About the service: Springfield Garth is a residential care home for up to 25 people. The service was providing personal care to 11 people aged 65 and over at the time of the inspection; some people were living with dementia.

People’s experience of using this service: The provider had not followed a recommendation made at the last inspection, to review best practice for care planning for people living with mental health and dementia related care needs.

Information about risks to people and their health conditions was not always well-documented in people’s care records. Issues highlighted following health and safety checks were not followed up.

Medicines were not well-managed by the provider. It was not clear what support people required to

take their medicines or that their medicines were being administered as prescribed.

The provider’s auditing systems were not robust and effective in checking quality and safety issues. There had been a considerable delay in the provider’s audit being given to the registered manager to action. Quality assurance systems did not identify the issues we found on inspection.

People’s care records were not always complete and up to date.

The registered manager ensured people, relatives and staff were engaged in the service. The service was well-regarded in the local community.

Staff obtained verbal consent prior to supporting people. Written consent records were 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 supported this practice.

Staff were encouraged to reflect on their work and develop in their roles.

The provider had good working relationships with other professionals to help ensure people received effective care.

Relatives provided consistently positive feedback about the service. People were able to maintain relationships with their family members and attend family events.

People were treated with care, dignity and respect. Staff provided care at people’s own pace and promoted their independence. They worked to improve people’s wellbeing and quality of life. Staff knew about people’s personal histories and lives.

For more details, please see the full report on the CQC website at www.cqc.org.uk

Rating at last inspection: Good (published 27 September 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Enforcement: We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 around safe care and treatment and good governance. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner. The overall rating at this inspection is requires improvement. We will continue to work with the provider to understand the action they have taken to improve the rating to at least good.

This was an unannounced inspection which we carried out on 2 August 2016. We inspected the service to follow up on a breach of regulation and to carry out a comprehensive inspection.

We last inspected Springfield Garth in June 2015. At that inspection we found the service was in breach of the legal requirements with regard to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risk assessments and associated documentation were not being completed or updated in a timely way.

The home provides personal care and accommodation for up to 28 older people and 18 people were using the service at the time of our inspection.

A registered manager was 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.

We found improvements had been made to the service. Risk assessments were in place and these identified current risks to people.

Robust recruitment processes were followed to ensure staff were recruited safely. Although the home was experiencing staff recruitment issues, measures were in place to address staff vacancies. We found there were sufficient staff available to supervise people and respond promptly to people's calls for assistance.

Records were up to date and these were regularly reviewed to reflect people's care and support requirements. We have made a recommendation regarding care planning for people who are living with dementia; this is to ensure people receive consistent care that meets their specific care needs.

Measures were in place to protect people against avoidable harm or abuse, as staff had received training about safeguarding vulnerable adults and understood about the local safeguarding protocols that were in place.

People received their medicines in a safe and timely way.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed.

Since the last inspection staff had received training on the Mental Capacity Act 2005 (MCA) and best interests decision making, when people were unable to make decisions for themselves. Notifications regarding Deprivation of Liberty Safeguards (DoLS) authorisations had been sent to CQC as required. We have made a recommendation regarding the MCA to ensure staff fully understand the importance of, and comply with, conditions made under a DoLS authorisation.

Staff received other opportunities for training to meet people's care needs in a safe way. A system was in place for staff to receive supervision and appraisal.

People who used the service confirmed they received a nutritious diet and we saw there was a varied menu on offer. People spoke positively about the care they received. They told us that staff were kind and patient and said that their privacy and dignity was respected.

There was a programme of activities on offer including individual and group sessions and trips out.

A complaints procedure was available. People told us the registered manager and staff were approachable. They said they would feel confident to speak to staff about any concerns if they needed to.

People had the opportunity to give their views about the service.

Effective management systems were in place to monitor the quality of care provided and drive improvement.

At the time of the visit the home was registered for 26 people to receive personal care, although currently 13 people were living in the home.

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

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

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

This is the summary of what we found:

Is the service safe?

People had been cared for in an environment that was clean and hygienic.

People had person centred care plans and risk assessments, however, CQC monitors the operation of the Deprivation of Liberty Safeguards, no risk assessments had been completed with regards to mental capacity assessments and individual decision making. A compliance action has been set for this and the provider must tell us how they intend to improve.

Is the service effective?

People told us they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff they understood people's care and support needs and that they knew them well. One person told us that they had experienced four other care homes and said "This one is very good compared to some others I've been in."

Is the service caring?

People were supported by kind and caring staff. We saw staff appeared unrushed and people were given time to respond and answer questions. People were always asked their preferences and no assumptions were made. In relation to the staff one person told us they were "friends with them all".

Is the service responsive?

Peoples needs had been assessed before they moved into the home. We saw that care plans were reviewed monthly by the key worker and the individual. Records documented people's likes and dislikes and supported people to be as independent as possible.

Is the service well-led?

Staff worked as a team and liked working at the home. Customer satisfaction was good or excellent and a programme of audits was undertaken by the manager. The home is in the process of recruiting additional staff to fill vacancies. Staff have regular supervision but no systematic appraisal system was in place, nor were there any individual staff development and training plans. A compliance action has been set for this and the provider must tell us how they plan to improve.

