The last inspection took place in February 2018 and Spring House was rated as requires improvement in all domains except safe which was rated inadequate. We found continued breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because the service had not kept people safe and was not effectively monitoring the quality of the service. We also found breaches of Regulations 11 Need for Consent, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took action and served a requirement notice on the registered provider in respect of these breaches. An action plan was received from the provider to show what actions would be taken to meet these regulations.

This inspection took place on 19 July and was unannounced. A further visit was carried out on 20 July 2018. We undertook this inspection to check that the provider had taken action to meet legal requirements and to comprehensively inspect the service against all of the areas services are required to comply with. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Spring House Residential Care Home' on our website at www.cqc.org.uk.

Spring house 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. Spring house accommodates up to 21 people in one building. There were 12 people living at the home at the time of this inspection.

The service had a manager who had registered with the Care Quality Commission in June 2018. 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.

During this inspection we found a number of significant improvements had taken place under the leadership of the new registered manager. The provider had taken action and implemented sufficient improvements to their systems, processes and practice which meant they had met the breaches of regulation imposed at the previous inspection. The overall rating has improved to good.

Care planning documentation had improved and focussed on what was important to the individual. People's likes and dislikes were recorded and the staff we spoke with knew people well. Risks to people had been assessed and measures put in place to reduce these risks.

Where people presented with behaviours that placed others and themselves at risk of harm, staff knew how to distract and divert people. The guidance contained in some care plans was not sufficiently detailed on how staff were to manage these levels of anxiety when people became frustrated. For example, what techniques were to be used to distract people. We have made a recommendation about this.

Further work was needed to embed the correct application of Mental Capacity Act legislation. Some people had assessments of capacity and records in their care files when restrictions were in place, but this was not consistent throughout the service. The registered manager acknowledged there was further work to do and was responsive, assuring us they would implement corrective actions to the concerns we raised. We have made a recommendation about this.

Staff were provided with the support, training and supervision they needed to deliver effective care. More training on how to support people with behaviours which posed a risk of harm to themselves or others had been provided to most staff. We found safeguarding referrals had been appropriately made. People using the service said

This comprehensive inspection took place on 23 November 2017. The inspection was unannounced. At the last inspection in March 2017 we found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in Regulation 12 Safe Care and treatment and Regulation 17 Good Governance of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection we requested an action plan from the provider which they provided.

At this inspection we found continued breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because the service had not kept people safe and was not effectively monitoring the quality of the service. We also found additional breaches of Regulations 11 Need for Consent, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Spring House is a ‘care home’. People in care homes receive accommodation and nursing or 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. The care home accommodates up to 21 people in one adapted building. There were 17 people resident at the care home when we inspected.

There was a registered manager employed at this service. 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.

Risks to people had not been identified resulting in concerns being raised with the local authority safeguarding team by CQC. Other concerns had been raised by visiting professionals. Staff were trained in safeguarding adults but had not identified or reported concerns.

Staff recruitment procedures were robust. However, there were insufficient numbers of staff on duty to meet people’s needs safely. One to one planned care had not always been provided.

Servicing and maintenance of the environment had been carried out in a timely manner except for the servicing of one lift.

The provider had not ensured training was up to date for all staff and staff knowledge and skill in dealing with behaviour that challenged them was only completed by half of the staff. People were not always protected by competent staff.

People were not always supported to have maximum choice and control of their lives and staff had not supported them in the least restrictive way possible; the policies and systems in the service were clear and supported this practice. Staff had not followed the correct process for making best interest decisions in line with company policy. In addition staff had restrained people by locking them in their rooms.

People’s nutritional needs were not always met and records to support people’s nutritional needs were incomplete.

Staff were described by people as being caring and we saw some positive interactions between people and staff. However, some people were not supported appropriately by staff.

Activities took place but were not always meaningful to people living with dementia. We had recommended at the last inspection that activities were developed further but could see little evidence of progress at this inspection.

The environment had some areas that were dementia friendly but others did not fully meet the needs of people living with dementia. The outdoor space was dementia friendly and allowed people to walk freely and safely.

There were no recorded complaints despite two complaints been made. There were no records of actions taken.

The quality assurance system was ineffective. Audits had been completed in some areas but did not have information about actions to be

Spring House is registered to provide accommodation and personal care for up to 21 older people, some of whom may be living with dementia. The accommodation is over three floors, with a lift to the first floor and chair lift to the second floor. It is located in the seaside town of Hornsea.

The inspection took place on 23 and 28 March 2017. The first day of the inspection was unannounced.

The service was registered in September 2015, and this was its first rated inspection. The service had been temporarily closed for refurbishment between May and November 2016, so had been re-open for four months when we visited. At the time of our inspection 17 people used service.

The registered provider is required to have a registered manager and 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.

There were policies and procedures in place to ensure people received their medicines but these were not always consistently followed and systems in place were not sufficiently robust. This was a breach of legal requirements. Quality assurance processes had not identified or addressed a number of issues we found during our inspection, in order to drive improvement. This was also a breach of legal requirements and you can see the action we have asked the provider to take at the back of the full version of this report.

There were systems in place to help make sure people who used the service were protected from the risk of abuse. People’s needs were assessed and risk assessments were in place to reduce risks and prevent avoidable harm. However, not all risk assessments had been reviewed in a timely manner. Improvement was required to the recording and analysis of incidents at the service, in order to ensure the risk of reoccurrence was minimised. More detail was required in some behaviour management care plans, to give clearer guidance to staff of how respond when people presented distressed behaviours. We did see that staff responded calmly and appropriately to incidents that occurred during the inspection.

The home had undergone extensive refurbishment in the year prior to our inspection and the registered provider employed domestic staff. However, we found some areas of the home were untidy and had not been cleaned effectively. Some of these issues were addressed during the inspection. We have made a recommendation that the registered provider takes action to ensure best practice in relation to infection prevention and control is consistently followed.

The registered provider had a safe system for the recruitment of staff and was taking appropriate steps to ensure the suitability of workers. There were mixed views about whether there were sufficient staff to meet people’s needs. After re-opening the service in November 2016 a significant number of people had moved into the home in a relatively short period of time. We found the registered provider had recruited new staff in order to meet the needs of the increased numbers of people and they had contingency arrangements in place until additional new staff were in post.

Staff received an induction, training and supervision to enable them to provide effective care for people, although there were gaps in the recording of recent supervisions.

Staff were able to demonstrate an understanding of the importance of gaining consent before providing care to someone. However, Deprivation of Liberty Safeguards (DoLS) applications had not been submitted for all people who required an authorisation to deprive them of their liberty. The registered provider addressed this during the course of our inspection and was taking action to improve knowledge and understanding in relation to Me