This comprehensive inspection took place on 30 October 2018 and was unannounced.

Springdale is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Springdale is registered to accommodate up to 36 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit, 32 people were living in the home.

A registered manager worked in the home. 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 of Springdale, we rated the home overall as Requires Improvement. This was because some equipment that people used such as commodes were unclean, staff were not consistently caring and improvements were needed to the provider’s governance systems. This resulted in three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question of safe, caring, responsive and well led to at least good. At this inspection we found that improvements had been made in most areas and therefore, the provider was no longer in breach of any regulations. The overall rating for the home has now changed from requires improvement to good.

People received care from kind, caring and compassionate staff who treated them with dignity and respect. Systems were in place to protect people from the risk of abuse. Staff had received sufficient training and supervision to provide people with effective care and they had sought people’s consent in line with the relevant legislation.

Most risks to people’s safety had been assessed and managed well and there were enough staff available to meet people’s individual needs and preferences.

People had received their oral medicines appropriately however, some people had not received their prescribed creams as they should have done.

There were several activities that people could participate in to enhance their wellbeing and people had choice and control over how they wanted to receive their care.

The home had been adapted to meet people’s needs and regular checks were in place to ensure it was safe for people to live in. It was also clean as was the equipment that people used such as commodes, wheelchairs and crash mats. Staff used good practice to reduce the risk of the spread of infection.

A culture of treating people as individuals and of providing compassionate care had been instilled within the home. The provider, staff and management had a drive to continuously improve the quality of care people received. This was achieved by consulting people who lived in the home, relatives and with outside professionals and the community.

Staff had good morale, received clear direction and leadership and were happy working in the home. There was an open culture where people living in the home, relatives or staff could voice their opinion that would be listened to and respected.

Most of the provider’s governance systems had been effective at monitoring the quality and safety of care people received. However, these had not identified all issues which had exposed people to the risk of avoidable harm. The registered manager took immediate action to correct this during our inspection of this service.

Although improvements had been made within the home since the last inspection, the current registered manager had only been appointed te

This inspection took place on 31 July and 11 August 2017 and was unannounced.

Springdale provides residential care for up to 36 older people. At the time of this inspection there were 32 people living within the home. The accommodation is over two floors with a variety of communal areas.

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.

However, at the time of the inspection they had not been at the service for three months. An acting manager was in place. This person was a registered manager of another of the provider’s services. This person is referred to as the manager throughout this report.

This inspection found three breaches of the Health and Social Care Act 2008 regulations. These related to cleanliness and infection control, dignity and respect and the governance of the service.

Some people’s rooms contained unclean equipment including commodes and bowls used for brushing teeth. Whilst the equipment was not being used communally, germs could still be passed indirectly from person to person by people touching unclean equipment or surfaces.

There were instances where people’s dignity was not upheld. Some people had not been given any choice about whether they had male or female staff to support them.

Other than issues relating to the cleanliness of commodes the provider had not identified the concerns found at this inspection. This indicated that the quality assurances systems were not robust in this service.

There were enough staff to meet people’s needs. However, there had been a high requirement for agency staff in recent months. Recruitment had taken place and the manager anticipated that the home would be fully staffed with permanent staff members in coming months. Robust recruitment processes were in place. There were well organised arrangements in place to manage people’s medicines.

People were supported by staff who had received appropriate training. However, staff training for infection control was the only area that was substantially behind with significant staff numbers not having undertaken updated training in this area.

The food was appetising and people had access to snacks and drinks throughout the day. The mealtime arrangements needed better staff organisation to ensure a more positive mealtime experience for people.

We received mixed reviews from people about the staff that supported them.

People’s care records contained sufficient detail to help staff provide effective support to people. However, aspects of care for two of the four people whose care records we reviewed had not been appropriately planned for or followed up.

The service had seen a lot of changes in staff over the previous six months. Some people felt that the service had deteriorated. However, others felt that improvements were beginning to be made in the home.

This was an unannounced inspection that took place on 22 June 2015.

Springdale provides accommodation for up to 35 older people, some of whom are living with dementia. There were 35 people living at Springdale at the time of our inspection.

There was a registered manager at the 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.

People who were living at Springdale felt safe and were happy living there. Relatives were also happy with the standard of care that was being provided and everyone we spoke with recommended it as a place to live. Systems were in place to protect people from the risks of harm and to keep them safe.

Medicines were given to people when they needed them and there were enough staff to help them when they needed assistance. The premises that people lived in and the equipment they used were both well maintained to make sure that they were safe.

People had a choice about the care that was provided to them. They were asked for their opinions about how they wanted to be cared for and these were listened to and acted on. People felt they were treated as individuals and that they mattered. Their independence was encouraged and they were able to participate in activities or experiences that they found interesting. This included activities within the local community.

