This inspection took place on 12 and 23 January 2018, and was unannounced. At the last inspection we found there were breaches of regulations relating to the management of risks and the recruitment of staff and we rated the service as Requires Improvement.

Following the last inspection, we asked the registered provider to complete an action plan to show how they were going to meet these regulations to improve the service. At this inspection we found the registered provider had made improvements to meet the requirements of these regulations but further time was needed to embed these improvements.

Springfield is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Springfield accommodates up to 69 people, many of whom are living with dementia, in one adapted building that is made up of four separate units. The service is located in a residential area of Garforth on the outskirts of Leeds. All bedrooms are single occupancy and have en-suite toilet facilities. Communal lounges, dining rooms and bathing facilities are provided. At the time of our inspection there were 64 people using the service.

The service 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.

Appropriate recruitment checks had been completed to ensure staff did not pose a risk to people who used the service. A range of management initiatives had been implemented to ensure people were kept safe from harm. We saw these included improvements in training and development arrangements to ensure staff had the knowledge and skills needed to perform their work. A pharmacy technician had been recently appointed to ensure people received their medicines in a safe way and arrangements for these were regularly checked. The dependencies of people were monitored to ensure there were sufficient numbers of staff available to meet their needs and additional staff were being recruited to cover busy times of the day. People’s environment was clean and well maintained and improvements were being made to reduce potential hazards.

Training for staff included courses on mental health and positive behavioural support to ensure they understood their responsibilities to promote people’s human rights and were able to manage the behaviours of people whose behaviours may challenge. Staff told us they were listened to by management and felt well supported by them. We observed people were provided with a positive dining experience and that a range of nutritious meals were served to enable their dietary needs to be met.

We observed staff interacted with people in a positive and friendly way and were kind and considerate of their needs. There was evidence staff knew people well and provided gentle encouragement to ensure their independence was promoted. We found people’s wishes for privacy were respected and that their personal dignity was maintained.

Staff had information about people’s individual needs to help them provide a personalised service, although we saw staff recording on this could be improved. A range of activities were available to give people opportunities for meaningful social interaction. A complaints process was in place to enable people’s concerns to be investigated and addressed. Meetings were held to help people to provide feedback about the service, although we were told management did not often attend these.

People told us management were approachable but recent changes had meant they were not always provided with responses to questions that were raised. A range of systems we

This inspection took place on 18 and 23 January 2017, and was unannounced. At the last inspection we rated the service as requires improvement. The provider was not in breach of regulation, however, we identified there were areas to improve. At this inspection we found they had made improvements in some areas but still needed to make other improvements.

Springfield provides accommodation for up to 69 older people. The service 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.

The registered provider did not take appropriate action to keep people safe. They were not carrying out appropriate checks before employing workers. The Care Quality Commission's data intelligence indicated there was an elevated risk due to the number of safeguarding incidents between people who used the service. We found management plans were not effective and repeat events were not prevented. Staff were not always deployed in a way which ensured people were safe. The home looked clean and tidy, and checks were carried out to make sure the premises and equipment were safe. Medicines were in the main managed safely although some additional guidance was required around the use of prescribed creams and lotions.

Staff we spoke with said they felt well supported and received training that made sure they knew how to do their job well; although training around behaviours that challenged the service and others had not been provided to most staff even though staff required knowledge in this area. Staff we spoke with understood their responsibilities around how they should support people with decision making. People had good meal experiences and enjoyed the food. Recent changes to the meal time arrangements had worked well. Systems were in place that ensured people accessed healthcare services.

People told us the service was caring, and care workers were kind and friendly but did not have a lot of time to chat because they were busy. Some visiting relatives told us not only did the service provide good care to people who used the service but also supported family members. Throughout the inspection we observed staff were caring, kind and attentive. They clearly knew people well and provided personalised responses such as using people’s names, talking about people’s relatives and things they liked to do. People had access to information which kept them informed.

Care plans had information relating to aspects of people’s lives including their likes, dislikes, hobbies and interests. However, guidance around how staff should deliver care was inconsistent; there was not always sufficient information which could result in people’s needs being overlooked. The registered manager agreed to review care plans to ensure there was sufficient guidance for staff. There was a programme of activity but this was not followed, and we saw people sat for long periods with very little stimulation. The registered manager said they were taking action to improve activities.

The registered manager held a regular weekly surgery to encourage and promote feedback. Systems were in place to respond to concerns and complaints. Several written compliments had been received.

We received positive feedback from people about the registered manager and several people commented that improvements had been made since the registered manager took up post, which included a more open welcoming culture, better communication, more responsive to feedback and a more homely approach. Recent survey responses from representatives of people who used the service complimented the management of the home. At the inspection we reviewed a range of audits, which were used to monitor the quality and safet

We carried out this inspection visit earlier than planned after receiving concerns. The concerns raised were there was a strong mal odour of urine in the lounge coming from the carpet and the chairs, people were not dressed in clean clothes, and their dining room experience was poor. Also staff presentation and appearance was not good.

Two inspectors were involved in the inspection. The questions we asked on this visit were: 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 the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

The relatives we spoke with raised no concerns about people's safety and said if they had concerns they would discuss them with the manager.

The manager said they had put a number of different measures in place to check systems within the home were safe and working effectively. Records showed this included audits on care plans, medication, accidents and incidents and complaints. We saw records which showed a number of safety checks had been carried out.

When we asked about personal evacuation plans (PEPs) for people who used the service in the event of a fire we were told they were in place. However the manager said she will ask the fire service to review their fire risk assessment and evacuation plans.

