This inspection took place on 4 December 2018 and 7 January 2019 and was unannounced on both days.

Spring Mount 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 can accommodate up to 25 people and specialises in the care of people living with dementia. The home offers care to younger people living with dementia. At the time of our inspection there were 22 people using the service.

Following the last inspection in September 2016 the overall rating for the service was ‘good’. During this inspection we found improvements were needed and the overall rating has changed to ‘requires improvement’.

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.

People told us they felt the service was safe. However, we found risks to people’s safety and welfare were not always managed effectively.

We found the home was clean and free of unpleasant odours. However, we found the registered providers quality monitoring systems had not been effective in identifying and dealing with risks such as those posed by radiators with hot surface temperatures.

There was an ongoing programme of refurbishment and some evidence the needs of people living with dementia had been taken into consideration. For example, the grounds were secure and people could go outside whenever they wanted. However, we found there was scope for improvement and made a recommendation about this.

People’s medicines were not always managed safely.

There were enough staff and safe recruitment procedures were followed. This helped to protect people from the risk of being supported by staff unsuitable to work in a care setting. Staff received training for their roles and told us they felt supported by the management team.

People told us the food was good.

People were not always supported effectively to access the full range of NHS services. We made a recommendation about this.

We found the service was acting in people’s best interests but this was not always reflected in their care records. Similarly, we found that although people’s relatives told us they were consulted about care this was not evidenced in the records. We found people’s care plans were not always up to date and accurate. However, staff could tell us about people’s current needs.

The service aimed to provide an enabling environment where people living with dementia were supported without the use of tranquilising or sedating medication. We observed many positive interactions between staff and people who used the service. However, we also saw examples of interactions which did not promote people’s privacy and dignity.

People were supported to take part in a range of activities inside and outside the home. However, some people felt this was an area which could be improved.

People spoke positively about the management team. They told us they felt confident any concerns they raised would be dealt with and said they would not hesitate to recommend the service to family or friends.

However, we found the registered providers systems for monitoring the quality and safety of the services provided were not always operated effectively. The management team acted quickly to address the concerns we identified during our inspection. From our discussions we were assured they were committed to making the required improvements to ensure people experienced consistently good outcomes.

We found the provider was in breach of two regulations. These were Regulation 12 (Safe care and treatmen

This was an unannounced inspection which took place on the 21 September 2016. The service was last inspected in August 2014 and was meeting the regulations in force at that time.

Spring Mount provides accommodation and personal care for 25 people who have a dementia related condition. Spring Mount supports people of working and retirement ages. 25 people were living there at time of inspection.

The service had a registered 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.

People were supported to have freedom of movement about the service and grounds, but staff had assessed any risk to their safety and wellbeing. Staff knew how to keep people safe and were aware of vulnerabilities people using the service may have had due to their dementia related condition or other individual needs. Any risks identified had clear plans drafted to ensure staff knew how to keep people safe, these plans afforded people as much freedom as possible and staff avoided unnecessary restrictions.

Any concerns or issues that arose were reviewed by the registered manager who took clear action to reduce future risk or adapted how the service was delivered to each individual to ensure that people were safe. Staff had been trained to support people with a dementia and felt able to raise any concerns and felt they would be acted upon. Relatives told us the service was a safe place and that staff supported people as distinct individuals, wrapping care around their needs. There was staffing deployed over the day and night to ensure that people’s needs were met in a timely fashion. Staff told us they felt they had the time, training, skills and knowledge to support people with a dementia related condition well.

The service was proactive in reviewing the use of sedative and anti-psychotic medicines to ensure they were effective, did not further disable people and were used only when required to support people’s wellbeing. Relatives told us this reduction in medicines had a positive impact on people and that the service adapted how it was delivered to meet people's individual behavioural needs rather than using “the chemical cosh” as relatives described it to us.

The staff team had been trained to meet the needs of people living with a dementia related condition and they were supervised and appraised regularly to ensure their skills were current and they shared good practice. Staff supported people who lacked capacity to be as involved in their care as much as possible. Staff had the skills and knowledge to communicate with each person as an individual, staff learnt new skills such as sign language when this was needed. Where necessary the service sought family and external professional advice and support when making decisions about peoples care. People’s rights and choices were respected and staff always sought the least restrictive intervention when making decisions. People were encouraged to live as they wished with as much freedom and choice as possible.

