Spring House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Spring House is registered to provide personal care for up to 25 people.

We carried out an unannounced comprehensive inspection on 15 and 21 November 2018. On the first day of the inspection there were 22 people living at Spring House.

At the last inspection in February 2016, the service was rated as ‘Good’ overall, with the key question caring rated as ‘Outstanding’. At this inspection, we found the service had developed further and was now ‘Outstanding’ as two key questions, caring and responsive are now rated as ‘Outstanding’.

There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Some parts of this inspection report are written in a shorter format because the rating of some key questions have not changed since our last inspection.

There was a registered manager working at the home. A registered manager is a person who has registered with the CQC 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 registered manager has been in post since November 2017. Prior to this they worked as the deputy manager at the home. People and visitors commented on the warm and welcoming atmosphere of the home. People said, “I’m so well looked after, we are treated as people” and “I don’t have to think about it, the care is good.”

Since our last inspection, the registered manager and the staff group have continued to develop how they respond to people’s individual needs. For example, staff recognised people’s different responses to moving to a care home and tailored routines for people’s social and emotional needs. Staff went the extra mile to ensure people had a varied social life and still felt part of the local community. One person said these types of activities “Make me feel part of society, I’m not separate…I’m useful.”

People received an exceptionally personalised and responsive service. One person was very active and liked to be kept busy. The registered manager and staff established when the person became frustrated and worked out an individual routine to keep them occupied, which included going out for a walk each day. We met with the person and saw they looked contented and fulfilled, chatting and laughing with other people and helping around the home, such as laying the tables.

People living at the service and their relatives said staff had outstanding skills and had an excellent understanding of people's life history. People’s care plans were created with them, and where appropriate their friends and families. Their social history had also been recorded in their care plan. We saw staff used this information to connect with people and make them feel valued.

The service continued to provide an outstanding level of care that was person-centred. The service sustained its strong culture of supporting people as individuals and people continued to be provided with support that was kind and compassionate by a caring and dedicated team.

People and relatives were consistently positive about the caring approach of the registered manager and staff. People’s well-being was valued. For example, one person said, “I feel I am among friends, staying with friends and given everything I want.” Relatives said how much they valued “the kindness and friendliness” of the staff.

The service continued to be well-led. People visiting or living at the home said, “Oh yes they are very well led”, “I think this place [Spring House] deserves a lot of praise”, “Yes, I do think they are well led”

The inspection took place on 11 and 19 February 2016. Our previous inspection in June 2014, found the service to be meeting the regulations inspected of the Health and Social Care Act (2008).

Spring House is registered to provide accommodation and personal care to a maximum of 25 people, most of whom are older people living with dementia. It is not a nursing home and health care needs are met through community health care professionals. There were 22 older people resident at the beginning of the inspection.

The service is required to have 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.

Excellent relationships had been built between people using the service and the staff. Staff provided kind and compassionate care. They were respectful and dedicated to the people in their care. This was led from the top.

People’s choices were consistently respected by the staff and they were consenting to the care they received. People’s capacity to make decisions was assessed and decisions were made in people’s best interest where necessary. However, staff did not have records of the detail of authorisations for reference, so as to ensure people's rights would be upheld in line with those authorisations. This was immediately addressed.

People’s health care needs were under regular review and they were supported to maintain their health through contacts with community health care professionals.. However, requests for community nurse advice and guidance had not always been timely. This was now addressed.

People were protected through the arrangements for staff recruitment, training, supervision and support. There were sufficient staff to meet people’s needs in a timely manner.

People received the support they needed with their medicines.

People’s nutritional needs were met by staff who were trained in how to promote a healthy, well balanced diet. People liked the food and said there was more than enough.

The home environment was pleasant, fresh and well furnished. There were some adaptations to help people living with dementia maintain their independence.

There was a computerised system in use, devised by the registered manager. It was used for the assessment, planning and recording of people’s needs, the care provided and any risks to their health and welfare. The system promoted people’s health and wellbeing.

There was a programme of daily activities for people and where possible any individual preferences were met.

People said they could raise any concern or complaint and were confident they would receive a satisfactory response.

People and their family members spoke very highly of the service and benefitted from the open approach of the home’s management. The registered manager and staff looked for innovative ways to continually improve the service. They listened to people’s views and monitored the service being delivered.

We considered our inspection findings to answer questions 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 summary is based on our observations during the inspection, speaking with people using the service, the staff supporting them and from looking at records.

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

Is the service safe?

One member of staff told us “I have had safeguarding training. If I notice a bruise I would check if this had been recorded; anything we pick up is recorded. I would immediately report any concerns about the way someone was being treated to the registered manager. People are vulnerable it is down to us to protect them”. This showed people were protected from abuse.

We looked at three care folders during our visit and saw that risk assessments had been completed and noted that all of these had been reviewed monthly. Risk assessments completed included a falls risk assessment, movement risk assessment and a comprehensive general risk assessment. This showed that the organisation reduced the risk to people of receiving unsafe or inappropriate care.

Systems were in place to make sure that staff learnt from events such as accidents and incidents, complaints and concerns. This reduced the risks to people and helped the service to continually improve and showed the service was safe.

Is the service effective?

The service was effective. Care plans were very detailed, comprehensive and reflected personal preferences.

