Springbank House Care Home 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.

Springbank House Care Home is registered to accommodate 41 people. At the time of our inspection 37 people were using the service. The service accommodates people in one building over two floors and had adapted facilities to meet people’s needs. This included four lounges and a conservatory. A courtyard garden was also available that people could access.

The service had 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.

Our last comprehensive inspection was undertaken in October 2015 and the service was meeting the regulations that we checked and was rated as good.

At this inspection we found that some improvements were needed to people’s meal time experience; to ensure they enjoyed the meals available and in a comfortable way. People were supported to eat meals that met their dietary requirements.

There was enough staff to support people in a timely way. People felt safe and staff knew about people’s support needs to enable the staff to provide this in a safe way. Staff felt supported by the management team and received the relevant training to ensure people’s needs could be met.

Staff were clear about what constituted abuse or poor practice and systems and processes were in place to protect people from the risk of harm. People received their medicine in a safe way and when they needed it.

Recruitment checks were done before staff started working at the home to check they were suitable to support people. Risks to people’s health and safety were assessed and care plans directed staff on how to minimise identified risks. Staff had the equipment needed to assist people safely and understood about people’s individual risks. The provider checked that equipment was regularly serviced to ensure it was safe to use.

Staff understood the importance of gaining people’s verbal consent before supporting them and helped them to make their own decisions when required. Where people were unable to do this; decisions were made in people’s best interests. People were supported to access healthcare professionals to maintain their health and wellbeing.

People liked the staff and their dignity and privacy was respected by the staff team. Visitors were made welcome by approachable and friendly staff. People and their representatives were involved in decisions related to the planning of their care. Opportunities were provided for people to socialise and take part in activities to promote their wellbeing. People and their representatives were supported to raise any concerns they had.

People and their representatives were supported to express their views and opinions about the service provided and felt the home was managed well. There registered manager and provider understood their responsibilities around registration and systems were in place to monitor the quality of the service, to enable them to drive improvement.

The inspection took place on 5 October 2015. It was unannounced.

At the previous inspection on 10 April 2014 it was identified that action was required in regard to the number of staff available to meet people’s needs. This was a breach of Regulation 22 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. At this inspection we found that this had been rectified and there were sufficient numbers of staff on duty to meet people’s needs.

Springbank House Care Home provides care and support for up to 41 older people. At the time of our inspection 37 people were living there. The service is situated near Chesterfield town centre on two floors; there is a lift available for people to use. An outside patio space was also available for people.

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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People and their relatives were satisfied with the care and support provided in the home and were complimentary about the support they received. They felt that all their needs were being met. People were treated with kindness and respect and felt safe using the service. Relatives we spoke with confirmed this. People told us that they felt involved in what was happening in the home and in the way that their care was delivered.

We saw that people were supported by a staff team that understood their individual needs. We observed that staff were friendly, kind and treated people with dignity.

Staff recruitment procedures were effective in ensuring that appropriate checks were carried out before staff started work in the home. Staff received a thorough induction and felt that they received good training, both internally and externally of the home. They also felt they had support for their continuing professional development.

Staff were aware of, and understood, the risks around avoidable harm and knew how to safeguard people. This was both in terms of bullying and harassment and the physical risks to people living their everyday lives. There were sufficient numbers of staff on duty to support people with their needs and to ensure they remained safe. We saw that staff had the skills and knowledge to meet people’s needs in an appropriate way. Training for staff was effective and up to date.

The registered manager had a good understanding of the Mental Capacity Act 2005 and how important it was that people were given the opportunity to consent to their care and treatment.

People told us that they enjoyed the food and people’s dietary requirements were catered for. There was also a choice at meal times so that people were able to eat what they enjoyed. Where people required assistance with eating this was done in a dignified way.

People experienced care and support from staff who enjoyed their role and were fully aware of what their responsibilities were. Staff were competent in incorporating the principles of dignity and choice into the way they provided care. This meant that people received personalised care that was responsive to their needs.