People we spoke with told us they were well cared for and liked living at Springfield Garth. We found people looked well cared for and they were treated with respect when attended to by the care staff. Comments we received included: "I like living here." And "It is very nice, very comfortable."

We found people were cared for in a clean, hygienic environment.

Medicines were prescribed and given to people appropriately; we saw people were given the right medicine, in the right way and at the right time on the day of our inspection.

We observed sufficient staff caring for people on the day of our inspection. We were told by staff there was a key worker system in place. This meant people had dedicated time to discuss their individual needs and wants.

People who used the service told us if they had any concerns or complaints they would discuss them with the Manager of the home or bring things up with staff at the time. No-one had any complaints.

To help us understand the experiences of people using the service, we spoke with seven people who lived in Springfield Garth and with the relatives of two people.

One person who lived in Springfield Garth commented, “I felt that this was my home as soon as I came here.” Another told us, “Just look at us, don’t we look happy? There is always something going on to keep us entertained.” We were told by another resident, “The staff are always ready to help you, if you need it, they are very kind.”

The two relatives we spoke with said they were involved in their family member’s care. Relatives told us there were activities for people to do, such as: walking, shopping, and board games. One relative said, “They have an Independent Living Facilitator who organises most of the activities. ”The relatives we spoke with told us people were well looked after. One relative told us, “I’m glad we have chosen here. I’m very happy. Mum always looks clean and well cared for.”

We saw that staff were kind and supportive to people, they treated people as individuals. Staff gave good examples of how people were treated with dignity and respect.

People we spoke with said there were plenty of activities to do and they enjoyed them.

We were told residents meetings were held regularly, “We had one yesterday.” The menus and different ‘exotic’ choices was the main topic which was reported.

People we spoke with told us the manager and the team made sure the home was well run.

People told us they were very happy with the care and support they were receiving at Springfield Garth Care Home.

The inspection took place on 9 and 10 June 2015 and was unannounced.

At our last inspection on 14 August 2014 we identified breaches of Regulation 11 and Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Regulation 13 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not been assessed under the Mental Capacity Act (MCA) 2005, which meant that people might not have their rights and freedoms protected. Staff appraisals and personal development plans were not up to date.

Following the inspection in August 2014 the provider wrote to tell us what they would do to make improvements to meet the legal requirements. The inspection in June 2015 was undertaken to make sure that the provider had followed their action plan, to identify that the provider met the legal requirements, and to provide a rating under the Care Act 2014.

Springfield Garth is a purpose built home on two floors situated on the outskirts of Boroughbridge, with local amenities and transport links with Harrogate, Ripon and York. Springfield Garth is owned and operated by North Yorkshire County Council. It is registered with the Care Quality Commission to provide accommodation for 28 people who require personal care and support. When we visited the manager informed us that they only admitted up to a maximum of 26 people and 14 people were living there.

There was a registered manager in post. 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.

At this inspection we found improvements had been made to staff training and development. Staff had access to a range of training through distance learning and classroom based training. Some staff told us that they would like to have the opportunity to undertake additional training. However, records showed us that not all staff were taking advantage of the training opportunities that were on offer.

We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risk assessments had not always included sufficient information to evidence how the decision was reached. For example, staff had not taken one person’s psychiatric history into account when assessing their ability to manage their own medicines safely. This meant that staff might not monitor whether the person was taking their medicines according to the prescribed instructions, which could put them at potential risk of harm. Not all risk assessments had been updated in a timely way. We found that the provider had not put appropriate measures in place following an accident in the home. This meant that action had not been taken to make the situation safe and prevent a similar incident reoccurring. There was incorrect information in the file which held the people’s emergency evacuation plans, which meant that essential information might not be readily available in the event of an emergency. You can see what action we told the provider to take at the back of the full version of the report.

Action had been taken to assess people in relation to the Mental Capacity Act (MCA) 2005. However, people’s care plans needed updating to ensure they included key information about deprivation of liberty safeguard authorisations that were in place. This would alert staff to the need to monitor changes in the person’s care or treatment, or their overall situation, which may mean that they may no longer require such measures in place. We found that the provider had failed to submit two notifications to CQC as they were required to do. This meant that the provider had not complied with the specific duty placed on them to inform CQC where a standard authorisation was approved under deprivation of liberty safeguards. Not all of the staff had completed training on the MCA and DoLS. We have made a recommendation about staff training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure they understand their role and responsibilities under the Act. This will help to ensure people receive safe, consistent care that protects their rights and freedoms.

People who used the service and managers and staff confirmed that staffing difficulties had impacted on the home’s ability to drive forward improvement. However, we saw that the staff team had worked well together to minimise the effects of the reduced staffing levels to keep people safe.

Information about people’s life history and their likes and dislikes was not fully reflected in their support plans. However, people told us they were well cared for and we observed staff were kind and patient throughout our visit.

Mealtimes were well organised and we identified that people received nutritious food that met preferences.

People’s daily records were maintained and referrals were made to healthcare professionals when necessary. The local GP practice held a surgery each week in the home. This meant people’s healthcare needs were kept under review and changing healthcare needs were identified and met. Care plans included individual assessments in relation to falls, mobility, skin integrity and nutrition and we saw that appropriate referrals had been made to community healthcare and social care professionals as needed.