People were supported to eat a healthy and nutritious diet. Staff supported people to eat well and they were able to evidence where interventions around weight loss had led to improved health outcomes for people. We saw that staff had developed personalised menus to suit people’s needs for finger food, or support was in place where required. Staff support at mealtimes was discreet and sought to support people’s dignity, whilst ensuring they ate and drank enough to maintain their wellbeing.

Relative’s feedback, our observations and discussion with staff showed us that the staff team truly cared for people using the service as distinct individuals. Staff knew people very well and there was consistent evidence fr

The inspection visit was carried out by two inspectors. We considered all the evidence the inspection team gathered and used it to answer the five key 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. The summary describes the records we looked at, our observations and what people who used the service and the staff told us.

Is the service safe?

The six people we spoke with raised no concerns about their safety with us during our visit and said if they had concerns they would discuss them with the manager.

Each person's care file had risk assessments which covered areas of potential risk. When people were identified as being at risk, their plans showed the actions required to keep them safe.

There were enough skilled and experienced staff to ensure people received a consistent and safe level of support.

Safeguarding procedures were in place to protect people from the risk of abuse and we found staff understood their roles and responsibilities in safeguarding the people they supported.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people’s care and support needs and that they knew them well.

Is the service caring?

We found the care staff we spoke with demonstrated a good knowledge of people’s needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was calm, relaxed and friendly and we saw that staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

People told us they were happy with the care and support they received. One person told us “I am very happy, what an amazing place it is here.” Another person said “We can have what we want to eat and drink, staff are really good.”

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.

Is the service responsive?

Care records were reviewed and any changes made either when people’s needs changed or as part of the monthly review process. We saw evidence of this within the care records we reviewed.

Where people’s needs changed and additional staff support was required we saw evidence the service put additional staff on duty to ensure people were kept safe.

Is the service well-led?

We saw there was a quality assurance monitoring system in place that was designed to continually monitor and identify shortfalls in the service. All the staff we spoke with said the organisation was well led and praised the manager and provider. They said they were both “lovely people”, who were open, approachable and they felt able to talk to them about anything.

The care records reviewed were relevant, complete and up to date; they were also stored securely to ensure confidentiality. We saw appropriate records were maintained in relation to the management of the service. All records were located promptly when requested.

During the inspection we spoke with three people who used the service, two relatives, staff and a visiting social care professional. People we spoke with told us staff always asked before helping out with personal care. One relative told us the homes system of care was “amazing” and that since coming to the home their relative no longer used sedation medication and they now had a much higher quality of life than they thought was possible. A second relative told us the care had improved at the home and they were now satisfied with the care as it was more person centred and that staff had been “super”.

We found staff sought the consent of people who used the service before assisting with care tasks. The provider had systems in place to obtain the consent of those who did not have capacity to make decisions .

The premises were suitably designed, laid out and maintained.

We found the provider had appropriate recruitment procedures in place which ensured staff were suitable for their role.

However the provider did not have robust systems in place to monitor the quality of its service provision or seek the feedback of people who used the service.

We found the provider did not maintain appropriate records as key care plan documentation was missing and it was difficult to find some information using the electronic care plan system.

Spring Mount provides care for people with dementia, within an environment which was designed to enable people to remain independent and make their own choices. It followed the philosophy of caring for people with dementia without the use of sedating medication. Spring Mount has recently been visited by the National Clinical Director for Dementia, who visited on behalf of the Minister of State for Care Services to review the philosophy and the type of care provided to ascertain if it was an example of good practice which others should be encouraged to follow.

During our inspection we used a number of different methods to help us understand the experiences of people living at Spring Mount, this included talking to two people living at Spring Mount and two relatives. Also observing the care being delivered because some of the people using the service had complex needs, which meant they were not able to give us their views.

We engaged in conversation with two people and two relatives. The people told us they “Liked it”. The relatives praised the care and treatment their relatives had received whilst being at Spring Mount, they described the care as “Fantastic”. Both relatives clearly described how their relatives had improved since moving into Spring Mount. One said “They had saved their relatives life”. Another explained how their relative had improved and they no longer needed help at meal times. Both described the staff working at Spring Mount as “An extended family”.

Throughout the visit we saw staff treating people with respect and dignity. We observed staff constantly engaging with people. People were smiling and fully engaged in activities, and offering support to each other. They were also enabled to move around the home and gardens with “Freedom” and without any restrictions.