The inspection took place on 11 December 2018 and was unannounced.

At our last inspection in October 2017 the service was rated ‘Requires Improvement’. At that inspection we identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This breach was in relation to the safe management of medicines. We also had concerns about the management and governance of the service. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe and well-led to at least good.

At this inspection we found that the registered provider had addressed all these issues. At this inspection the service was rated ‘Good’.

Spring Lane is a care home registered to provide accommodation and personal care for up to 63 older people, some of whom are living with dementia.

People in care homes receive accommodation and 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. At the time of our inspection there were 50 people living in the home.

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.

People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

Staff understood their responsibilities to protect people from abuse and knew how to raise any concerns with the appropriate safeguarding authorities.

Risks to people’s safety had been identified and the management had thought about and recorded ways to mitigate these risks.

Staff understood their roles and responsibilities in relation to maintaining high standards of cleanliness and hygiene in the premises.

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

There were enough staff on duty to support people safely.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood the principles of the Mental Capacity Act 2005 and knew that they must offer as much choice to people as possible in making day to day decisions about their care.

People were included in making choices about what they wanted to eat and staff understood and followed people’s nutritional plans in respect of any cultural requirements or specific healthcare needs people had.

Both people who used the service and the staff who supported them had regular opportunities to comment on service provision and made suggestions regarding quality improvements.

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

Staff treated people as unique individuals who had different likes, dislikes, needs and preferences. Staff and management made sure no one was disadvantaged because of their age, gender, sexual orientation, disability or culture. Staff understood the importance of upholding and respecting people’s diversity. Staff challenged discriminatory practice.

Everyone had an individual plan of care which was reviewed on a regular basis.

People were supported to raise any concerns or complaints and staff understood the different ways people expressed their views about the service and if they were happy with their care.

This unannounced inspection of Spring Lane was undertaken on the 5 October 2017 and was carried out by one inspector and one inspection manager.

We carried out an unannounced comprehensive inspection of this service in April 2017. The Care Quality Commission (CQC) recently received anonymous concerns in relation to the management of medicines, staffing, personal care, hygiene, nutrition and hydration and governance.

As a result of these recent, anonymous concerns we undertook this focused inspection. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Spring Lane on our website at www.cqc.org.uk

At our last inspection, this service was rated ‘good’ overall with well-led being rated as ‘requires improvement’. At this inspection safe had been rated as ‘requires improvement’ and well-led remains as ‘requires improvement’. The overall rating for this service has changed to 'requires improvement'.

Spring Lane is a care home registered for a maximum of 63 adults some of whom are living with dementia.

The previous registered manager had recently resigned and the provider was in the process of advertising for a new manager. 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.

Staff used an electronic system for the management of medicines at the home. This had reduced the risk of errors but medicines were not always being stored securely.

The registered provider was not always notifying the Care Quality Commission about certain changes, events and incidents that affect their service or the people who use it.

Windows fitted at the home required reviewing by the provider to ensure they were meeting the requirements of current health and safety legislation.

After the former registered manager had resigned, an acting manager had been employed to manage the home. This manager was being supported by a number of other managers. However, this had led to an overly complex management structure which both staff and people using the service told us they often found confusing.

People and their relatives had mixed views about the openness of the management and staff told us that communication was an issue at the home.

We did not find any evidence to substantiate the other anonymous concerns that were raised with the CQC. These concerns related to personal care, hygiene, staffing and nutrition and hydration.

People were provided with sufficient to eat and drink and mealtimes were relaxed and unhurried.

People told us they liked the staff and they there were generally enough staff on duty to meet their needs.

There were enough domestic staff on duty to ensure the home was clean throughout and to limit the risk of cross infection.

We found two breaches of regulations during the inspection. These were in relation to the management of medicines and notifications of incidents.

We inspected this service on 24 April and 4 May 2017. The inspection was unannounced. Spring Lane is a care home registered for a maximum of 63 adults. At the time of our inspection there were 52 people living at the service.