People’s care needs and preferences about how they wished to live their life had been fully assessed and were being met.

People had access to plenty of food and drink and were monitored if there were any concerns about their food or fluid intake. Advice from other healthcare professionals was sought and acted upon when any concerns about people’s health had been identified.

Staff were well-trained. They knew what to do in an emergency situation and acted quickly when people became unwell. Staff asked for people’s consent and where the person was unable to provide this consent, they worked within the law to ensure these people’s rights were respected.

The staff were kind and compassionate and treated people with respect and dignity. They were happy in their job and felt valued. They found the registered and deputy managers at Springdale approachable and worked well as a team.

The registered manager had promoted a culture where the person was seen as an individual. People and staff felt able to raise concerns without any fear of recrimination. The registered manager demonstrated good leadership.

Systems were in place to make sure that the care being provided was of good quality. The registered manager was pro-active in trying to improve the quality of care that was being provided to the people who lived at Springdale.

One adult social care inspector undertook the inspection of Springdale. At the time of the inspection there were 32 people using the service.

We spoke with five people who used the service, three people’s relatives, the registered manager and five care staff. We reviewed four people’s care records and six staff files. We also reviewed a selection of other records that included four weeks of staff rotas, a training schedule, the provider’s policies and procedures and audit results.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act (MCA), 2005, and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The MCA provides a framework to empower and protect people who may make key decisions about their care and support. The DoLS are used if extra restrictions or restraints are needed which may deprive a person of their liberty. At the time of this inspection no person was subject to a DoLS authorisation.

The people who used the service told us that they felt safe. The service had a safeguarding policy that made reference to the local authority’s safeguarding procedures. Staff had received training in relation to safeguarding and could tell us about the different types of abuse. Staff had the appropriate security checks before they commenced employment at the service.

Mandatory training was up to date for all of the staff. The registered manager maintained a training schedule that showed when people’s refresher training was due.

There were enough suitably experienced and qualified staff to meet people’s needs. However, staff and some of the people who used the service told us that at times, more staff were required to meet people’s needs in a timely manner. We highlighted this to the registered manager. They told us that they agreed more staff were required some of the time and were trying new staffing schedules.

There was an effective system in place to manage accidents and incidents. We saw evidence that these were audited by the manager and actions were taken to reduce the risk of further occurrences.

There were procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to fire and evacuation and the loss of power. People had ‘personal evacuation plans.’ Staff we spoke with were aware of these.

Is the service effective?

People received effective, individualised care. People’s needs had been discussed and assessed with them and they were involved in reviewing their care plans and risk assessments. Nationally recognised screening tools had been used to help identify people at risk of malnutrition and pressure ulcers. Staff we spoke with could tell us about the needs of the people they cared for. We observed positive interactions between staff and people.

There was evidence in people’s care plans to show that the provider worked closely with other health and social care professionals. This included people’s general practitioners, speech and language therapists and physiotherapists. This helped to ensure all of people’s needs were met by the appropriate person.

Is the service caring?

People we spoke with told us that the staff were caring. One person said, “All of the staff are lovely. Every one of them. They are so kind and caring. They help me with my personal care.” One person’s relative said, “I visit at all times of the day and I cannot fault this home. It is one of the best homes there are. All of the staff are lovely and kind. I have no concerns.”

At all times, we saw that staff were compassionate and respectful towards people. People had been actively involved in the planning of their care and could tell us what information was in their care plans. People who used the service told us that they were given choices about how they wished to spend their day or what they would like to eat. We observed that staff encouraged people to be independent but ensured they were safe and assisted them where necessary.

Relatives visited people throughout the day of our inspection. We saw that relatives were welcomed and staff interacted in a positive and supportive way with them.

Is the service responsive?

The care and support people received responded to their needs. The people we spoke with felt that they were well cared for and said that they thought staff knew their needs well. People’s care plans were person-centred. This means that they were specific to people’s individual needs. People’s personal histories had been documented as well as their hobbies and interests. There were some activities for people to do in the afternoon and people told us that they enjoyed these. However, staff and some of the people we spoke with said that they felt there could be more to do in the afternoon. Staff told us that they wished they had more time to spend with people to help ensure their social needs were being met.

The environment responded to the different needs of people. There were television lounges, a quiet reading room and a large patio area with accessible gardens. All of the people we spoke with said that they thought the home ‘had everything’ they needed. They told us that staff assisted them to where they wished to spend their time. Everyone remarked on how ‘splendid’ the gardens were. We noted that all areas of the home, internal and external, were wheelchair accessible.

The service had a complaints policy and people told us that they knew how to complain. Although the service had not received any written complaints, there was evidence that the provider took account of any verbal concerns to improve the service.

