We carried out an unannounced inspection of Spencefield Grange on 1 September 2015. We found people’s care needs and risks were not always assessed or reviewed regularly. The care plans we looked at were not up to date and lacked sufficient information for staff to support people safely. The management, administration and recording of medicines were not always safe. The provider did not always follow the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards where people were unable to give their consent. The provider could not effectively monitor the quality of care provided consistently because some audits and quality checks we looked at were not always carried out to improve the service provided. The service did not have a registered manager in post although a manager had been appointed. We issued requirement notices as the provider was in breach of legal requirements. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

This inspection took place on 10 August 2016 and was unannounced. At the time of our inspection there were 50 people in residence.

This report covers our findings in relation to the breach and other areas that required improvements at our last inspection visit. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the 'all reports' link for Spencefield Grange, House on our website at www.cqc.org.uk

A registered manager was 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.

People’s care needs were assessed including risks to their health and safety. Plans had been put into place where potential risks were identified along with clear guidance for staff as to their role in promoting people’s safety. Care plans were updated and centred on people’s needs, which included the measures to help promote their safety and independence. Care plans provided staff with clear guidance about people’s needs which were monitored and reviewed regularly.

People received their medicines at the right times. We found there was clear guidance for staff to follow and the systems to store, manage and administer medicines safely were safe.

People felt safe at the service. Staff were trained in the safeguarding procedure and understood their responsibility in protecting people from the risk of harm.

People lived in an environment that was safe, which people could use safely and promoted the lives of people living with dementia. The premises and equipment were routinely serviced and maintained.

People told us they were provided with a choice of meals that met their dietary needs and preferences. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

People’s consent had been appropriately obtained and recorded. Staff understood the principles of the Mental Capacity Act and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

Staff were recruited in accordance with the provider’s recruitment procedures. People’s needs were taken into account to ensure there were sufficient numbers of staff to promote their safety and wellbeing. Staff were supported through regular supervisions and meeting to ensure they had the knowledge and skills to support people.

Staff received support and guidance from the registered manager, through supervision and meetings. Staff confidence and knowledge has increased through the provision of further training, which has increased their conf

This inspection took place on 1 September 2015 and was unannounced.

Spencefield Grange is a care home that provides residential care for up to 60 people and specialises in caring for older people including those with physical disabilities, mental health needs and people living with dementia. The accommodation is over two floors, accessible by using the lift and stairs. At the time of our inspection there were 49 people in residence.

A registered manager was not in post. The service has been without a registered manager since December 2014 however there has been an acting manager in place since this date.

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 told us they felt safe at Spencefield Grange. Staff had a good understanding of safeguarding (protecting people from abuse) and knew how to keep people safe.

People’s care needs were assessed including risks to their health and safety when they started to use the service. However, risks to people’s health and wellbeing were not monitored or reviewed regularly. Care plans which staff referred to were not reflective of people’s current needs; therefore staff relied on any new information shared at the handover meetings. That meant people may at risk of receiving unsafe or inappropriate care.

The systems to store, manage and administer medicines safely were not followed correctly. Further action was needed to ensure the national guidance was followed in relation to safer management and administration of people’s medicines.

Staff were recruited in accordance with the provider’s recruitment procedures, which helped to ensure suitable staff were employed to look after people.

People lived in an environment that was kept clean. All the bedrooms had an ensuite facility and were personalised to reflect people’s interests and taste.

Staff received an induction when they commenced work and on-going training to support people safely. We saw staff used equipment to support people correctly. Staff received support through meetings and staff appraisals.

We found the requirements to protect people under the Mental Capacity Act and Deprivation of Liberty Safeguards had not been followed. Further action was needed to ensure a mental capacity assessment was carried out to so that people’s wishes were known and kept under review. Where a person lacks capacity to make decisions or are unable to do so, then the provider must act in accordance with their legal responsibilities to ensure that any best interest decisions made involved the relevant people and health care professionals.

People were provided with a choice of meals that met their dietary needs. Drinks and snacks were readily available. People at risk of poor nutrition had assessments and plans of care in place for the promotion of their health.

People’s social needs were met. People received visitors and spent time with them as they chose. There were a range of opportunities for people to take part in hobbies and activities that were of interest to them.

People’s health needs were met by nurses and other health care professionals. Staff sought appropriate medical advice and support form health care professionals when people’s health was of concern and were supported to attend routine health checks.

People told us that they were treated with care and that staff were helpful. We observed staff respected people’s dignity when they needed assistance.

