This inspection took place on 25 April 2017 and was unannounced. We previously visited the service on 23 February 2016 and found that the registered provider was not meeting two of the regulations. This was in relation to the safe management of medicines and the management, organisation and monitoring of the work involved in delivering a safe quality service. We found at this inspection that the necessary improvements had been made and the shortfalls had been addressed.

Springfield House Retirement Home provides accommodation for up to 22 older people. The home is a large stone-built detached property, which stands in its own grounds. It is situated in a quiet residential area of Morley, on the outskirts of Leeds. It is fairly close to shops and public transport links into the centre of Morley. The original house has a large ground floor extension added and the home provides 18 single bedrooms and two double rooms, some of which have an en-suite.

The registered provider is also the registered manager and is therefore known as the ‘registered person’. 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. In addition to the registered manager/owner there was also a care manager and deputy manager.

Records concerned with people, care workers and the running of the home were stored securely and were available during our inspection. Records were maintained and up to date. A revised system of audits and quality assurance checks were in place on all areas of the service. This included a time limited action plan for any identified areas of concern.

People were supported to maintain good health. Care plans identified individuals daily care needs which included people's night-time support requirements and daily living. We found charts in place to record activities of care, for example food and fluid intake for people identified as being at risk of being malnourished.

People usually consented to care and support from care workers by verbally agreeing to it. Records included provision for people or their representatives to sign their agreement to the care and support they received. The care manager told us that the organisation was looking to implement a new tool to further improve people’s ability to record their consent.

Care workers received support in their role from the registered manager, care manager and senior staff. There was a process for completing and recording supervisions and annual appraisals and we saw this was being reviewed and updated.

Where people required support with their medicines this was done safely and people received their medicines as prescribed.

Systems and processes were in place that ensured sufficient numbers of suitably trained and competent care workers were on duty to meet and respond to people’s needs and provide additional one to one support throughout the day. Pre-employment checks on employees were completed that helped to minimise the risk of unsuitable people from working with adults at risk.

Care workers confirmed they received induction training when they were new in post and told us that they were happy with the training provided for them. We also spoke with a new member of staff who was on her first day of induction, shadowing an experienced member of staff. Training for care workers was managed electronically and care workers confirmed they were able to manage some of this on-line.

We found that people were protected from the risk of avoidable harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Care workers received training on safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The registered provider had systems and processes to record and learn from accidents and incidents that identified trends and helped prevent re-occurrence.

Syst

This inspection took place on 23 February 2016 and was unannounced. At the last inspection in January 2014 we found the provider was meeting the regulations we looked at.

Springfield House Retirement Home provides care and support for up to 22 older people. The service had an individual who is a ‘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.

During the inspection there was a pleasant and friendly atmosphere. People knew others they lived with and the staff who supported them. They enjoyed the company of staff who often sat and chatted to them. Through our observations and discussions we found there were enough staff to keep people safe.

People were offered a variety of meals. Everyone told us the food was good. It was often described as “great” and people said there was plenty of choice.

People told us the service was caring and they received person centred care. The service used an electronic care planning system. Some aspects of care planning and assessment were effective but other areas needed developing to ensure people received appropriate and consistent care. The management team recognised they were not using the electronic system to its full capacity and planned to utilise this better.

People were comfortable in the environment, which was warm, and generally clean and well-furnished. Individual rooms were personalised. We noted a small number of areas that needed addressing to mitigate risk. For example, security on the front door and the electrical installation certificate had expired.

People had regular health checks and the service had recently agreed to participate in a scheme to help improve access to healthcare for people living in care homes. However, we found medicines were not always managed consistently and safely. Some people were not given their medicines as directed by the prescriber, for example, before food.

The service had a flexible approach in relation to staff roles which meant that everyone who worked at the home was able to carry out care responsibilities. People we spoke with said this worked well. There was a low turnover of staff and no new staff had been recruited for nearly two years. The provider had a recruitment procedure but this did not cover the key steps that should be followed when new staff were recruited.

People who used the service could make decisions about their care, such as choosing where to spend their time and whether to engage in activities provided.

Staff received training and supervision to help them understand their roles and responsibilities. Staff told us they felt well supported and enjoyed working at the home.

Staff told us they were confident people received good care and knew how to safeguard people from abuse. They gave examples of how they promoted choice and provided opportunities for people to make decisions. However, some staff were unclear about the key requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Information was displayed to help keep people informed. This included how they could access additional services and what they could expect when living at Springfield House Retirement Home.

The management team were friendly and approachable. They had created a positive culture and set high standards around caring for and respecting people who used the service. However, during the inspection we identified they were not consistently assessing, monitoring and mitigating risk, and the systems they had in place were not always operated effectively. The care manager and owner were both very receptive where suggestions for improvement were made.

People had no concerns about their care but were informed how to make a complaint if they were unhappy with the service they received.

We found the home was in breach of regulations of the Health and Social Care Act 2008 (Regulate

We observed staff treating people who lived in Springfield House with respect and dignity. We saw that people had opportunities to contribute their views and express their preferences. People experienced treatment that met their needs and supported their rights.

We spoke with people and their relatives and they told us that they were happy with the care and support they received and enjoyed the range of activities available. One person we spoke with said of the staff, "It doesn't matter how long you need, they give you the time."

Staff were trained to order, store and administer medication safely and records were kept up to date in line with the policy and procedures.

We observed that the food provided was varied, freshly cooked and people's individual preferences and dietary needs were met.

People were cared for by suitably qualified and skilled staff who had access to staff meetings, regular training, supervision and annual appraisals.

We saw that the home had a variety of mechanisms for receiving feedback and they had responded to issues raised appropriately with clear actions. Information and feedback on the quality of care provided was gathered from people living in the home, relatives and staff. Health and safety checks were carried out, requirements for staff training were discussed and care plans were reviewed on a regular basis. These measures ensured that the home continuously monitored the quality of care provided.

People who used the service and/or their families had contributed their views and preferences in relation to how care was delivered. We observed staff treating people with respect, being polite and courteous. There was a supportive atmosphere between staff and the people who used the service. One person told us, “I consent to what is happening with me and I make my own decisions.”

People experienced treatment and support that met their needs and protected their rights. People’s care plans contained a good level of information that ensured their needs were being met. We spoke with seven people and they told us they were happy with the care and support they received. One person told us, “You are so happy you don’t realise how long you have been here, I don’t have any worries.”

We observed that people were cared for in a clean, hygienic environment. There were effective systems in place to reduce the risk and spread of infection. The people we spoke with told us that they had no concerns with the cleanliness of the home.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began work. This included carrying out a Criminal Records Bureau check.

Complaints people made were responded to appropriately. People told us if they had any concerns or complaints they would discuss them with the manager or members of staff and they were confident of using the complaints system.

During the visit we spoke with people using the service and they told us they were happy with all aspects of service.

The people we spoke with told us that they were cared for well. People felt safe and comfortable in speaking to staff about concerns or problems.

Comments included

“Have lots of activities, bingo, tea dances and quizzes.”

“Staff listen to you”

“Like the tea dances.”

“Staff are nice.”

“Staff are friendly”

“I’m able to ask questions.”

“If you don’t like the food they will give you something else.”

“Staff are good.”

“Like bingo and the tea dances.”

“Like living here I think it is well run.”

“Enjoyed the Christmas dinner/sing-a-long”