The service is located in a large purpose built building. We previously inspected the service on 22 March 2016 and the service was found to be meeting the regulations inspected.

Spring Lane had a registered manager at the 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.

We found staff were caring and kind to people living at the service. People laughed and joked with staff and each other, and the home had a relaxed and friendly atmosphere. Visitors brought in their dogs and there was a buzz of energy in the main reception area where people routinely sat.

We found that in the last year there had been two occasions when the provider had not followed their own recruitment process. However, the provider could show with more recent recruitment, all appropriate checks had been undertaken before staff began work.

On the day of the inspection we saw there were enough staff to meet people’s needs. The provider was using agency and bank staff to fill vacancies and interviews had taken place to recruit to vacant posts.

The service was clean throughout and in good décor. People’s rooms were personalised and homely.

Medicines were stored securely, within temperature range and administered safely. The provider had recently implemented an electronic system of monitoring the medicines that were given to residents and this had provided a number of benefits to the service, including quickly identifying any errors.

Risk assessments, were on the majority of care records to provide guidance to staff in relation to identified risks. New processes had been introduced in the last 12 months to reduce the risk of falls.

Staff told us they received appropriate support through training and supervision and we saw regular staff meetings took place. Staff told us they could contribute their views to the running of the service.

There were a wide range of activities taking place at the service and there was a specific activities worker for people with significant cognitive impairments. There was also a Namaste programme designed to improve the quality of life for people with advanced dementia.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We could see the provider was compliant with DoLS.

There were elements in which the service was well led. In the last 12 months increased quality assurance processes had been introduced. We could see systems were being implemented to prompt key activities such as supervision, training and renewals of DoLS applications. Audits of care records took place on a regular basis. Senior managers reviewed key indicators on a weekly basis and an action plan for the service had been developed to continually improve the service and was being implemented. The provider had introduced a new electronic medicine monitoring system and planned to roll out an electron

We inspected this service on 22 March 2016. The inspection was unannounced. Spring Lane is a care home registered for a maximum of 63 adults. At the time of our inspection there were 57 people living at the service.

The service is located in a large purpose built building. We previously inspected the service on 20 February 2014 and the service was found to be meeting the regulations inspected.

Spring Lane had a registered manager at the 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.

There was a warm and friendly atmosphere at the service. The staff we met were caring and kind and treated people with dignity and respect. People using the service informed us that they felt safe at the home and the staff in general were kind and patient.

Care records were not always easy to read because of handwriting or to navigate through due to the system for collating the information. Although care plans were up to date they were not always person centred.

People living at the service had good access to healthcare and relatives told us they were kept fully informed if there were any changes in people’s health conditions.

People living at the service were relatively happy with the food. We were told by people living there and their relatives it had improved recently. We saw there was a plentiful and varied range of food available. People’s cultural and religious needs were facilitated by staff.

We looked at the administration of medicines. Medicines were stored safely and controlled drugs were safely administered and recorded. There were some issues with the recording of ‘as needed’ medicines. We also noted medicines for one person were being crushed without the necessary paperwork fully in place. This was rectified by the manager following the inspection.

Staff had been carefully recruited. Staff felt supported and there was evidence of regular supervision taking place in the last 12 months. Staff knew how to recognise and report any concerns or allegations of abuse and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

There was documentation relating to complaints and incidents in place, and people’s money was well managed.

There was a wide range of activities at the service with good community links. The two activity co-ordinators had devised differing plans to cater for the broad range of needs in terms of people’s cognitive abilities and preferences.

The registered manager carried out audits in some key areas but in other areas there was a lack of records to confirm actions the registered manager told us he had taken. The registered manager had a visible presence within the home, and was thought well of by the people living at the service and their relatives. Whilst staff meetings with senior care workers took place regularly, there was less evidence of meetings with the majority of care staff in the last 12 months.

The service was located in an accessible building on five floors with a lift to each floor. Communal bathrooms had accessible bathing equipment. There was a garden at the rear of the premises for use by people living at the service.

We found the building was clean and tidy, although there were some issues with monitoring infection control in some areas. We have made a recommendation in relation to this.

