This inspection took place on 18 and 26 September 2018. It was unannounced, which meant no-one knew we were going to inspect the home.

At our last inspection on the 9 June 2016 the location was rated 'good' overall, with all key questions being rated as ‘good’, except for ‘safe’, which was rated as, ‘requires improvement.’ At that time, we identified a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to safe care and treatment. Following the last inspection, we asked the provider to complete an action plan to show us what they would do and by when to improve the key question of safe to at least good.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment, safeguarding service users from abuse and improper treatment, good governance and fit and proper persons employed.

We discussed our concerns with the registered manager at the time of our inspection and requested an action plan was submitted to the Care Quality Commission within 24 hours of the first day of our inspection, to show how improvements were going to be made in order to protect people’s safety. The action plan was received within the time frame agreed and was found to be satisfactory. The registered manager provided us with an updated action plan on the second day of our inspection and we saw some improvements had been made, However, further improvements were still needed.

The Spinney Nursing Home (The Spinney) 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.

The Spinney is located in the village of Upholland. It provides accommodation for up to 35 people requiring help with nursing or personal care needs. The home is situated in its own grounds on a main road position with onsite car parking available. There are three floors served by a passenger lift. Most bedrooms are of single occupancy, although facilities are available for those who prefer to share. A variety of amenities are nearby and public transport is easily accessible.

At the time of our inspection there were 29 people who lived at The Spinney.

The service had a registered manager in post. A registered manager is a person who is 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 manager was on duty at the time of our inspection and she was co-operative and helpful throughout.

We found those who lived at The Spinney were not protected by the recruitment practices adopted by the home, as these were not sufficient to ensure all staff were fit to work with vulnerable people. This was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found concerns around fire safety and the general safety of some areas of the home. The management of risks within the environment was insufficient and therefore people were potentially at risk of harm. Some parts of the premises were dirty, which did not promote good infection control practices. The management of medicines was poor. These findings constituted a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that a system had been implemented for assessing and monitoring the quality of service provided. However, this was ineffective, as concerns identified during our inspection had not been recognised by the internal auditing system. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The Spinney is located in the village of upholland. It provides accommodation for up to 35 people requiring help with nursing or personal care needs. The home is situated in its own grounds on a main road position. There are three floors served by a passenger lift. The majority of bedrooms are of single occupancy, although facilities are available for those who prefer to share. A variety of amenities are near by and public transport is easily accessible. Car parking spaces are available.

This inspection took place on the 9 June 2016 and was unannounced.

We last inspected this service on 3 June 2014. At that time, the service was judged to be compliant in all the areas we looked at.

The registered manager of the service was present throughout our inspection. 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.

Safeguarding procedures were in place and we felt reassured by the level of staff understanding regarding abuse and their confidence in reporting concerns.

Staff were kind and respectful towards people ensuring privacy and independence was promoted. Staff understood their roles and people were supported in a person centred way.

People's rights were protected because management and staff understood the framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Management applied these measures appropriately and staff understood their responsibilities and how to keep people safe.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process.

People's views had been gathered using effective systems These included regular surveys and staff Meetings.

The service had a registered manager who was available to people who used the service, relatives and staff. People we spoke with told us the manager was approachable.

We found the manager receptive to feedback and keen to improve the service. They worked with us in a positive manner providing all the information we requested.

We reviewed accident and incident records and found shortfalls in the recording of unwitnessed falls.

We have made a recommendation with regards to following NICE guidelines for documentation around ‘as required’ medicines and ensuring the cleanliness of the property at all times.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 relating to safe care and treatment.

You can see what action we have asked the provider to take at the back of this report.

This unannounced visit was conducted by two inspectors from the Care Quality Commission (CQC). During the inspection we gathered evidence against the outcomes we assessed in order to answer our five key questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, a relative, the staff on duty and from looking at records.

If you want to see the evidence supporting our summary please read our full report.

Is the service safe?

The care and welfare of people living at the home was well planned. Any areas of potential risk were identified and strategies were implemented, in order to reduce the possibility of harm.

People told us they felt safe living at the home. Safeguarding procedures were robust and staff understood how to protect people they supported from abusive situations.

People told us they felt their needs were being met by a kind and caring team of staff, who were competent to deliver a safe service. Systems were in place to make sure managers and staff learned from events, such as accidents and incidents. This helped to reduce the risks to people and helped the service to continually improve.

People had access to choice and remained, where possible in control of decisions about their care without being put at unnecessary risk. People’s care needs were taken into account when making decisions about the deployment of staff. This helped to make sure people were kept safe and protected from harm. Recruitment practices were safe and thorough. Policies and procedures were in place to make sure unsafe practices were identified and people were appropriately safeguarded.

Is the service effective?

People’s health and personal care needs were assessed with them or their relative and they were involved in planning their own care, in accordance with their individual preferences. Specialist dietary needs had been identified where required. System were in place for people to access the local advocacy service, should they wish to appoint someone to act on their behalf.

Evidence was available to show that a wide range of external professionals and other providers were involved in the care and support of those living at The Spinney. This helped to ensure people received effective health, personal and social care.

The home had adopted effective recruitment practices, which helped to ensure only suitable people were appointed to work with this vulnerable client group. Those working at the home were well supported to deliver effective care and support.

Is the service caring?

We spoke with five people using the service. We asked them for their opinions about the staff that assisted them. Feedback was consistently positive. When speaking with staff it was clear that they genuinely cared for the people they supported.

People using the service and their relatives were asked to complete an annual satisfaction survey. Where shortfalls or concerns were raised these were taken on board and dealt with appropriately. People’s preferences and interests had been recorded and care and support had been provided in accordance with people’s wishes.

One person living at the home commented. "I think it is nice here. It is very comfortable and the staff are very caring. I have no complaints thankyou."

Is the service responsive?

People knew what to do if they were not satisfied with any aspect of the service. The service worked well with other agencies and services to make sure people received care in a coherent way. The home was responsive to people's nutritional needs so that they received a well balanced diet in accordance with their preferred choice of meals.

Is the service well-led?

The manager of The Spinney had been in post for one week only and therefore was not registered with the Care Quality Commission. However, he had submitted his application,which was being processed at the time of our inspection. The service had a quality assurance system in place and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance processes that were in place. This helped to ensure people received a good quality service at all times.

The staff we spoke with showed a good understanding of the support needs of people living at the home. We were able to observe staff following the actions outlined within written care plans.

The relatives we spoke with gave positive feedback about the care provided. Comments included; “Everything is fine. The staff are very kind.”

However some information was difficult to find and could lead to people not having their needs met appropriately or in a timely manner. Care plans addressing challenging behaviour did not provide clear information for staff to follow and did not promote a consistent approach.