There was clear guidance for staff to follow to ensure appropriate care was provided. Care plans were reviewed and updated monthly and we saw evidence of equipment being provided to maintain independence and ensure people were comfortable.

We saw that the organisation consulted with the person's GP when a deterioration in health was observed and care had changed following advice by the GP. We saw at a later review there had been a significant improvement in the person's health and care plans had been updated to reflect this change in need. This showed that people received effective, safe and appropriate care.

Staff we spoke with told us they had sufficient information to provide the level of care that people required and that communication about care needs within Spring House were good.

We spoke with three staff during our inspection and all staff told us they felt well supported. One member of staff said “If I had a problem I would talk to my senior and the registered manager is very approachable. There is always someone to speak to if I needed to; I would never hesitate. There is superb support; we are a team and each of us support one another, nobody is left on their own. Another member of staff told us “there is good support, the registered manager and other staff are very approachable”.

Is the service caring?

The service was caring. A member of staff we spoke with said “I will go in to the person’s room in the morning and say good morning and ask what they would like to wear. I will show them different clothes to choose from. We like to co-ordinate clothes, we like people to look nice and will give a spray of perfume. Maintaining people’s dignity is very important”.

During our visited we observed people in the lounge, in the garden and during lunch time and we observed that staff interacted with people in a caring, respectful and sensitive way. Some people required assistance to eat their meal and we observed staff sitting with people patiently helping and encouraging them to eat and giving people the time they needed.

We spoke with three people during our visit and each told us they were happy with the care they received. One person said “I am looked after properly; I would tell them if I wasn’t. It’s pretty good considering; we go out to tea and have music days quite often, I love music. The place wouldn’t be the same without music. Lots of people come and visit. The food is good, if you don’t like something you can have something different.

Is the service responsive?

The service was responsive. We noted that staff responded to requests from people very quickly and we noticed one person who was a little distressed being responded to by two staff in a timely and appropriate way. Throughout the day we observed that staff regularly asked people if they were comfortable or wanted anything.

Care records included a personal life history. One member of staff told us “We use life history information as a source for discussion with people and this has been very positive. When reminding one person of an event in their life you could see a twinkle in their eye”.

Care was planned to meet individual needs. We noted in one person’s records they had night time continence problems as they forgot where the bathroom was. A commode had been provided in the person’s room and a pressure mat fitted which alerted staff when the person got out of bed. They could then offer assistance.

Is the service well-led?

The service was well led because staff had a good understanding of the ethos of the home and the quality of care they were expected to provide.

One family visitor we spoke with said “Surveys and questionnaires are undertaken and I have been involved. They are always asking for suggestions; they are very open”.

We saw that paper records of accidents had been kept and we noted that accidents had been reported appropriately. We were informed by the registered manager that accidents were also recorded in the computer system and this allowed for easy searching and collation of any recurring themes that could occur.

Senior staff had a weekly meeting that was used to share information relating to complaints, accidents or incidents that may have occurred.

Most people could not tell us about their experience of living at Spring House but we spoke to one person, one person's family and spent time observing care workers delivering care.

We were told, "Very nice. Look after you like a baby. Lovely food. Keep changing the bedding. Baths and showers. There is always tea and coffee going round." A person's family said, "I want mum to be here. Everything I have seen has been excellent over four years. They listen."

We saw staff providing kind, respectful and skilled care to people. Staff were well organised, knowledgeable and professional in their approach. People's care needs were assessed, planned and monitored so that their health and welfare were promoted. Staff understood their legal responsibilities to gain people's consent to care or involve people who know them best in decisions about their welfare where they could not provide verbal consent.

People's dietary needs were well met. Where a person's diet was a challenge staff took expert advice and followed a planned and consistent approach to improve their diet and health. There was a wide choice of nutritious meals available and a good provision of drinks.

People's views were sought through a variety of methods including feedback questionnaires, meetings and e mail and we were told that their views were taken into account. Regular audits at the home ensured that areas of concern would be quickly identified.

We conducted an unannounced visit to Spring House on 16 August 2012 as part of a programme of scheduled inspections. During our visit one person who used the service was able to talk to us about the home and we spoke with another person's family. We observed most others receiving support and care. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to with us.

We looked closely at the care of two people. This involved meeting/observing them, looking at records of their care and talking to staff about their needs and care. We also spoke to two care workers about their role, the registered manager and a district nurse with knowledge of the service.

We saw through observation and computerised records that people's individual needs were met. Care workers offered choice and supported people in their day to day activities. Time was spent engaging with people, for example, trips away from the home and table games. One person told us, "I do everything I like". Another went out for a walk, any risks associated with this activity had been assessed and agreed with her.

We saw how care workers took time and were kind when a person was anxious and that expert advice was sought. People's health needs were well monitored. A district nurse said that she had no concerns about the home.

A person told us that they felt safe at the home and that care workers came quickly when she used the call bell. The home had ensured that staff knew how to alert concerns which might indicate abuse and the registered manager was aware of how to escalate concerns and promote people's rights through the legal systems for that process (the Mental Capacity Act 2005).

The registered manager had very robust arrangements in place to ensure an overview of the service provided and we were given examples of how this had improved the service for people.