This inspection took place on 28 February and 1 March 2017 and was unannounced. At our last comprehensive inspection in August 2014 the overall rating for the service was ‘Good’. At this inspection we found the service remained ‘Good’.

Springview is a privately owned care home for older people in Enfield. The home is registered to accommodate 58 older people. The home has four floors and the second floor is specifically for people living with dementia.

There was a registered manager in post. 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 inspected this service in September 2016 because we had concerns about how the management and staff were dealing with falls management at the home. At this inspection we found that this issue was being appropriately addressed and the incidences of people falling had reduced.

People told us they felt safe at the home and risks to people’s safety and been identified, acted on and, where possible, were being reviewed with the person.

Staff knew about various types of discrimination and abuse that could occur in a residential setting and its negative effect on people’s well-being. They were aware of their responsibilities to keep people safe from potential abuse.

There were systems in place to ensure medicines were handled and stored securely and administered to people safely and appropriately.

Staff were positive about the management and told us they appreciated the clear guidance and that their input was acknowledged and praised.

Staff understood the principles of the MCA and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People told us they enjoyed the food provided and that they were offered choices of what they wanted to eat.

People had good access to healthcare professionals such as doctors, dentists, chiropodists and opticians.

Staff demonstrated a good understanding of peoples’ likes, dislikes, needs and preferences.

People told us that the management and staff listened to them and acted on their suggestions and wishes. They told us they were happy to raise any concerns they had with any of the staff and management of the home.

People we spoke with confirmed that they were asked about the quality of the service and had made comments about this. They told us the service took their views into account in order to improve.

This unannounced inspection took place on 8 September 2016 and was undertaken by one inspector and a specialist advisor in falls management and prevention.

We carried out this focussed inspection because we had concerns regarding falls management at the home. This report only covers our findings in relation to falls management within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springview on our website at www.cqc.org.uk.

Springview provide accommodation for persons who require personal care to a maximum of 58 people some of whom are living with dementia.

There was a registered manager in post. 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.

Relatives and people who used the service were very positive about the staff and the way they were being supported at the home.

There were systems in place to monitor and analyse information about people who had suffered from falls at the home. There was a falls management policy and procedure in place with the direct aim to reduce the incidences of people falling. The service was following the requirements of the Health and Social Care Act 2008 and associated Regulations by notifying the Care Quality Commission (CQC) when people had suffered falls at the home.

The management and staff were aware of the need to ensure the safety of people and had put in place a number of practical measures in an attempt to reduce the number of people falling.

However, these systems and safety measures were not always effective or being followed appropriately. Additional measures and improvements to existing systems were identified, at this inspection, that the service needs to put in place to further reduce the risk of people falling at the home. We have made a recommendation about falls prevention.

At our last inspection of this service on 8 February 2016, the provider was in breach of the regulation relating to medicines management, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that covert medicines were not being administered correctly and there was a lack of information on ‘as required’ (PRN) medicines, including when these medicines should and should not be given.

The provider sent us an action plan after the inspection detailing how they would address the breach in order to ensure medicines were being managed safely. At this inspection we found that progress had been made, medicines were managed safely and the provider was no longer in breach of this regulation.

This inspection took place on 26 July 2016 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springview on our website at www.cqc.org.uk.

Springview provides accommodation for 58 older people some of whom are living with dementia.

There was a registered manager in post. 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.

All of the issues we found with medicines at the last inspection had been addressed. We found that the process for covert administration was now safer, and information on 'as required' medicines (PRN) were in place, as required by current national medicines guidance.

The provider was no longer in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The service met all of the regulations we inspected against at our last inspection on 2 August 2013.

This inspection on 13 August 2014 was unannounced. Springview is a care home on four floors that provides care for 58 elderly people, some of whom have dementia. There were 54 people living at the service when we inspected. The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us they felt safe. Staff knew how to recognise and respond appropriately to incidents or allegations of bullying, harassment and abuse. Staff were aware of people’s individual risk assessments which included moving and handling and falls.

Medicines were disposed of correctly. However, we found some medicines were not stored correctly and staff needed further training and guidance to help them administer all medicines correctly.

People told us they were receiving the care they needed, they knew most of the care staff and they and their relatives had been involved in their care planning. Staff were aware of people’s preferences and had the necessary skills to provide care to people with dignity and respect.

People were supported to maintain good health, access to healthcare services and receive healthcare support. This included doctors, district nurses and physiotherapists.

People and their relatives told us people were listened to and were encouraged to make their views known and meetings took place with people using the service.

The managers of the service undertook audits and checks of various aspects of the service provided.

There were a wide range of activities available and we saw people enjoying those activities. Call bells were responded to promptly.

Assessments of people’s capacity to understand and make decisions about their care had been undertaken in line with the requirements of the Mental Capacity Act (2005), and the provider understood how the Deprivation of Liberty Safeguards (DoLS) applied to the people who lived in the home.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

We found that people gave their consent verbally, in writing and with the assistance of people significant to them. One person told us, "you can discuss what you can and can’t do". One relative told us "we are always involved."

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. Care plans showed the person's individual needs and choices including their personal care, risk assessments, emotional and health needs. The provider was working with other professionals to reduce the number of falls in the home.

Records showed that equipment was regularly maintained and serviced. People told us that the equipment was suitable for their needs and was kept clean.

Care professionals had raised concerns about the number of care staff. People, relatives and staff we spoke with told us that mostly there were enough staff to attend to people's needs. However one person told us that “they come as soon as they can but it would be good to have time to talk with staff, sometimes there are less staff at weekends”. Records showed that staffing levels had not recently been calculated based on people’s dependency.

The provider had a system in place for responding to complaints and comments made by people using the service and those acting on their behalf. Some people and relatives told us that they were aware that there was a complaints system and if they had any concerns they would speak with staff or the manager.

On the day of the inspection there were fifty five people using the service.

The home was warm, clean and had a relaxed and friendly atmosphere.

People who use the service told us that staff were kind and respected their privacy.

They told us they could talk with the manager or staff about any issues in the home.

We observed staff supporting people in a friendly and professional way and saw that people were being offered choice with regard to menus, activities and care preferences.

People who use the service were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support with their care and that staff were very helpful. People also told us they had good access to health care professionals such as doctors, district nurses, dentists and chiropodists.

People who use the service indicated to us that they felt safe at the home. They told us they had no concerns about their care but would speak with a relative or the staff if they needed to.

There were a number of effective systems in place to obtain the views of people using the service about the quality of care provided by the home.

At our last inspection of this service on 13 August 2014 the provider was in breach of the regulation relating to medicines management, Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which corresponds to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). The provider sent us an action plan after the inspection detailing how they would meet this standard. At this inspection we found although progress had been made, the provider continued to be in breach of this standard.

This inspection took place on 8 February 2016 and was unannounced. This inspection was carried out by a single pharmacist inspector. This report only covers our findings in relation to the safe management of medicines within the safe section. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springview on our website at www.cqc.org.uk

Springview provides accommodation for 58 older people some of whom have dementia.

The manager of the home has applied to be registered with the Care Quality Commission (CQC). 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.

Some of the issues we found with medicines at the last inspection had been addressed. However the revised medicines policy had not been fully implemented in 2015 as the provider told us it would be.

We found that the process for covert administration was still unsafe, and one person had continued to be placed at risk of unsafe medicines administration since our last inspection.

Information on as required medicines (PRN) and risk-assessments for people self-administering medicines were not yet in place, as required by current national medicines guidance.

The provider was still in breach of the medicines regulation, Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014).