People were involved in making decisions about their care and in the development of their plans of care when they first started to use the service. Care plans were not up to date to reflect people’s current needs and how staff should support them. People were not always consulted or involved in the review of their care plan. Where appropriate the relatives or relevant health care professionals were not involved or consulted with regards to reviewing people’s needs to ensure staff provided the care that helped to maintain people’s safety and wellbeing.

People were confident to raise any issues, concerns or to make complaints, which would be listened to and acted on appropriately. Records showed complaints received had been documented.

Staff knew they could make comments or raise concerns with the management team about the way the service was run and knew it would be acted on.

The provider currently supports the manager to manage the service. The acting manager was in post over six months. However, they had not yet submitted an application successfully to become the registered manager

The provider’s quality governance and assurance systems were not used effectively and consistently to ensure people’s health, safety and welfare. We found gaps in the records for daily checks which the management team were not aware of. The internal audits were not always completed in full and actions to address any shortfalls were not monitored and sometimes not addressed. Therefore, the provider could not effectively monitor the improvements because the issues found were not always recorded and no plan of action developed.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We recently undertook an inspection visit to Spencefield Grange to check that people received their medicines on time. We spoke with three people who used the service and reviewed people’s medication records. We spoke with two relatives. We spoke with visiting health care professional. We spoke with three staff supporting people and reviewed their training records. We also reviewed the records in relation to the management of the service. We considered all the evidence we had gathered under the outcomes we inspected.

Is the service safe?

We found the provider had safe systems and procedures in place for the ordering, receiving and storage of medicines into the service; and the administration and disposal of medicines. People told us they received their medicines on time. The relatives we spoke with were confident that their family member received their medicines reliably. One relative said “I haven’t got any concerns about this place. I know the staff will call me immediately if he’s not well.” This showed that people who used the service and their relatives were confident that people’s health and wellbeing was protected.

We recently undertook an inspection visit to Spencefield Grange. We spoke with five people who used the service and reviewed four people’s care records. We spoke with three relatives. We spoke with five staff supporting people and reviewed their training records. We also reviewed the records in relation to the management of the service.

Is the service safe?

People told us they felt safe and secure because they were cared for in an environment that had been well maintained. Communal areas were furnished and decorated to a good standard to promote people’s wellbeing and safety and individual rooms were personalised to reflect each person’s interests.

People’s needs were met as staff had been trained to look after people safely. One person said, “I’ve stayed here on a number of occasions and know staff try to keep us all safe.” Staff we spoke with were able to describe the different ways to support people with dementia and understood what action to take to meet their needs safely and reliably.

Staff rotas we checked showed there were sufficient staff on duty to meet people’s needs at all times. Staff we spoke with had the knowledge, skills and training required to support people to ensure they received a consistent and safe level of support.

Is the service effective?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff training records showed that relevant staff had been trained in Mental Capacity Act 2005 and DoLS. The registered manager had acted in accordance with their responsibilities and referred people to the appropriate authority when they had a concern about a person’s capacity to make decisions. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met reliably.

People told us that they were happy with the care that had been delivered and that their needs had been met. Records we looked at showed people’s care needs were met and that they had access to a range of health care professionals. One person said they preferred to remain in their room and that they used the call bell when they needed any assistance from staff. It was clear from our observations that staff had a good understanding of people’s care and support needs and that they knew them well.

Staff told us they were trained for their job role to help ensure people’s needs were met reliably. Staff training certificates and training matrix we looked at confirmed the provider had taken steps to ensure staff kept their knowledge and skills up to date in line with current best practice.

Is the service caring?

People were supported by kind and attentive staff. We saw staff supporting people to do things at their own pace and saw they were not rushed. Staff offered encouragement and praise when supporting people. People told us that staff were caring and supported them in a manner that respected them as a person. One person said, “I’m quite lucky that my family visit me and I enjoy that.” Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Staff were aware of people’s preferences, interests and cultural needs. This included supporting people to continue to observe their religious or spiritual beliefs and to go out on other outings. One person had a daily newspaper delivered which they read in the privacy of their room. Another person who enjoyed doing arts and crafts said, “I’m very happy with the care I get which is just as important as keeping my brain active by doing lots of different things that I enjoy.”

People were given information about the advocacy service when they moved to the home. This meant that people could access additional support and/or advice when required. Staff had received ongoing training to help ensure the needs of people living at the home would be met.

Is this service responsive?

People’s needs had been assessed before they moved into the home. People told us they were involved in reviewing their plans of care when their needs changed. People had access to health care professionals such as the doctor and/or the community nurse to meet their specific health needs. Records confirmed people’s preferences and expectations had been recorded and care and support had been provided in accordance with people’s wishes.

