This inspection took place on 11 and 12 January 2017. The first day of the inspection was unannounced. We had previously inspected this service in October 2015 when we identified two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because there were not robust recruitment procedures in place and there was a lack of accurate records in relation to the care people who used the service required.

Following the inspection in October 2015 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. This inspection was undertaken to check whether the required improvements had been made.

Springfield Care Home is a purpose built service which is registered to accommodate up to 69 people who have nursing or personal care needs. The service is split into four separate floors. Two floors provide specialist rehabilitation services. The service also has a residential unit and a unit for people living with a dementia. On the days of our inspection there were a total of 61 people using the service.

The service had a registered manager in place as required under the conditions of the provider’s registration with CQC. 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 registered manager was supported in the day to day running of the service by a deputy manager.

People who used the service told us they had no concerns about their safety in Springfield Care Home. Staff had received training in safeguarding adults. They were able to tell us of the correct action to take if they witnessed or suspected abuse. Policies were available to provide staff with information about possible indicators of abuse and reporting procedures. Staff told us they would be confident to report any poor practice they observed, using the whistleblowing procedure if necessary. We noted the registered manager had taken appropriate action following concerns being raised regarding the conduct of two staff.

There were sufficient numbers of staff available to meet people’s needs in a timely manner. People who used the service told us staff were always kind, caring and respectful of their dignity and privacy; this was confirmed by our observations during the inspection. Our discussions with staff showed they had a good understanding of people’s needs and were committed to providing high quality care. We saw that people were supported to maintain their independence as much as possible.

Systems were in place to help ensure the safe handling of medicines. Staff responsible for the administration of medicines had received training for this role. The competence of staff to administer medicines safely was regularly assessed.

People's care records contained detailed information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified, such as the risk of falls, pressure sores and poor nutrition. We saw that plans were in place to help reduce or eliminate the identified risks. Risk assessments had been regularly reviewed to ensure they fully reflected people’s needs.

People were cared for in a safe and clean environment. Procedures were in place to prevent and control the spread of infection. Regular checks were made to help ensure the safety of the premises and the equipment used. Systems were in place to deal with any emergency that could affect the provision of care.

Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. Care staff were able to access additional training to further their professional development and enable

We spoke with seven people living in the home (residents) and most told us staff treated them respectfully and kindly. One person said, "The staff are exceptional; they can't do enough for you". Another said, "All the girls are very pleasant" and "They are all very kind and helpful". However two residents had some concerns which the manager assured us would be addressed.

Residents also told us they had sufficient involvement and choices in their care and routines, such as being able to spend time in their rooms, when to get up and go to bed, and in the meals. People expressed their views in questionnaire surveys and residents meetings.

Some residents who could talk to us about the care and support they received said they were very satisfied. Four people in the rehabilitation (rehab) unit said they were receiving the right kind of care and support to enable them to become independent and return home. One person said they did 'exercises' several times a day with staff support. Other comments included: "Nothing is too much trouble", "They can't do enough for you" and "We are very well looked after".

Some people told us they enjoyed varied activities, including trips out. One person spoke appreciatively of these trips. She said, "I love it when I go out".

The staff we spoke with told us there was sufficient training and support to help them do their work properly. Some said they had undertaken additional training to help them better understand people with dementia.

People living in the home, and their visitors, with whom we spoke on the inspection visit

told us they felt staff treated them respectfully and upheld their dignity. People said

personal care was carried out 'properly and respectfully'. One person said, "The staff are very good". Another said, "Staff are very kind and respectful; I can't say a word against them" and "They are so patient with me when I am down".

People also felt they had sufficient involvement in the planning and delivery of their care and support. People told us they had a choice in such matters as spending time in their rooms, and when to get up and go to bed. One person told us they chose to spend most of the time in their room and that staff understood this and did all they could to make them comfortable. However one relative felt insufficient effort was made to ensure people with memory loss were offered the type of food they enjoyed before going to live in the home.

We were also told people filled in questionnaires about the service and were able to

express choices and preferences to the manager and staff. 'Residents meetings' also gave people a chance to air their views and influence developments.

People living in the home told us they received the care and support they needed and that they felt their needs were met. A resident said, "Staff are there when you need them" and "Staff come in the night when I buzz". Another resident said, "They look after me really well; they're all grand". A relative told us, "They (the staff) seem pretty good with him".

