We carried out an unannounced inspection of the service on 4 October 2017. On our previous inspection visit on 5 May 2015, the service was rated Good overall, with requires improvement in our question ‘Is this service?’ On this inspection we found the service was rated as Good in all areas.

Spring Tree Residential Care Home can provide accommodation and support for up to 30 people who may be living with dementia. There were 22 people living there at the time of our inspection. The home accommodated people over three floors and on the day of our inspection the lift was being repaired; small lounge areas had been established on each floor and staffing had been reorganised to ensure they were staff available over each of the three floors. Following our inspection we received confirmation that the lift was now operational.

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. At the time of the inspection a registered manager was in post.

We had received information that people may be at risk of harm. Our evidence demonstrated that staff understood their role in protecting people from the risk harm or abuse and the actions they needed to take if they had concerns. Where concerns had been identified the staff worked closely with other professionals to ensure these were investigated. People were confident that the staff supported them well. There were enough staff available to be able to support people. The staff were knowledgeable about people’s needs and understood the risks to people’s health and wellbeing. Recruitment checks were made before staff employment to confirm they were of good character and suitable to work in a care environment.

People could have food and drinks that they enjoyed throughout the day. People received support from health care professionals to help ensure their well-being was maintained and received their medicines as prescribed. Health concerns were monitored to ensure people received specialist health care intervention when this was needed.

Staff were kind and caring when supporting people and knew their likes and dislikes. People’s privacy was respected and the staff made visitors feel welcome and were approachable. There were processes in place for people to raise concerns and express their views and opinions about the service provided.

People were supported to have control of their lives and were supported in the less restrictive option possible. Staff understood people’s preferred communication method and the support they needed to make their own decisions. When people were unable to consent to specific decisions they were supported in their best interest.

Staff were kind and caring when supporting people and knew their likes and dislikes. People participate in social activities according to their interests. The staff and management team made visitors feel welcome and were approachable.

There were processes in place for people to raise concerns and express their views and opinions about the service provided. There were systems in place to monitor the quality of the service to enable the registered manager and provider to drive improvement.

This inspection visit took place on 5 May 2016 and was unannounced. Our last inspection visit took place in November 2015 and at that time we found the provider needed to make improvements to ensure risks for people had been assessed; The provider needed to make sure people were supported to be independent and received the correct medicine at the right time. We also identified concerns that people were not supported to make decisions that were in their best interests where they no longer had capacity. On this inspection we saw improvements had been made. However, the provider needed to consider how to support people’s independence within the home as some of the doors could not be opened unless accompanied by staff, which could restrict people. The provider also needs to consider how to promote people’s dignity at meal times.

Spring Tree is registered to provide residential care for up to 30 older people. Following the concerns we identified during our inspection visit in May 2015, we issued a condition on the provider’s registration to prevent further admissions into the home. On the day of our inspection visit 18 people were using the service. As a result of the improvements demonstrated by the provider at this inspection, we will remove this condition.

A registered manager from another home owned by the provider was managing the service. They were applying to become the registered manager of 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.

Staff were available at the times people needed them and they had received training so that people’s care and support needs were met. People were protected from the risks of abuse because staff understood where harm may be caused and what action they needed to take. Where risks associated with people’s health and wellbeing had been identified, there were plans to manage those risks which meant people could continue to enjoy activities as safely as possible.

People made decisions about their care and staff helped them to understand the information they needed to make informed decisions. People received support in the ways they preferred and were encouraged to pursue their hobbies and interests. People liked the staff and had developed good relationships with them. People were supported to maintain relationships with people that were important to them and visitors were welcomed at the home.

People had a choice of food, and were encouraged to have enough to drink. People were referred to healthcare professionals to ensure their health and wellbeing was maintained. Medicines were managed so that people received their medication as prescribed.

Staff listened to people’s views about their care and people were able to influence the development of the service. People knew how to complain about their care and concerns were responded to. The provider and manager assessed and monitored the quality of care to ensure standards were met and maintained. They understood the requirements of their registration with us and kept us informed us important events that happened at the service.

This inspection took place on the 18 November 2015 and was unannounced. At our previous inspections in September 2014 and May 2015 multiple regulatory breaches were identified and the service was judged to be ‘Inadequate’ and placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing

inadequate care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care

and work with, or signpost to, other organisations in

the system to ensure improvements are made.

• Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek

to take further action, for example cancel their

registration.

This meant the service would be kept under review and inspected again within six months. We told the provider they needed to make significant improvements in this time frame to ensure that people received safe care and treatment that was responsive to their changing needs, were protected from abuse and not unlawfully restricted. We also told them that they needed to ensure that effective systems were in place to monitor the quality and safety of the service and to drive improvement.