We undertook this inspection in response to concerns raised with the Care Quality Commission regarding the quality of the records of care kept at the home. We found that people were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We saw that people had their needs assessed and that plans were put in place to meet these needs. Daily records were maintained and where required records were kept monitoring aspects of a person’s care, for example their fluid intake.

In the inspection we also looked at the processes for managing medications. We found that people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines.

In undertaking the inspection we spoke with eight residents, three relatives of people living at the home, seven members of staff and a GP visiting the home. We also spent time observing staff interacting with people, looked at the care files for 10 people and looked at other general records of care.

When we spoke with people who lived at the home and their relatives they were generally positive about the home. The following are examples of the comments we received from the residents we spoke with and their relatives:

“It is lovely here. They do the best they can do. The staff are very nice."

“We have been very impressed. Generally felt involved. Staff are very good.”

“I feel in control. I can say no. We can do dancing.”

“I think it is good.”

“In general we have felt involved. We have felt able to raise concerns whenever we have had them.”

On the day of the inspection there were 11 care workers on shift at the home. In addition to this there was one activities co-ordinator. In general, the interactions we saw between staff and residents were positive, with staff spending time interacting with people in a kind and respectful way. All residents were dressed appropriately and looked well cared for. We observed an organised art activity being undertaken with residents in the morning. We saw that they seemed to be enjoying this activity. When we observed lunch on the fourth floor unit we saw staff supporting people to eat.

We visited the home on a weekday evening, at which time there were fifty-one people living at the home (twelve vacancies). We spoke with twelve of them and spent time on each floor of the home. We also spoke to eight staff members including some members of night staff, and looked at eleven people's care records.

People we spoke with told us that they were happy living there, and that they were treated with respect by staff. People told us ” “I like it here,” “It’s very nice,” “I’m looked after well,” “Everything seems fine to me,” and “Right now it’s perfect.” We observed staff supporting people appropriately and attempting to maintain people’s independence as far as possible.

People spoke positively about the home environment and indicated that they received sufficient support from staff and that there were enough staff to meet their needs effectively. Staff confirmed that they had received appropriate training relevant to their role. A new manager had been appointed for the home, with an acting manager covering until they commenced work. Appropriate quality assurance systems were in place for the service, to ensure that people received a high standard of care and support.

People told us what it was like to live in this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective, and a practising professional. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. At Spring Lane there were a number of people who had dementia or found it difficult to communicate.

People told us ”If I had to give a mark out of ten I would give this home nine and a half,” “The care I get is terrific,” and “It’s the best care home – I’ve been round 23 others.”

All of the people we spoke to told us that they were happy living there, and that they were treated with respect by staff. We observed many examples of staff supporting people in a friendly manner that respected their dignity.

People were happy with the food provided to them at the home, and we noted that there was a choice of foods available at mealtimes, including cultural choices and foods to meet people’s specific nutritional requirements.

People indicated that they received sufficient support from staff and that there were sufficient staff to meet people’s needs effectively.

People told us that they felt safe at the home, and the home had effective systems in place to ensure that people were protected from abuse.

We talked to people living in the home and spent time observing the care and lifestyle that people experience. Overall the feedback was that people are provided with the care that they need, and are well settled in the home. They are given choices and have formed good and supportive relationships with staff.

People were very positive about the support provided by staff at the home, with comments including ‘you can say you met one satisfied customer!’ ‘It’s nice here,’ and ‘I’m glad I came here, isn’t it lovely?’ Most people liked the food, and enjoyed activities provided for them at the home.

People said that staff asked them what their needs and wishes were, and met these as far as possible. However an improvement is needed in the frequency of supervision and training for new staff members. They confirmed that they received their medication at the prescribed times, and that they saw healthcare professionals when needed. However improvements are needed regarding a small number of areas relating to medication storage and administration.

People were clear about who they could speak to if they had a complaint or felt at risk of harm. Appropriate quality control procedures are in place for the home so that people know that their views are taken into account.