This inspection was carried out on the 26 and 27 July 2017 and was unannounced. At our previous inspection on 11 May 2016 we found several breaches of legal requirements. Staff did not have access to protective equipment, there were risks of infection because of the inappropriate storage of personal items and some equipment was not fit for purpose.

In addition, there were not enough staff to meet the needs of people and a recommendation was made about the need for staff to update their training. There was also a lack of understanding around the implications of the Mental Capacity Act 2005 (MCA) where people lacked capacity and the need to seek people’s consent for care and support.

There were issues with the recording of essential information related to people’s care and auditing and checking on the provision of care..

We asked the provider to make improvements in all of these areas and they kept CQC informed of the changes that had been made.

At this inspection we found that significant improvements had been made in all of these areas.

We found that people were not being deprived of their liberty inappropriately and staff were aware of the need to seek consent in line with the MCA. Equipment had been replaced and personal items were being properly stored.

Proper records were kept around essential items of care, action had been taken to support people with sufficient numbers of well-trained staff and checks were being made to ensure that the service operated effectively.

Springfield Nursing Home is located in Coppull in the county of Lancashire. The home is registered to provide accommodation and support for up to 40 people and cares for elderly people including those living with dementia. At the time of our inspection 38 people were using the service.

There was a registered manager in place who had been registered since 30 May 2017. 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 using the service said they felt safe and that staff treated them well. There were enough staff on duty and deployed throughout the home to meet people’s care and support needs. Safeguarding adult’s procedures were robust and staff understood how to safeguard people they supported. There was a whistle-blowing procedure available and staff said they would use it if they needed to. Appropriate recruitment checks took place before staff started work.

People were supported to maintain a balanced diet and had access to a range of healthcare professionals when required. People received appropriate end of life care and support.

We found that people and their relatives, where appropriate, had been involved in planning for their care needs. Care plans and risk assessments provided clear information and guidance for staff on how to support people using the service with their needs. There was a range of appropriate activities available for people to enjoy. People and their relatives knew about the home’s complaint’s procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The registered manager conducted regular checks to make sure people were receiving appropriate care and support. The registered manager took into account the views of people using the service, their relatives and staff through meetings and surveys. The results were analysed and action was taken to make improvements at the home. Staff said they enjoyed working at the home and received appropriate training and good support from the management team.

We inspected this service on 11 and 12 May 2016. The home was last inspected in April 2014, when it was compliant with the outcomes inspected. This is the home’s first comprehensive inspection under the changed methodology.

The home is a nursing home providing nursing and residential care for up to 40 people. On the two days of the inspection there were 39 people living in the home.

The home is an extended period building over two floors. The home has communal areas on both floors including lounge and dining room provision. The kitchen is located on the ground floor and the laundry is a designated building in the grounds. The gardens are spacious and well maintained. We saw people enjoying the outside space during the inspection. People appeared settled and we saw some preferred to stay in their room and others liked to utilise the communal space.

The home had a registered manager at the time of the inspection who knew the home well. 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 home was in breach of four of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014 including identified issues with staffing, how the home acquired consent specifically within the principles of the Mental Capacity Act 2005, how the building was maintained, the records kept and quality audit.

There were a number of issues with how the home was maintained. This included obstructed fire exits, a lack of available PPE (Personal Protective Equipment), cluttered bathrooms and inappropriate storage of clinical items. The provider was required to take action to improve this.

The home had not fully embedded the principles of the Mental Capacity Act 2005 and more work was required to meet the requirements of the Act and the associated Health and Social Care Act regulation for consent. We found most consent that was acquired was given by family members rather than individuals themselves. When family members have power of attorney this is appropriate. However, we found required best interest decisions and capacity assessments had not been completed in some circumstances where family members did not have power of attorney.

When we looked in people’s care files, we found information was difficult to find and care plans and the records for meeting people’s needs were not routinely updated to ensure assessments and plans of care reflected the care being delivered. We found the home needed to address how records were kept, collated and used to inform assessments and care plans. We also found the quality audits had not been routinely completed in the last couple of months and this had an impact on the quality of the service provided, as identified within this report.

The home had a pleasant and calm atmosphere. The staff and people who lived in the home interacted well and people told us there were good relationships between staff and residents. However, we noted people were left in wheelchairs for too long and some for the majority of the day. Staff and people who lived in the home told us there was not enough staff to attend to people’s needs as they would like. Dependency assessments had been completed but the scores had not been used to determine if there was enough staff. There were particular issues when staff called in sick at short notice. The provider was required to take action to ensure there was enough staff at all times.