Is this service well led?

People’s personal care records and other records kept in the home were accurate and up to date. People’s care and support needs were reviewed regularly to make sure any new needs could be met reliably. Records showed the home’s staff worked with other agencies and services to help ensure people received their care and support that was joined up.

The home had a system in place to assure the quality of service they provided and act on any feedback and comments received. This included surveys to gather the views of people who lived at the home, relatives and/or representatives. Regular meetings were held at the home where people could share their views and experiences. The complaints policy and procedure was effectively used for the benefit of people living at the home and for making continued improvement to the quality of service provided.

Regular checks were carried out to ensure people’s health, safety and wellbeing was protected. Information from analysis of incidents and accidents had been used to identify changes and improvements to minimise the risk of them happening again. Prompt action had been taken to improve the service and put right any shortfalls that were found.

People told us they were pleased with the care provided at Spencefield Grange. Comments included, “I am happy with the care here and the staff look after me very well.” And, “The care is good and I have everything I need.” One person said staff helped them maintain their independence. They told us, “I like to do things for myself as much as possible so I only need the staff for certain things, but when I do need them they are there.”

We observed lunch being served in the dining room. People told us they liked the food. One person said, “The food is fine – I’ve no complaints.” Another told us, “Good food. We get a choice at every meal.” The menu was written up on a large board for people to see and both English and Asian dishes were served.

The home was purpose-built and had four lounges, an activity room, a conservatory, and a large dining room. This meant the people who used the service had a choice about where they spent their time. One person told us, “There lots of space here if you need it and quiet places to go if you prefer a bit of solitude.”

People told us they liked the staff at Spencefield Grange and were satisfied with the care provided. One person said, “The staff are really good – I wouldn’t be here if they weren’t.” Another person told us, “The staff are very kind.” Staff were warm and friendly in their approach to people and had a good understanding of their needs.

People told us they liked living at Spencefield Grange and the care was good. One person said, “I am well looked after here, the staff get things for me and do things for me, I have all the help I need.” Another told us, “The staff give me a lovely shower in the morning.” Activities were popular in the home and people commented on how much they enjoyed them. One person said, “I love going out in the minibus – the staff take us all round and they always make sure we have seatbelts on.”

We observed people socialising in various parts of the home. As it was a sunny day some people were sitting outside and staff had provided umbrellas and sunhats. Others were taking part in activities in the lounges, or were in their bedrooms. One person told us, “I like the peace and quiet in my room so I stay there but I could go in the lounges if I wanted.”

People told us they felt safe in the home and knew who to go to if they had any concerns. One person said, “I am here because it’s safe and I trust the staff.” Another said, “If I wasn’t happy I would talk to the manageress.” People also said staff treated them with respect. One person told us, “They are always nice and kind and they never get cross or order me about. They are nice to all of us.”

People said they liked the staff team and got on well with them. One person told us, “The staff are very helpful and if I need them I press the buzzer and they come to me.” We observed staff spending time with people, chatting to them and taking an interest in what they were doing. One member of staff said, “Once our jobs are out the way we can talk to the residents – it’s the best part of what we do.”

People told us the home was well-run and staff and management were approachable and easy to talk to. One person told us, “This is a good home and the manager seems to be on top of things.” They also said they had opportunities to speak out and share their views at residents meetings. One person told us, “If we have anything to say we can go to the residents meetings and then our comments get passed on to the manager.”

We spoke with people who were visiting their relatives. They told us when we asked for their views about the care provided “absolutely fabulous, very, very happy. I have no concerns about the care they receive.” I can’t fault the staff they are very caring.” Visitors told us that the management team keep them updated about the health and welfare of their relatives and contact them should they become unwell.

We spoke with people at lunchtime and asked them for their views about the food. “The food here is lovely; I have a very healthy appetite.” Whilst some one else said “I like the food here, there’s always plenty and your given a choice as to what you want to eat.”

A visiting health care professional told us that referrals are appropriately made by the service and that staff work well with them and follow their advice and instructions, which have brought about improvements to the health and wellbeing of people

People are offered assistance and support by staff who spoke with them with courtesy and respect. We saw staff encourage people to take part in activities, and a relative we spoke with told us about the day trip their relative had been on. Staff told us that people are encouraged to take part in activities, which include art and craft sessions. Evidence of things made by people is on display.

Staff told us about the training they receive and how this enables them to provide the care and support people need. They told us that they encourage people to maintain their independence and how they encourage people to make decisions about their daily lives.