There were processes in place to collect people’s views about the care and support people received and we noted that these were acted on by the manager.

Is the service well-led?

The service was well-led. All of the staff we spoke with told us that they felt well supported and listened to by the manager. People who used the service and their relatives said that the manager was very approachable and always available to speak with.

We saw that there was a positive culture within the home and staff told us that they were encouraged to raise new ideas of working to help improve the quality of the service. Staff told us that the manager worked with them to deliver care and support at times. They said that they appreciated this and it helped to maintain positive working relations.

The manager was knowledgeable about each person who used the service and we saw them interact with people on an individual basis.

The service has a system in place for monitoring the quality of the service. This included audits in relation to care plans, medicines management and the reporting of accidents and incidents. The manager also held regular staff and ‘residents’ meetings to determine people’s views about the service. We saw that the manager acted upon people’s comments and suggestions appropriately.

We spoke with eight people living at Springdale and they told us they liked living there. One person said, "I couldn't live in a better place". Another person said, "It's brilliant here". People spoke about the meals that were provided and one person told us, "The food is very good and the cook is excellent". Staff at the home were described as, "Wonderful".

The service was meeting people's nutritional needs, with special and fortified diets being catered for. Drinks were available throughout the day and each person had a jug of fruit juice to hand to ensure adequate hydration.

We looked at care documents and also spoke with staff and this showed us that the service cooperated well with other health providers. There was evidence that staff at the home followed instructions and made referrals appropriately to other professionals in a timely way. We inspected the equipment used by the service to make sure that it was well maintained and safe to use. The service records were up to date and all equipment was in good working order.

We spoke with staff and looked at staffing records. These showed us that staff received training appropriate to their role and that they were well supported through regular supervision sessions. We looked at a variety of other records and saw that they were well maintained, up to date and stored appropriately. The manager was undertaking a monthly audit of the records to ensure they were accurate.

People we spoke with said they were very happy living at this home. They all said they were very happy with how they were cared for and spoke openly about their experiences of living at the home. People said they could spend their time where they wished and one person said, "I like my room but I don't spend much time in it as I enjoy the company in the lounge." We saw people throughout the home, including in their own rooms, but mostly in communal areas where they could spend time chatting with other people. We were told by one person, "I love it here."

People spoke warmly about the staff. One person said, "All the staff are marvellous, I won't grumble about any of them." Another person told us, "They have time to sit and talk to us." Whilst another person said, "Sometimes there aren't enough of them and other days there's four or five."

People told us they enjoyed the food at the home and said it was well cooked and plentiful. One person said, "The cook is great." Another person was speaking about the choices that were available on the menu and they told us, "they come round and tell you what there is but they always cook you something else if you don't want what's on the menu."

People told us that there were no strict routines at Springdale. They said they could choose their daily routines. One person commented, "You are not forced to do anything you don't want to do and you are not stopped from doing anything you do want." People told us that they were able to make decisions about their care and treatment.

We were told that staff were respectful to people using the service and we saw evidence of this during our inspection. People were treated with dignity and everyone we spoke with confirmed that staff respected their privacy. One person said, "They are very discreet about everything, you never hear them discussing other people."

People we spoke with told us that the care at Springdale could not be faulted. A family carer said, "I know that mum is well looked after here." People using the service told us that staff encouraged them to be independent but were always around to help if needed. They said that staff looked after them if they were not feeling well.

People were offered their medicines at times that suited them, for example their night time medicines could be given at the time they chose to go to bed, rather than having to be woken. The people we spoke with said they were happy with how medicines were given out.

Most people we spoke with said that they enjoyed the food. We were told that it was well cooked and there was always a choice. Just one person said they did not like the meals. They told us they had made complaints about the food in the past and the staff had given them alternatives and they tried to make things right.

There were activities that people could join if they wished. On the day of our visit some people participated in a quiz. One person commented, "We have them quite often and we always get a laugh." Other people told us that they preferred to pursue their own interests and said that staff still made time to talk to them.

Everyone we spoke with praised the staff. We were told that staff were kind and treated people well. People said that they would be able to talk to the manager or staff if they had any concerns about practices in the home.

People told us that they liked Springdale. They were comfortable in the home and said that it was clean and warm. One person told us, "It's a homely home."

People told us that they thought that most of the time there were enough staff on duty at Springdale. We were told that people did not have to wait too long if they pressed their bell for help. More than one person commented that they received help straight away in the night. Some people told us that they thought there had been staff shortages at mealtimes. We discussed this with the manager and found she had made changes to improve this.

People had opportunities to make their views of the home known. They could attend residents' meetings and there was an annual survey they could complete. People also told us that the manager was always around and they could talk to her at any time.