatives of the people and reviewed thirteen people’s files. We also checked ten staff files and observed people during breakfast, lunch and activity sessions.

People indicated that they had care plans and their needs were met. People’s comments about the home and staff were positive and included statements such as the home “is very good” and “I am treated well” by staff. We noted that staff had attended training programmes that enabled them to provide care that reflected each person’s needs. People’s cultural and medical needs were provided for by the home and people had nutritious food available to them.

There were arrangements in place to ensure that risk assessments were completed and people were protected from harm. The provider had sufficient number of staff at most times but this could be improved, especially during meal times. Even though staff were experienced and had appropriate training they had no regular supervision which meant that they might not be up-to-date with information and feedback relating to the quality of their work. We have asked the provider to address this. However, the provider had system in place for obtaining people’s views and monitoring the quality of the service.

We inspected the home during the evening of the 18th December 2012, following the service of a warning notice after our inspection on the 2nd and 3rd October 2012. The visit was to check that the provider had made the necessary improvements to comply with the warning notice. This report is supplemental to our report of that visit published in November 2012.

In October we had found that on the night shift, between 10.00pm and 8.00am, there were three care workers on duty. We concluded that there was not a sufficient number of suitably qualified, skilled and experienced staff during the night shift to safeguard the health, safety and welfare of service users. By failing to ensure that there was a sufficient number staff on duty at all times, the provider had failed to comply with Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Under the terms of the warning notice, the provider was required to take appropriate steps to comply with the requirements of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

People were supported to be able to eat and drink sufficient amounts to meet their needs and were provided with a choice of suitable and nutritious food and drink. People we spoke with said that the food was tasty, served hot and there was good choice. One person said the “food couldn't be better” and was very happy that their needs were being met due to their specific requirements.

Spring Grove have failed to take appropriate steps to ensure there are sufficient numbers of suitably qualified, skilled and experienced persons employed at all times.

Staff received appropriate training and professional development. Staff told us that training was useful and helped them to care for the people living at the home. There was an induction, supervision and appraisal process in place.

We spoke to people and their relatives about how to make a complaint and they were able to tell us how they would go about doing this. People’s complaints were fully investigated and resolved, where possible, to their satisfaction.