The inspection took place on the 20 and 27 March 2018 and was unannounced. Three inspectors carried out the inspection.

Springfield Nursing Home is registered to provide accommodation for up to 46 older people. There were 41 people living at the home at the time of the inspection. The home is a large extended property and accommodation is arranged over two floors, the ground floor offering dining and lounge areas and bedrooms. The first floor had further bedroom accommodation. All bedrooms were for single occupancy and most had ensuite facilities. Bathrooms and toilets were provided on both floors. There were three passenger lifts and stairs available to access the first floor. There was level access to a patio and flat garden area.

Springfield Nursing Home is a ‘care home’. People in care homes receive accommodation, nursing and 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. We found the home to be well maintained throughout the 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.

A previous inspection of the service in December 2016 had identified that the service had breached regulations in relation to the use of restraint when a person required essential personal care. Improvements had been made.

At this inspection we found several occasions where incidents/accidents where there had been a significant impact on people had not been reported to CQC as required. This included safeguarding concerns and where people had been injured and required medical attention. This was a breach of regulations. The home had informed the Isle of Wight safeguarding team and ensured people received any necessary medical care as well as investigating the circumstances around the accident or incident to reduce the likelihood of a repeat occurrence.

Audits to check the quality and safety of the service had not identified that the entire kitchen area was unclean and visibly dirty, including the food storage areas, kitchen equipment and beverage making area. Other quality assurance systems in place were effective and where audits had identified areas that needed improvement action had been taken.

The provider had arrangements in place to protect people from risks to their safety and welfare. Arrangements were also in place to store medicines safely and to administer them according to people’s needs and preferences. People were supported to access healthcare services, such as GPs and community nursing teams.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only staff who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

There were processes and procedures in place to protect people from the risk of abuse. Risks to people were managed safely with plans in place to minimise risks where possible.

Staffing levels enabled people to be supported safely and in a calm, professional manner. Recruitment processes were followed to make sure only staff who were suitable to work in a care setting were employed. Staff received appropriate training and supervision to make sure they had the skills and knowledge to support people to the required standard.

Care and support were based on care plans which took into account people’s needs and conditions, as well as their abilities and preferences. Care plans were adapted as people’s needs changed, and were reviewed regular

This inspection took place on 21 December 2016 and was unannounced. Springfield Nursing Home provides accommodation and personal care for up to 46 adults, including people with dementia and physical disabilities, who require nursing care. There were 38 people living at the home when we visited.

There was a registered manager at the home. 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 provider’s quality assurance procedures were not sufficiently robust. They had failed to identify the areas of concern we found in relation to the way restraint was being managed and that pressure relief mattresses were set incorrectly meaning that people were placed at risk harm. The quality assurance systems also failed to identify that people had not received their prescribed topical creams appropriately and records of their administration were not accurately recorded or up to date. Reviews and audits of care plans and related records had failed to identify that information within MCA assessments did not always correlate to the information held within other sections of the person’s care plan and had not been amended as people’s needs changed or reviewed on a regular basis.

Procedures for the use of restraint had not been followed placing a person at risk of harm. Otherwise people were protected from the risk of abuse and staff knew how to identify, prevent and report abuse.

Not all risks were managed safely although immediate action was taken by the provider to rectify these concerns. With the exception of prescribed topical creams medicines were managed safely and people received these when they required them.

People and external health professionals were positive about the service people received. People were also positive about meals and the support they received to ensure they had a nutritious diet.

Care plans provided comprehensive information about how people wished to be cared for and staff were aware of people's individual care needs and preferences. Reviews of care were conducted regularly. People had access to healthcare services and were referred to doctors and specialists when needed. At the end of their life people received appropriate care to have a comfortable, dignified and pain free death.

Staff offered people choices and respected their decisions. People were supported and encouraged to be as independent as possible and their dignity was promoted.

There were enough staff to meet people's needs. The recruitment process helped ensure staff were suitable for their role. Staff received appropriate training and were supported in their work.

People and relatives were able to complain or raise issues on a formal and informal basis with the registered manager and were confident these would be resolved. This contributed to an open culture within the home. Visitors were welcomed and there were good working relationships with external professionals. There was an opportunity for families to become involved in developing the service and they were encouraged to provide feedback on the service provided both informally and through an annual questionnaire.

Staff worked well together, which created a relaxed and happy atmosphere that was reflected in people's care. Plans were in place to deal with foreseeable emergencies and staff had received training to manage such situations safely.

People's families told us they felt the home was well-led and were positive about the registered manager who understood the responsibilities of their role. The registered manager and provider were aware of key strengths and areas for development of the service.

We found a breach of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. Y

We spoke with five people who used the service and two relatives. They all said they did not have any concerns with how they were treated and felt involved in their care. They told us they were happy with the level of care provided and staff understood their needs. One person said “all is very good here. The staff are very good, I get my tablets on time”. A relative told us “everyone in the home is very aware of [their relative's] needs and managing his anxieties. I feel much more relaxed now".

We looked at seven care plans and saw they were individualised and included the necessary information to inform staff as to the specific care people required. We saw these were reviewed on a regular basis. We observed care in the communal areas of the home and saw staff interacted with people in a positive way. One person said staff are “very good, they chat away with us”.

We saw the home was clean and well maintained. The manager told us the deputy manager was responsible for overseeing infection control. We spoke with five members of staff, including the head of cleaning and the manager. They all confirmed they had received infection control training. Everyone we spoke with told us the home was always clean.

We saw there were enough qualified, skilled and experienced staff available to meet people’s needs. A relative told us “staff seem to be well trained, when [their relative] calls out they are straight there to see to her. I have no concerns around staffing levels”.

We spoke with 10 of the 42 people who were living at the home. They all said they were very happy with the way they were cared for. People also said the “staff were excellent” and “knew what care they required”. People told us staff were available when they needed them. One person had previously received respite care at the home and had chosen to return. We spoke with eight relatives. All were very positive about the care their loved ones were receiving.

We spoke with nursing and care staff. Staff were aware of how people should be supported, individual likes and dislikes and the help they required. Staff stated they felt they had sufficient time to meet people’s needs. Staff also told us they had attended relevant training and had all the necessary equipment to safely care for people.

We found medication was correctly managed and good recruitment and induction procedures were completed. The home was well maintained and suitable for the people living there. Care plans and related care records were relevant to people’s needs. Other records related to the running of the home were also well maintained and stored securely.

Some people using the service were able to tell us about their experiences and we also spoke with relatives and external health professionals. People said they were very happy with the way their health and personal care needs were met. People said that staff were available when they needed them and knew how to care for them. People were also very positive about the meals provided. However other people were unable to talk to us due to their age related memory loss. We spent some time in the home’s communal areas observing people and staff. Interactions were warm and friendly with staff clearly having a good knowledge about the people they were caring for.

Visitors were all positive about the way the home met the needs of their relatives. They confirmed that they were kept informed about any illness or untoward incidents. Relatives said that if they had any concerns or complaints they would raise these with the staff or the manager.

We also spoke with other professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met.