We carried out an unannounced inspection of Springfield House on 3 October 2018. Springfield House is a care home which provides care and support for up to 23 predominantly older people. At the time of this inspection there were 19 people living at the service. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is on two floors with access to the upper floor via a stair lift. Some rooms have en-suite facilities and there are shared bathrooms, and toilets. Shared living areas included a central lounge and sun lounge. There was also a dining room which had been extended to the side of the service. This led out onto an enclosed rear garden area which was suitable and safe to use for people living with dementia. The service is situated in its own grounds with a large side garden area.

The registered provider was also the registered as manager of the service and will be referred to as the registered manager throughout this report. 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 and associated Regulations about how the service is run.

At the last inspection in February 2016 we rated the service as overall Good. However, the safe domain of the report was rated Requires Improvement. This was because risk assessments contained limited or no information about measures staff should take to ensure people were safe in relation to specific risks. Where pressure relieving mattresses were in use the procedures to check them were not clear. The recording of people receiving repositioning was not always consistent.

There were no measures in place to reduce the risks of Legionella.

Medicines were not always stored and administered to people as prescribed. The temperature was not being monitored in the medicines room. Prescribed creams were not being managed and recorded appropriately. The registered manager gave us assurances the issues were being addressed.

At this inspection we found that issues identified as requiring action in February 2016 had not been addressed in full. Some people required management of specific risks and these had not been effectively managed using a risk assessment format, which would support staff to mitigate those risks.

Three people required pressure relieving mattresses. When we checked the settings, we found they did not correspond to their weight and therefore posed a potential risk for skin damage. There were no audits taking place to ensure the mattresses were operating at the correct pressure for the person. In one instance the equipment had been reported as faulty and therefore the service could not determine if the pressure was accurate. This meant peoples skin integrity could be at risk.

Some people required repositioning to reduce the risk of skin damage. The service had records in place monitoring the times people needed to be repositioned. The charts were up to date and response times were generally in line with the assessment. A visiting professional told us the staff were responsive to instruction from them and referred any concerns quickly.

The service had employed a contractor to monitor water in the service, including temperatures at various points so it met with current Legionella guidance.

People received their medicines as prescribed. Systems and processes relating to the administration and storage of medicines helped ensure medicines were managed safely. The service had included body maps to identify areas where creams were to be applied and when. Creams were dated upon opening and kept in a locked wall facility in people’s rooms.

Care plans contained information about th

This was an unannounced inspection which took place on 25 February 2016. Springfield House Residential Care Home provides care for up to 23 older people. At the time of our inspection 23 people were living there.

The home had 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’s medicines records did not always give clear guidance to staff. Documentation regarding people’s creams was incomplete which meant it was not always clear where to administer the cream or whether people had received it. There was no clear protocol in place to inform staff when to administer, as required medicine to someone who experienced behaviour that may challenge others. This meant, if staff who knew them well weren’t available, they may receive it too soon or too late for their needs. Checks were not routinely done to ensure staff continued to be competent to administer medicines.

People were not always protected from risks associated with their care because staff did not have the correct guidance and direction about how to mitigate people’s individual risks. Risks relating to the environment were not always assessed meaning safety measures were not identified and put in place.

Care plans did not always reflect people’s up to date needs but the registered manager had committed to updating them and ensuring they contained more detail about people’s wishes and preferences.

People, their relatives and healthcare professionals spoke highly of the care and support people received. Comments included, “I think it’s excellent. Absolutely excellent.” Care and support focussed on the person, their individual needs, their likes, dislikes and the routines that were important to them. When people’s needs changed staff reacted promptly, involving other social and health care professionals if needed. People told us, “We receive very good care and attention if we’re not feeling well.” Care plans needed updating to ensure they reflected people’s current care needs and included advice from professionals.

People were provided with the right food and drink to maintain their nutritional health. Staff supported people according to their needs and where concerns were raised action was taken. People chose the meals they wished to eat and decided where to eat them. A relative told us, “Mum is very fussy but they always accommodate her.” Special diets were available for people with particular dietary needs. People who were at risk of choking had their meals prepared in line with their care plan to reduce the risk.

People told us they felt safe. All staff had undertaken training on safeguarding vulnerable adults from abuse. They demonstrated good knowledge of how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment. There were sufficient staff to meet people’s needs.

Relatives and friends were always made to feel welcome by the staff and registered manager who treated them with respect. Comments included, “You won’t find better. There’s lovely staff here.” People and those who mattered to them knew how to raise concerns and make complaints.

New staff received an induction programme when they joined the organisation. Staff training was not all up to date. However, during our inspection the registered manager produced a plan of action to address this.

People, their relatives and healthcare professionals spoke positivel

Our inspection of 27 September 2013 found that people's welfare and safety had not been assured. Also that people were not adequately protected against the risks of unsafe or unsuitable premises.

For this inspection we spoke with the provider about their improvement plans, spoke with three people using the service, met other people using the service, spoke with two care workers and looked at records.

People told us that they were happy with the care they received. They said "The girls are lovely" and "The girls are very friendly". They said they liked their room, their bed was comfortable, they were always warm enough and they had no complaints. One person said "I would tell them, and the boss, if I was not happy, and he takes notice."

We found that assessment and care planning were very much improved. One person using the service fetched their 'Daily Living Plan' to show us and they said that the information within it was correct. The monitoring of care was better organised. Examples were pressure sore prevention, diet and personal care. Care workers were clear around people's right to determine their rising and retiring times, whilst protecting them from neglect. The correct equipment protected people from falls. Care was better organised and monitored.

