Spring Lodge provides a residential care service for up to 46 older people. Some people using the service were living with dementia. At the time of this unannounced inspection of 27 September 2017 there were forty people who used the service.

At the last inspection of 26 November 2014 the service was rated Good. At this inspection we found the service remained Good.

A registered manager was not 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. An acting manager had recently been appointed at the service and their application to register with CQC had been submitted.

The service continued to provide a safe service to people. This included systems in place intended to minimise the risks to people, including from abuse, falls and with their medicines. Staff understood their roles and responsibilities in keeping people safe. They were available when people needed assistance and had been recruited safely.

People were complimentary about the care they received and the approach of the manager and staff. They told us that they felt safe and well cared for. Staff had developed good relationships with people. People were able to express their views and staff listened to what they said and took action to ensure their decisions were acted on. Staff consistently protected people’s privacy and dignity.

People were supported to eat and drink enough to maintain a balanced diet. They were also supported to maintain good health and access healthcare services. Systems were in place to receive, record, store and administer medicines safely. Where people required assistance to take their medicines there were arrangements in place to provide this support safely.

People were involved in making decisions about their care and support and were supported to participate in meaningful activities. They received care and support which was planned and delivered to meet their specific needs.

People were supported by staff who were trained and supported to meet their needs. They 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.

Both the manager and the staff understood their obligations under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). The manager knew how to make a referral if required. 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.

People received care that was personalised and responsive to their needs. The service listened to people’s experiences, concerns and complaints and took action where needed.

People, relatives and staff told us the manager was accessible, supportive and had good leadership skills. The service had a quality assurance system and shortfalls were identified and addressed. As a result the quality of the service continued to improve.

Further information is in the detailed findings below

We inspected on 26 November 2014. Spring Lodge provides accommodation and personal care for up to 46 older people who require 24 hour support and care. Some people using the service were living with dementia. There were 43 people using the service when we visited.

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.

At the last inspection on 9 and 15 May 2014, we asked the provider to take action to make improvements to ensure people’s needs were met, that they were protected from abuse and that their rights were upheld. The provider gave us an action plan and this action has been completed. At this inspection we saw that the improvements required had been made.

People’s needs were met because there were enough suitably qualified, trained and supported staff available to support them.

People were kept safe because there were arrangements in place to protect people from avoidable harm and abuse. People’s medications were stored and administered safely.

People were protected from harm because staff received sufficient training and support to carry out their role. Staff had knowledge of how to identify and protect people from abuse.

People were protected from the risk of having their liberty unlawfully restricted because the service was adhering to the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

People were protected from the risks of poor nutrition as they received appropriate support to eat and drink sufficient amounts.

Interactions between staff and people using the service we observed were caring, kind and staff knew people well. Staff treated people were treated with dignity and respect. Observations identified that staff responded to people's needs in a timely manner.

People or their advocates were given the opportunity to participate in care planning and to voice their views on the service. People were supported to make complaints about the service and these were acted on.

People’s care was person centred because care plans contained individualised information about their needs. Staff engaged people in meaningful and purposeful activity which took into account their individual hobbies and interests.

The management had in place a robust quality assurance process that identified issues in service provision. The management of the service promoted a positive and open culture with care staff and the management of the service was visible at all levels.

We carried out this inspection because we had been contacted by the Suffolk County Council safeguarding team informing us that they had received a referral about this service which gave them reason to be concerned about the safety of the people who used the service. We carried out this visit with one of the safeguarding team to see if the concerns were substantiated.

We did not talk to the people who used the service on this occasion because we arrived at 10pm and most of the people were in bed.

The majority of the people staying in Spring Lodge were living with dementia and were unable to tell us about the quality of care they received. To enable us to assess people’s wellbeing we spent time sitting with them, observing the care they received and the level of staff interaction with the people.

During our inspection we observed that the staff were attentive to people’s needs. Staff interacted with people who used the service in a friendly, respectful and professional manner. We saw that staff were proactive in providing people with activities and pastimes.

We observed that staff received training essential for caring for older people and when we talked to staff we found that they were knowledgeable about the people they supported.

We spoke with four people who used the service and they told us that they were comfortable living in the service and also that staff were good to them. One person said, “Look (indicating the room), I have what I need.” The same person also said that, “The food is fine, I certainly get enough.”

The building was comfortable, clean and well maintained. We saw that the service had taken precautions to protect people from Infection and that staff had received training in infection control and food hygiene.

Medication was managed and dispensed effectively and the provider had systems and procedures in place to regularly monitor and assess the quality of the service provided.

The majority of the people staying in Spring Lodge were living with dementia and were unable to tell us about the quality of care they received. To enable us to be able to assess people’s wellbeing we spent time sitting with them, observing the care they received and the level of staff interaction with the people.

During our inspection we observed that the staff were attentive to people’s needs. Staff interacted with people using the service in a friendly, respectful and professional manner. We saw that staff sought the agreement of the people using the service before providing any support or assistance.