The registered manager had a clear vision for the home and was motivated to improve the quality of the service. There was a robust quality assurance system in place which monitored and responded to any issues or risks. Staff and people using the service had confidence in the management of the home.

A single inspector carried out this inspection. We spoke to five people who use the service, three visitors and four members of staff.

Below is a summary of our report. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read our full report.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. All of the staff we spoke to during our visit were familiar with safeguarding procedures and told us they would report any concerns to their manager. Staff had a good understanding of the needs of people living in the home. They were able to describe different people’s needs and what care they required.

We saw that people had a medication administration record (MAR) chart which recorded what medication people were having. We looked at four MAR charts which had information on; the person’s name, frequency of the medication, allergies to medication, codes if medication had been omitted, and, the reason why. All of the MAR charts were signed and demonstrated that medication had been given at the appropriate times.

CQC monitors the operation of the Deprivation of Liberty Safeguards, which applies to care homes to ensure that proper legal processes are in place if a person lacks capacity to make decisions and their liberty is being restricted in some way. While no applications have needed to be submitted, policies and procedures were in place. Staff had been trained to understand when an application should be made.

Is the service effective?

We saw that people’s needs were assessed and care and treatment was planned in line with their individual care plan. We looked at four care records and saw that care records had information on assessments being carried out in areas such as personal care, mobility, eating and drinking and maintaining a safe environment. We saw that risk assessments had been carried out and covered areas such as moving and handling, nutrition, tissue viability and falls.

We saw information on involvement from other healthcare professionals such as GPs, District Nurses, speech and language therapy (SALT) and dieticians, which demonstrated that people were getting the care they needed from other healthcare professionals.

Is the service caring?

We observed staff speaking to people in a kind and caring way and supporting people to be as independent as possible. We observed staff being respectful to people by talking to them in a kind and caring way and knocking before entering people’s rooms. We observed that people were comfortable in the presence of staff.

People said they were very happy with the care they received. One person said “It’s very good here I get well looked after”. Another person said “I am happy here. I have a bit of fun with the staff”.

Is the service responsive?

People’s needs had been assessed before they moved into the home. Records included information on people’s preferences, interests and the care they required. People had access to activities that they enjoyed and had been supported to maintain relationships with their family and friends.

We saw that some people had to wait a significant amount of time before call bells were answered. We saw that staff had discussed the high incidents of accidents which had been occurring during the evening and had felt that a twilight shift with extra staff would help reduce this number. This however, had not been agreed because it was felt it would impact on staffing levels at other times of the day.

Is the service well led?

Quality assurance processes were in place and we saw that actions had been implemented where necessary. Staff told us they were clear about their roles and responsibilities and that they felt supported by their manager. We saw that management had consulted with people who used the service and their families. We saw that changes had been made after these consultations. For example, menus were changed to reflect people's preferences.

We saw that audits were carried out across areas such as nutrition, falls, infections and pressure damage. We saw that action plans were completed when areas for improvement were noted. For example we saw that the falls team had been requested when it was identified that the number of falls people were having was increasing.

There were 35 people living at Springbank House at the time of our visit. We spoke with four people living in the home and the four relatives who were visiting, everyone we spoke with was happy with the care they (or their relative) received. One person told us, “I’m happy here, I’ve made some friends and the staff are great”.

We saw that people were asked for their consent to their photo being taken and for how it could be used by the provider. Where people did not have the capacity to consent, their best interests were considered and this was recorded appropriately.

People’s care plans showed input from a multi-disciplinary team including, primary and secondary care and specialist services such as psychiatrist and the speech and language therapy team (SALT). Staff were following advice given by the health care professionals.

People were being care for in a clean, hygienic environment. We did observe however that some areas of the home were cluttered and untidy.

A satisfaction survey was underway at the time of our visit and a survey of the catering service in the home had been completed in January 2013. The results of the survey were generally positive. We saw that additional food items had been added to the menu and two people were receiving different portion sizes following feedback from the survey.