The provider and care workers knew people’s needs well. We saw them providing kind and thoughtful care. The environment was bright, enlivening and we found no hazards or concerns.

We received information which suggested that people's welfare was not being promoted and they might be at risk. We did an unannounced visit to the home arriving at 4.45am and leaving at 8.15am. On arrival we asked to be escorted into each person's room.

Some people's liberty was being restricted and they were at risk of harm because they were held in their bed by chairs or commodes. We were told that this was to stop them falling, but there was no risk assessment of the possibility of them falling and no plan as to how that risk should be reduced. We found that there were no risk assessments or care plans to protect people from pressure damage, weight loss or poor personal hygiene. There were no care plans of people's needs at night or instructions about the night workers role.

People were not receiving an acceptable standard of personal care and they lacked dignity.

One person’s weight loss had not led to a plan to improve their weight. Of the care plans we saw none reflected the person's current needs. A care worker told us, "The care plans aren't really any use."

A district nurse told us that the home meets people’s emotional needs very well.

We found worn and torn bedding and curtains loose. We found a fire exit which was locked and basins with no hot water. There was no formal method for recording and dealing with maintenance issues. People were living in a premises in need of refurbishment but there was a programme of refurbishment started.

We spoke to three people who used the service and one person's family. There were no negative comments about the care provided or the staff and management. People told us, "A 1. Anything you want they are right here. I like the attention..." and "I ring the bell and they come and help".

We saw that care workers were attentive to people's needs and that people clearly enjoyed time with them. We observed care being delivered in a respectful and safe way. A district nurse and GP said that they had no concerns about the service. People had regular opportunity to have their views listened to and decisions were made in people's best interest and in a lawful way where they could not make those decisions for themselves.

People were better safeguarded from abuse due to good staff knowledge and medicines were handled appropriately and safely.

Staff were being supported through a training programme and this was delivered in ways which suited their learning best. Part of the programme was support and supervision. The owner/manager was very knowledgeable about people as individuals and supported staff to deliver good care.

Quality monitoring and management of the home had improved and there were plans for future and continuing improvements.

Record keeping was improved. Information was available to inform staff about people's needs and safe care delivery but care plans still lacked information about people's social needs. However, monitoring records were well completed.

Many of the people who use the service were not able to comment directly on the care and support they received at Springfield House. However one person was able to say that "They let me do what I like, I can't complain. The girls come up and ask. There isn't a strict routine".

Relatives told us that they had found the home welcoming, that information was shared freely, and that they were involved in planning the care of their relative. We were told that "nothing is too much trouble".

Relatives told us that they had visited the home "on spec", and had found it to be clean and homely. They said that their mother was always well dressed and clean.

The people who we spoke with said that they thought that Springfield House was “as good as you can get” and one visitor told us that she felt her relative was safe. The food is described as being good and home cooked, thought there was no actual choice. We were told that that people are generally very well cared for, and staff are caring. We found that there is still a need to ensure that care plans clearly state what people need but the way each person would like their care provided. We have found that there are limited activities for people, particularly those with dementia, and that the fact that the dining room is locked, for safety, means people have less space to walk and explore than might otherwise be the case.

None of the people who live at Springfield House have concerns about their medication; however we found that there were a number of errors in recording medication given and, in the storage of medication. We have issued a Warning Notice which requires Mr Jahmeerbacus to make improvements by 8 August to meet the regulatory requirements under Outcome 9: Management of Medicines. If this is not achieved further enforcement action may be taken.

The people we spoke with who live at Springfield House told us that they were happy with the service. Comments included: “It’s lovely” and the “The staff aren’t too bad, and one of the staff is a thoughtful maid”.

Relatives of some of the people told us that the home is very friendly, and the staff are very good. Another person told us that they were really happy with the service, that the staff are very nice and that the place is nice and clean.

Some of the people who use the service have dementia and were not able to speak for themselves. We observed that they were all treated with kindness and consideration; however there was a lack of choice around meals.

Health care professionals told us that staff were kind; some health care professionals considered that advice was sought when needed and taken. Other professionals felt that advice, particularly in relation to dementia, was not sought. We were also told that sometimes staff appeared not aware of some of the basics of care.

We conducted unannounced visits to Springfield House on 30 July 2012 and 17 August 2012 as part of a programme of planned inspections. We had also received information of concern. 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 us.

We looked closely at the care of five 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 five staff, three peoples' families, the registered manager and a district nurse with knowledge of the service.

People were receiving respectful and kind attention from staff. One person's family told us, "Absolutely brilliant. Staff are so nice. He (the manager) can't do enough". A person using the service said, "The carers are kind and treat me well" adding that they treated her respectfully.

People's physical and emotional needs were understood by staff and a district nurse said she had no concerns about the care delivered. We saw that improvements had been made to the arrangements to safeguard people from abuse but those arrangements were not yet robust and risk remained.

There was no clear system in place to monitor and understand how people felt in terms of respect and involvement . The way medicines were administered could lead to errors. Records and documentation did not protect people from the risks of unsafe or inappropriate care because they did not always reflect the current situation. Risks, for example from pressure damage, had not been assessed and so actions to minimise risk could be delayed. Staff did not receive formal supervision or appraisal of their work and were unsure about policies and procedures. They were supervised as they did their work.