We observed that staff received training essential for caring for older people and when talking to staff we found that they were knowledgeable about the people they supported.

People told us that they were comfortable living in the service and also told us that they had not needed to make a complaint. One person told us that, “This isn’t too bad, I’ve lived in worse places.” The same person also said that, “I have nothing to complain about.”

The building was comfortable, clean and well maintained. We saw that health and safety checks are carried out and that equipment was kept well maintained.

People were encouraged and supported to make complaints. The manager told us that they tried to ensure that complaints were dealt with informally and that they had not had a formal complaint for several years.

The majority of the people who used the service lived with dementia and they varied in their abilities to share their views with us about the service that they were provided with. We observed the care and support provided to people and how they interacted with staff. We also spoke with eight people who used the service.

Four people who used the service told us that they were happy with the care that they were provided with. They were complimentary about how they were treated by the staff. One person said ‘they are all nice’ and another said that they felt that the staff treated them with respect. A person told us that the staff assisted them when they asked for help. Another person told us that they chose what they wanted to eat and they said that they had enjoyed their lunch.

During our visit we saw that the staff interacted with the people who used the service in a caring, respectful and professional manner. People responded to the staff positively with smiles and laughter. Where people asked for assistance or showed signs of discomfort or distress the staff acted promptly to ensure that their needs were attended to.

People were seen to participate in various activities throughout the day such as playing ‘name games’, playing board games, bouncing a ball to each other and listening to music.

During this inspection we spoke with six people who used the service, three relatives, two healthcare and one social care professionals. Prior to this inspection the Care Quality Commission (CQC) had received feedback from three people who told us that their experience of the service had not lived up to their expectations. Issues raised with us were around the service’s admission procedures, early morning routines, unexplained bruising, and level of support people were given to maintain their oral health. Therefore we brought the service’s planned inspection forward and looked at the issues which had been raised.

We looked at five people’s care records. Other records viewed included information on staff training, staff supervision, medication and health and safety. We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service a member of staff asked to see our identification and asked us to sign in the visitor’s book. We saw all visitors to the service were asked to sign in. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

People were provided with a clean, safe and well maintained environment which supported their dementia needs. The use of bright colours, signage, themed areas and objects provided a stimulating homely environment to support people living with dementia.

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

We found action was needed by the provider because people were not protected from the risk of abuse. This was because the recording and monitoring of how people obtained a bruise were not robust enough. Therefore there was insufficient information to identify the possibility of abuse and prevent abuse from happening.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse, Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). No DoLS applications had been made. However, discussions with the registered manager identified that they were not aware of the latest changes. This meant that they had not reassessed people to identify when a DoLS referral was required.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person told us, “I am very comfortable.” One person’s relative said, “As far as we know (person’s) needs are being met.” Another relative who told us that, “Carers are usually the same ones, I think carers are a key point, those who love the job, between those who are doing a job.”

We found action was needed by the provider to ensure people’s individual oral health needs were met. This was to ensure that where a person’s care plan stated that they required assistance, it was given.

Staff were supported through supervision and appraisal which provided staff with constructive feedback on their work practice.

People’s care records showed that care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare. We found that staff had a good understanding of how dementia impacted on the daily lives of people living with dementia.

Is the service caring?

People were supported by kind and attentive staff. One person who lived in the service told us, “Staff are wonderful, always smiling.” Another person told us, “I love it here,” as they walked up to a member of staff and gave them a hug.

Throughout our inspection we saw positive staff interaction as they supported people living with different stages of dementia. This was because we saw staff demonstrated genuine affection, care and concern for people. There was acceptance of a person’s reality. This meant where the impact of living with dementia affected a person’s memory, that staff did not patronise or correct them. Instead we heard staff instigate meaningful conversations, which supported the person to feel valued.

One person's relative said, “I think they (staff) are very kind.”

Is the service responsive?

People’s preferences and choices were taken into account and listened to. We saw staff involved people in making decisions and acted on the information they received.

However, we found improvements were needed to ensure that people’s preferences for when they wanted to get up were followed. The service needed to demonstrate that when night staff assisted a person to get up, it was in their best interest and not to fit into the service’s routines.

This was because where people lacked the capacity to inform night staff that they wanted to get up early, care records did not state if it had been through choice, or a best interest decision. When we pointed this out to the management, they took responsive action and called a staff meeting. Where on the first day of our inspection we identified a person had got up at 5.45am three days in a row, when we returned, we found that they had been getting up between 8am and 8.30am.

People’s care records showed that where concerns about their health and wellbeing had been identified that staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from healthcare professionals which included a doctor, community nurse, dentist and dietician.

Is the service well-led?

The service had quality assurance systems in place and records seen by us showed that identified shortfalls were addressed. We found the provider had listened to feedback they had received from people who used, or had contact with the service. As a result the quality of the service was continually improving.