At this inspection, we made the judgement that the provider had made sufficient improvements to take them out of special measures but some further improvement was needed to ensure the quality and safety of the service was effectively monitored.

Spring Tree Rest Home provides accommodation and personal care for up to 30 people who may be living with dementia. At the time of the inspection 19 people were using the service.

The previous registered manager had left since our last inspection. Another manager registered to manage another of the providers services was in place. 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 assessed in relation to their individual needs. Some people were being restricted of their liberty due to the lack of effective risk assessments. People's care was not always based on their individual needs. People's preferences were not always respected and their independence was not promoted.

We found the provider continued not to work within the guidelines of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The (MCA) is designed to protect people who cannot make decisions for themselves and lack the mental capacity to do so. The (DoLS) are part of the MCA. They aim to make sure that people in care homes are looked after in a way that does not inappropriately restrict their freedom. We found that although DoLS referrals had been made for all the people who used the service, people's capacity to make decisions and consent to their care had not been assessed.

Some improvement were seen in the safe management of people's medicines, however people were at risk of not receiving their medicine at the times they needed it due to the lack of clear guidance and protocols for staff.

People were protected from abuse and the risk of abuse as staff knew what to do if they suspected someone had been abused. There were enough staff to keep people safe. The provider had employed new staff to improve the safety and quality of the service provided. Safe recruitment procedures were in place.

Staff felt supported and had received training to be able to fulfil their roles effectively.

People had enough to eat and drink and were supported to have their health care needs met in a timely manner by health professionals.

Staff were kind and compassionate to the people they cared for. Relatives were kept informed and were welcome to visit at anyt

This inspection took place on 12 May 2015 and was unannounced. At our previous inspection in October 2014 we had concerns that people were not receiving care that was safe and effective. People were at risk of abuse and were being deprived of their liberty. People had not consented to the care, treatment and support they received. We found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulation 2010.

Spring Tree Rest Home provides accommodation and personal care to up to 30 people with dementia, mental health and physical disabilities. At the time of the inspection 22 people were using the service, two of which were in hospital.

The registered manager was absent on the day of the inspection. 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.

The provider did not work within the guidelines of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty safeguards (DoLS). The (MCA) is designed to protect people who cannot make decisions for themselves or lack the mental capacity to do so. The (DoLS) are part of the MCA. They aim to make sure that people in care homes, looked after in a way that does not inappropriately restrict their freedom. People were being unlawfully restricted of their liberty within the service and no applications for a DoLS authorisation had been made.

People were not protected from the risk of abuse. Incidents of suspected abuse were not reported or investigated.

Some people’s medicines were unaccounted for and were not being stored safely. Equipment was not maintained to ensure it was safe and effective in its use.

When people required support in maintaining their health, support was not gained in a timely manner. People were not able to have a drink when they requested.

People did not receive care that was personalised and reflected their individual needs and preferences. People spent long periods of time with little or no stimulation and were restricted within areas of the service.

Relatives of people we spoke to did not feel that their complaints were managed and taken seriously. When improvements had been identified and agreed these were not met.

No improvements had been made since our previous inspection. The provider was unaware that the required improvements had not been made. There were no systems in place to monitor and improve the quality of the service.

We found several continued breaches of Regulation of The Health and Social Care Act 2008 (Regulated Activities) 2014 and issued an urgent notice of decision to suspend all new admissions into the service until the required improvements are made.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

The inspection took place on the 2 October 2014. It was unannounced.

Spring Tree Rest Home had opened in January 2014 and this was their first inspection. The service could accommodate up to 30 people. At the time of our inspection 20 people were using the service.

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 and associated Regulations about how the service is run.

Staff did not know who to contact if they suspected someone had been abused.

Staff were not following the Mental Capacity Act 2005 for people who lacked capacity to make a decision and had not considered whether people were restricted. People’s capacity to make decisions for themselves had not been assessed.

When concerns had been raised about two people’s health care, support from external agencies had not been sought.

People who used the service and their relatives told us that they were happy with the care they received from the service, however they felt that they could be more involved in the decisions about their care and day to day choices.

People received their medication at the appropriate times in a safe manner. However there was no audit trail to ensure that people had received their prescribed medication and equipment used was not regularly maintained.

Care plans and risk assessments had not been reviewed and up dated to reflect a change in people’s needs. Risk assessments were not always followed and meant that people were at risk of injury.

Staff did not always feel confident to fulfil their role and had not received training to ensure they could fulfil their role.

From our observations and what people told us, people were treated with dignity and respect. People’s privacy was maintained at all times.

The registered manager investigated and responded to people’s complaints, according to the provider’s complaints procedure.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 and have made some recommendations to improve. You can see what action we told the provider to take at the back of the full version of this report.