A pharmacist inspector from the Care Quality Commission visited the home. There were 34 people living in the home at the time of our visit. We found that improvements had been made and that there were appropriate arrangements in place to manage the risks associated with the unsafe use of and management of medicines.

We looked at the medicine administration records for eight people living in the home and one care plan. All medicines prescribed for people in the home were available on the day of our visit. Appropriate arrangements had been introduced to ensure that medicines were consistently available and that guidance was available to staff so they that could obtain medicines more easily.

We spoke with four members of staff and they told us arrangements for medicines in the home had improved since our last visit and they had had been more able to access medicines for people. Staff told us new systems for the ordering of medicines were working well.

We looked at the storage of medicines, people’s medicine records and some care plans. We spoke with four members of staff.

We found that medicines were kept safely and stored at the right temperature. We also found that procedures were in place for giving people medicines. However we found that some people were not getting the medicines they needed because they were not available in the home. Medicines were not properly recorded and accounted for, which meant it was not possible to check if people were getting their medicines as needed.

At our visit we spoke with four people and two people’s advocates about the care and services they received and their experiences in the home.

Two people told us about some of the ways the service engaged and involved them. Examples they gave included involvement in meetings to determine their care, social activities and daily living arrangements, provision of key service information and satisfaction surveys conducted with them.

All said they were confident to raise any concerns or complaints they may have and felt these would be properly dealt with.

Many people commented positively about the arrangements and facilities for activities and the enthusiasm of the activities co-ordinator present at our visit. One person told us, ‘Activities are based around what we like,’ ‘There’s a choice of group activities and some on an individual basis.’

People said they were satisfied with the food provided and told us about a range of daily menu choices. One person said, ‘The food is good, with plenty of home made baking.’ There’s plenty of choice and you can always change your mind.’

All four people we spoke with expressed overall satisfaction with the care and support, they received and confirmed that staff treated them with respect and ensured their dignity and privacy at all times. They also described suitable arrangements for their health care needs to be met, including for their medicines.

Two people told us about necessary equipment they were provided with, such as pressure relieving equipment and aids for their mobility and all felt the home was clean, fresh and well maintained and equipped.

All confirmed that staff was usually available when they needed them and listened and acted on what they said. One person said, ‘The staff are marvellous, they are kind and treat you properly.’

At our visit there were thirty two people accommodated. We were not able to converse in any depth with a significant number of people that used the service, due to their conditions and frailty.

However, some people who were able to express their views described some positive ways in which they were able to make choices about aspects of their care and daily living arrangements. They said that staff treated them with respect and maintained their dignity and privacy. Examples of choices they made included for their meals, joining activities and receiving visitors.

People told us that the manager held meetings with them and their representatives and they were asked about their views and experiences of the service, sometimes by way of satisfaction surveys. We saw from the minutes of a recent meeting held with them, that guest speakers were invited to talk about aspects of care and financial advice.

We saw that a range of service information was provided for people and to assist them. This included newsletters, minutes of meetings held with them, findings from satisfaction surveys, activities information and information about how to complain, along with an overall service guide for the home.

One person said, ‘staff work hard, but people sometimes have to wait too long.’ Another said, ‘I mainly get the care I need.’

The home’s recent satisfaction survey findings from 18 returns out of 30 indicated that 95 percent of those were happy with their overall care.

People generally felt that food was satisfactory and said it was provided in sufficient quantities, with an alternative choice at each mealtime. Findings of the home’s most recent satisfaction survey found that menu reviews had brought about some improvements in people’s dietary experiences.

We were advised activities were sometimes organised that people could join if they chose and with a number of trips out planned over the coming weeks, including a river boat trip. The home’s satisfaction survey results and action plan showed this was also an area where further improvements were being sought.

Some people said they were able to personalise their own rooms and that the home was usually kept fresh and clean. Two people told us further improvements could be made in this area. One person said they were pleased about areas of redecoration being undertaken.

The home’s recent satisfaction survey results showed that although the majority of respondents were satisfied with the laundry system and arrangements, a significant number were not. Although people were not informed as to what would be done about this.