We have made five recommendations within the report. Staff had not received recent safeguarding training we recommended the provider ensures all staff receive up to date safeguarding training to refresh their understanding. The provider used a training matrix to keep track of the delivery of training

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

This is a summary of what we found -

Is the service safe?

We looked at care plans for four people living at the home including people with nursing needs. People's needs were assessed and care and support was delivered in line with their individual needs. We saw that care assessments had been carried out and daily monitoring records had been completed. Care plans were easy to follow and it was evident that regular reviews of people's needs were carried out. Risk assessments were in place covering areas such as moving and handling, falls and nutrition. Evidence was in place showing that monthly reviews of all risk assessments were carried out.

When speaking with members of staff they were all able to demonstrate they understood the home's policy in relation to safeguarding and told us they would report to a senior member of staff if they had concerns about the safety of people living at the home.

Is the service effective?

We found evidence of the involvement of, and referral to, other professionals such as the speech and language therapy service, Incontinence service, GP's and opticians.

We spoke to four members of staff. All were clear what to do in the event of an emergency at the home such as fire or if a person living at the home had fallen. People had 'hospital passports' in place in the event of them being admitted to hospital or if they were attending a medical appointment. This document included any current medication, allergies and other key information that medical staff needed to be aware of.

Is the service caring?

We spoke with six people who lived at the home and three visiting relatives. All the people we spoke with were happy with the care they or their relatives were receiving at Springfield Nursing Home. One person who lived at the home told us, "I have no complaints here at all. I feel at home here". Another person who lived at the home told us, "It's a happy place, a clean place and people are very helpful".

Is the service responsive?

The home had a keyworker system in place. Each person living at the home had a named care worker and nurse. Staff we spoke to were able to name which people they were the key worker for although not all people living at the home were aware they had a key worker allocated to them.

Is the service well-led?

A number of audits were carried out by the service including monthly care plan reviews, medication, complaints and infection control. We saw evidence of some of these areas during our inspection.

Two surveys were sent out to people who lived at the home and their family/representatives every year. The latest survey had been sent out in August 2013. Results were collated and converted into a graph to show visually what the responses were. Results were shared at resident, relative and staff meetings and posted within the reception area. The results from the latest survey were, in the main, very positive.

At the time of our Inspection there were thirty eight people living at Springfield Nursing Home. We spoke to a number of residents, relatives who visited on the day, a visiting professional as well as members of staff. People who lived at the home were positive about their experiences and the comments received reflected this. One person living at the home stated, "I feel much more relaxed for being here. I feel like a different person, I was in a bad way when I came here". Another resident said, "I feel very safe here. There are even people who come and check on you during the night". However, we found evidence that there were insufficient staff at the home at times which meant that some people may have to wait for assistance.

Care plans showed that people's care was delivered in a person centred way and that their likes and dislikes were noted and recognised by staff. From speaking to staff, looking at their personnel files and staff training files it was apparent that staff felt supported and had the opportunity to develop.

The premises were clean and tidy and the design, layout and security of the premises were fit for purpose to meet the needs of the residents.

People told us they could make their own decisions regarding their care and support. We found before people were admitted they had been given information about the service, the support that would be provided to meet their needs and the terms and conditions of residence.

People told us the staff were very good. Staff attended to all their personal care needs as they required. They had a key worker who did extra little jobs for them such as organising their wardrobes and making sure they had everything they needed. They said, “I can’t stand up and they use a hoist to help get me out of bed. They will come and see to me if I ring my buzzer day or night.” “I am quite independent and can manage to do most things for myself. If I need help I get it. The staff are good fun. We have a good laugh and they take me out. We go all over; matron is keen for us all to get out and about. We’ve had trips to different places, gone shopping, had meals out and here in the home we have plenty to do and have party days. We’re not the forgotten ones here. The food is good and we have a choice. What more do we need, it’s lovely here”. We found people were cared for by staff that were recruited properly and were trained well.

We spoke to people living at the home, the manager, staff, relatives visiting, and

received comments from other professional agencies such as social services and the

Lancashire Council's Contracts Monitoring Team, who told us they currently had no concerns with the service. Responses we received were positive and included from people living at Springfield Nursing home, " I settled in well from the start, the staff are caring and respectful". Also, "No complaints, staff who help and support you all the time".

Staff spoken to had a good awareness of individuals care needs and the importance of

treating people with respect and dignity. One relative visiting the home said, " I feel content about mum's care I have no concerns". A staff member spoken to said, "I have been here a number of years and seen some changes, at present the is run well and we have good support form the management".

Lancashire Social Services spoken to have no concerns with the home and have not

received any 'safeguarding' alerts recently.