Some people who lived in the home were unable to express their opinions about it so we used the Short Observational Framework for Inspection (SOFI) to observe their experiences. SOFI is a specific way of observing care and activity to help us understand the experiences of people who can't speak about them. We undertook this in a part of the dementia unit of the home. We saw staff looking after people in a kind and understanding way to which the residents responded positively. However whilst in this unit we also saw some residents were in a lounge without any contact with a member of staff for about 30 minutes and could have been at risk from harm.

Some people felt there were sufficient suitable activities to keep them active and

entertained, and one person spoke with enthusiasm and enjoyment about a trip they had been on the day before.

The staff we spoke with told us they had sufficient experience, training and support that enabled them to feel skilled and competent in their work. They also felt the staff team had improved since the inspection last year when there were staff vacancies and a relatively high use of agency staff.

Residents told us that they were satisfied with the care and facilities in the home. They said thay felt well looked after and that staff were kind and attentive. They also said that staff treated them with respect and that their right to privacy was upheld. People said that the food was satisfactory, that they were served meals that they liked and that there was sufficient choice. There was also choices in other aspects of daily life such as times of going to bed and getting up and whether or not to spend times in their rooms.

Staff told us that things had improved in the home since the present manager had been employed and that there were good training opportunities and support. The manager was described as approachable and committed to running a good home. We were told that there had been some recent staffing shortages but that this was being improved through the appointment of new staff. People felt that the home ran well and provided a high level of care when fully staffed.

This was an unannounced inspection which took place on 28 October 2015 and 2 November 2015. We had previously inspected this service in January 2015 when we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to a lack of suitable equipment to meet people’s needs, a lack of measures to protect people from the risk of cross infection and a lack of person-centred care.

Following the inspection in January 2015 the provider wrote to us to tell us the action they intended to take to ensure they met all the relevant regulations. This inspection was undertaken to check whether the required improvements had been made.

Springfield Care Home is a purpose built service which is registered to accommodate up to 69 people who have nursing or personal care needs. The service is split into four separate floors. Two floors provide specialist rehabilitation services. The service also has a residential unit and a unit for people living with a dementia. On the day of our inspection there were a total of 62 people using the service.

The service did not have a registered manager in place. 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. A new manager had been in post since June 2015. They had submitted an application to register with CQC as manager for Springfield Care Home.

During this inspection we found two breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because there were not robust recruitment procedures in place and there was a lack of accurate records in relation to the care people who used the service required. You can see what action we have told the provider to take at the back of the full version of the report.

Recruitment processes were not robust enough to ensure that people were protected from the risk of unsuitable staff. This was because checks had not always been made regarding the conduct of staff in their previous employment. Procedures to ensure staff were competent to carry out their role were not always followed.

People’s care records showed us that risks to people’s health and well-being had been identified and plans were in place to reduce the risk. We saw that people’s wishes and preferences were not always documented in their care records. Records we reviewed showed people who used the service or their relatives were not always involved in the reviewing of their care plans.

People who use the service told us they felt safe at Springfield Care Home. We saw sufficient staff on duty during the inspection. Staff had received training in safeguarding adults. They were able to tell us of the correct action to take if they witnessed or suspected any abuse. Staff also told us they would feel confident to use the whistleblowing policy and report any concerns they observed.

People we spoke to told us that the staff at Springfield Care Home were kind and caring. During the inspection we observed kind and respectful interactions between staff and people who used the service.

Medicines were mainly administered safely, although we found improvements could be made to the systems for ensuring people received ‘thickeners’ as prescribed for them. Thickeners' are added to drinks, and sometimes to food, for people who have difficulty swallowing, and they may help prevent choking

All areas of the home were clean. Procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care such as utility failures. Personal evacuation plans had been developed and regular checks were in place to ensure staff were aware of the action they should take in the event of a fire at the service.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. The manager was aware of the action to take to ensure any restrictions in place were legally authorised under the Deprivation of Liberty Safeguards (DoLs).

Staff told us that they completed an induction and mandatory training. They told us that they would benefit from additional training, including in the Mental Capacity Act (2005). This was confirmed by the training records we saw.

People told us that they enjoyed the food. We observed the food to be well presented and nutritionally balanced. Systems were in place to help ensure people’s nutritional needs were met. We observed people being individually supported to eat their meals.

A programme of activities was in place, although some people told us that there was not enough stimulation provided for people who used the service. On the rehabilitation units people who used the service had access to kitchens to assess their independence skills.

Systems were in place to investigate and respond to any complaints received. However people we spoke with did not know who to speak to if they wished to make a complaint. Resident and relative meetings were not regularly held to obtain people’s views of the service.

A number of quality audits were in place. We saw that action plans were formulated from the findings of the audits to help improve the quality of the service.