All of the staff we spoke with had a good understanding of the whistleblowing policy.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans. Some people were not aware of what was in their care plans.

Staff we spoke with said there were effective systems in place to monitor quality and safety. Everyone said they received good support and managers regularly checked everything was in place. One member of staff said, "We go through everything that needs doing at handover and we all know what we are doing."

Visitors confirmed they were able to see people in private and visiting times were flexible.

Part of the concerns received involved the environment and the need for some refurbishment and redecoration to both keep fresh and maintain the home. The manager said there were refurbishment plans in place and will send the commission a plan with timescales. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to making sure people were involved in their care planning and in relation to maintenance of the home.

Is the service caring?

All the people spoken with who lived in the home were complimentary about the care and support they received. Some comments were: “The care is good and I praise them highly. I give the care staff top marks.”

“The staff are kind they look after us”

We saw staff interacted kindly with people and this was confirmed by people’s comments.

Is the service responsive?

We saw evidence the manager had acted quickly to respond to the concerns raised and put in place actions to improve people’s experience of care.

We saw people were suitably dressed and had clean, tidy hair and clothing. We observed care of people in communal areas and we saw staff were kind and caring. Staff communicated with people in a positive manner when they spoke with them and were genuine and sensitive to people’s needs and feelings.

We observed people’s experiences of lunchtime and we found staff were extremely busy and this was a task-centred process, rather than a positive dining experience. For example, people were served their lunch with little consultation or discussion about the food.

Speaking with staff they confirmed the manager wanted them to focus on improving people’s dining room experience. Their comments included “We try to prepare people more for their food now” and “The manager is really keen we focus on how people feel when they are eating.”

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to monitoring people’s nutrition and improving their dining room experience.

Is the service well led?

The manager had been in post since the end of April 2014. They had drawn up an action plan and implemented a number of audits and policies to help improve people’s experience of care. They completed an audit of staffing levels to make sure people could be supported at all times.

Staff were complimentary about the manager and the deputy manager and felt supported and encouraged in their work.

We saw people who used the service looked comfortable and clean.

There was a relaxed atmosphere within the home, staff were observed chatting with people and music was playing.

We spoke with two people who used the service and the relative of a person who used the service. Comments included;

“I like it here, staff are good.”

“I wouldn’t have let my mum come in here if I didn’t think the care was good.”

We saw that the home was clean and well maintained. Personal Protective Equipment (PPE) was readily available for staff throughout the building.

We spoke with two members of staff who told us that PPE was used at all times when providing personal care.

We reviewed procedures for recording, storing and administering medication on all four units and found steps had been taken to rectify previous areas of non-compliance. However we noted that further work was required.

We spoke with four people who were resident at Springfield and three relatives to gain their views of the service. One relative described how impressed they had been with how the staff treated their loved one with patience and respect. The person said “Since my relative has come to live here they have settled well and become much happier and more content.”

We saw how staff maintained people’s privacy and dignity when carrying out personal care and maintained confidentiality when speaking to people and other staff. For example staff were observed knocking on people’s bedroom doors before entering their rooms.

All the people spoken with said they were given appropriate information and support regarding their care or treatment. One person said “The care is very good.” A relative described how they had been involved in the planning of the care and support for their relative when they first went to live in the home and said communication with staff in the home was very good. However during our visit It was evident that care staff were not actively following care plans.

We reviewed seven staff files and found appropriate checks had been undertaken before staff began work. People spoken with said they were happy and felt safe in the home. One relative said “I have no worries or concerns about safety and well being here.” All the people spoken with told us they were happy with the service and said they would tell the staff of they had any worries or concerns.

We have not spoken directly with people who use services

We inspected the service on 19 and 20 March 2015. The visit was unannounced. Our last inspection took place on 27 May 2014 and, at that time; we found the service was not meeting the regulations relating to care and welfare of people who used the service and not meeting nutritional needs. We asked them to make improvements. The provider sent us an action plan telling us what they were going to do to ensure they were meeting the regulations. On this visit we checked and found improvements had been made in the required areas.

Springfield provides accommodation and personal care for up to 71 people. The home is located in a residential area of Garforth on the outskirts of Leeds. All bedrooms are single occupancy and have en-suite toilet facilities. Communal lounges, dining rooms and bathing facilities are provided.

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.

We looked at the arrangements in place for the storage, administration, ordering and disposal of medicines and found these to be safe. Medicines were administered to people by trained care staff.

People received sufficient amounts to eat and drink. We found the dining experience throughout the home was not consistently good.

Deployment of staff within the home was not arranged according to the dependency of people using the service.

The premises of the home were well maintained and in a good state of repair. Regular environmental checks were carried out by the registered manager. We looked in people’s bedrooms and found people had personalised their rooms with ornaments and photographs.

Robust recruitment processes were in place which ensured staff were suitable to work with vulnerable adults.

The local authority had limited the amount of deprivation of liberty applications they would accept from the home at any one time however, the registered manager had not taken steps to identify people who were potentially at risk of having their liberty deprived.

A programme of activities was in place with staff employed to deliver this. People using the service told us this was not delivered consistently throughout the home.

Staff received regular supervision and annual appraisals. This gave staff the opportunity to discuss their training needs and requirements.

People using the service and their relative had opportunity to give their views and opinions on the service provision. There were regular resident and relative meetings and satisfaction surveys were also distributed to people using the service on an annual basis.

Staff demonstrated a good understanding of how to protect vulnerable adults. They told us they had attended safeguarding training and were aware of the policies in place regarding reporting concerns.

Care plans were person centred and individually tailored to meet people’s needs.

We found a number of issues which the provider had failed to identify through an effective system of quality assurance.