This inspection took place on 4 April 2017 and was unannounced. Springbank Nursing Home provides personal care and accommodation, diagnostic and screening procedures and treatment of disease, disorder or injury for up to 42 older people some of whom are living with dementia, at the time of the inspection there were 32 people living at the service.

A registered manager was 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.

We carried out a focussed inspection on 8 March 2016 and checked on whether people were safe and if the service was well led. We found the provider was meeting the regulations; however we asked the provider to make improvements to the administration of medicines and demonstrate the quality assurance systems were used to drive sustainable improvements.

At our last comprehensive inspection on 27 November 2015 we found the provider was not meeting some of the regulations. At this inspection we checked to see if the provider was meeting the regulations and we found the provider had taken action to make all the improvements required.

People felt safe and staff knew how to protect them from potential abuse. Staff could describe how they supported people to reduce risks and we found peoples risks were managed safely. There were enough staff on duty to provide care safely and promptly to people. Staff administered medicines safely and people were happy with the support they received.

People received support from knowledgeable staff that had access to good support from the provider. Staff understood the Mental Capacity Act 2005(MCA) and supported people in line with the principles of the act. People enjoyed the food, could choose what to eat and had their dietary needs met. People received support to access health professionals to maintain and improve their health.

People received care and support from staff that supported them in a kind and caring way. People were able to make choices for themselves and were supported to maintain their independence by staff. Staff respected people’s rights to privacy and ensured people were treated with dignity.

People were involved in assessing their needs and developing their care plans which identified their individual needs and preferences. People were supported by staff that had a good understanding of people’s needs and preferences. People could maintain their hobbies and had access to individual and group activities. People knew to make complaints and had confidence they would be appropriately managed. The provider had a system to effectively manage complaints.

People were positive and complimentary about the management of the service. People felt involved in the service and were asked about their experiences. The provider looked for ways to improve the quality of the service people received and had effective monitoring systems in place.

We carried out an unannounced comprehensive inspection of this service on 13 October 2015, and we found breaches of legal requirements. After the inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the way risks were assessed and managed, improvements to medicine administration and actions to be taken to ensure that the quality of the care provided was regularly assessed and monitored.

We undertook this focused inspection on the 8 March 2016 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springbank Nursing Home on our website at www.cqc.org.uk

At this inspection we found that the provider had made the required improvements to meet the legal requirements in the areas we inspected, but further requirements were needed to ensure that the service were providing a good standard of care.

Some improvements were still needed to ensure that people who needed topical creams were supported with these as prescribed. Improvements were needed to ensure that staff had guidance to follow when administering ‘as required’ topical creams.

Improvements had been made to the way other medicines were administered and managed.

People’s risks were assessed and managed. Staff understood people’s risks and followed the assessed plans of care to protect people from harm.

We inspected Springbank Nursing Home on 13 October 2015. The inspection was unannounced. At our last inspection on 30 May 2013, we found that the provider was meeting the required standards. During this inspection we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration Requirements) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide accommodation and personal care for up to 42 people. People who used the service were over 65 years old and have physical and/or mental health diagnoses. At the time of our inspection there were 39 people who used the service.

The service had a manager but they were not registered with us (CQC). 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. We requested that the manager registered with immediate effect.

Risks to people’s health and wellbeing were not consistently identified or managed to promote their safety. We found there were not always enough staff available to deliver people’s planned care or keep people safe.

Effective systems were not in place to ensure medicines were administered in a consistent and safe manner at a time when people needed them.

People did not always get the support they needed to eat and drink. Systems to monitor people were receiving sufficient amounts to eat and drink were not always in place. This meant some people’s nutritional needs were not met.

People were not always supported to have their care in an environment that protected their privacy and dignity.

People and their relatives were not always involved in planning their care. Staff had a varied knowledge of people’s care preferences. This meant that people were at risk of receiving inconsistent care.

The provider did not have effective systems in place to consistently assess, monitor and improve the quality of care. This meant that poor care was unable to be identified and rectified by the manager and provider.

People were not always protected from potential abuse because staff did not recognise some incidents that may be considered as alleged abuse.

People told us they were treated with care and given choices. However, improvements were needed to the way the provider gave choices at lunchtime.

People’s health and wellbeing needs were monitored and advice was sought from health and social care professionals when required. However, we saw that the advice received was not always followed to ensure their health needs were met effectively.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Staff received training. However, we found that improvements were needed to ensure that the quality of the training followed the correct guidelines. There were no systems in place to ensure that staff understood and followed the training supplied.

People were given the opportunity and supported to be involved in social and leisure based activities.

People knew how to complain about their care and complaints were managed in accordance with the provider’s complaints policy.

People and their relative’s feedback was gained and we saw that systems were in place to address feedback to improve people’s care experiences.

We spoke with people who used the service who told us that they were happy with the care that they received. One person told us, “The staff are good they speak to me in a caring manner”. Another person told us, “The carers are good. It’s a pleasure to be here”.

Staff we spoke with knew the needs of people who used the service and explained how they recognised signs of deterioration in people’s health and wellbeing.

We found that systems were in place for the recruitment of staff. The provider had undertaken the necessary checks to ensure that staff employed at the service were suitable to work with vulnerable people. Staff told us that they had received training to undertake their role.

The provider had an effective complaints system in place. Complaints were investigated and people’s concerns were listened to and acted on. People we spoke with told us they knew how to complain if they needed to.

We carried out this inspection as part of our schedule of inspections. We wanted to see what life was like for the people who lived in the home. We also wanted to see whether the service had made any improvements since we last visited.

During our visit to the service we spoke with the registered manager, the new acting manager, the deputy manager, four care staff and the activities coordinator. We also spoke with a total of twelve people who lived in the home and five sets of visitors.

The visit was unannounced. This means that the service did not know that we were coming.

An expert by experience took part in this inspection and talked to people using the service and staff. An expert by experience is some one who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. Our expert by experience took some notes and wrote a report about what they found; we have included their observations in the main body of this report.

The service was able to accommodate up to 42 people with personal and nursing care needs. At the time of our inspection visit there was a total of 40 people accommodated in the home. Most people had some degree of physical care needs and some people had dementia care needs. Two people had challenging behaviour needs.

There was a new manager working at the home who had been in post for two months. She was not on duty at the time but joined us during the inspection visit. The new manager explained that she would be applying to become registered manager as the current registered manager would be taking a more operational role. The registered manager and the deputy manager also joined and assisted us during the inspection.

The new manager had started to make improvements by introducing new systems, processes and procedures. This was having a posiitve effect for people who live at the home and the staff who work there

Staff said that they felt supported at the home and people who were visiting were very pleased with the care and support their relatives were receiving there. Comments we received included, “It’s great here. I have been very pleased with it so far” and “Oh they are very good to us here, no complaints” and “The staff are really friendly. They will do anything for you”.

There was a relaxed feel to this home and evidence of a friendly and light-hearted relationship between staff and the people who live there. Staff treated people with care and respect, but were also able to share banter without giving offence. People and their visitors were able to talk freely to staff.