Springfield 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 home is registered to provide accommodation and personal care for up to 39 older people, including people living with dementia, across three separate units. Each unit has separate adapted facilities. At the time of the inspection 38 people were living at the service.

The inspection took place on 4 October 2018 and was unannounced.

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.

At our last inspection we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Although staff said they had been trained to keep people free from harm and abuse, not all were familiar with what constituted abuse. Training records showed that three staff had not completed safeguarding training for at least two years and it was unclear when or if they had completed training because the training matrix did not show this information. Despite this, people and their relatives, told us they felt safe. We recommend the provider considers methods of managing staff training needs and records.

Supervision sessions were provided for staff; however actions arising from these were not always followed up. For example, overdue safeguarding training had been raised during supervision sessions, but there was no record of this being followed up with staff. We recommend the provider considers ways of monitoring outstanding actions following supervision sessions.

Although there was a range of quality assurance audits undertaken, these were not carried out frequently enough to highlight the issues noted above.

Care plans contained risk assessments and guidance for staff was clear. There was enough staff on duty to meet people’s needs. Medicines were managed safely.

People were supported to have enough to eat and drink. Staff sought people’s consent prior to supporting them. People had access to ongoing healthcare.

People and their relatives spoke highly of staff. Positive interactions between people and staff were observed.

Care plans were person centred. Complaints were reported, investigated and resolved. The provider sought feedback from people about the service they received.

Staff told us the registered manager was approachable and visible. A positive culture amongst staff was observed.

Further information is in the detailed findings below.

The inspection took place on 06 June 2016 and was unannounced. We carried out an unannounced comprehensive inspection of this service on 30 July 2015. At which breaches of legal requirements were found. This was because safeguarding concerns were not always being properly reported and some staff did not understand what abuse was. In addition, some staff were not caring in manner. Staff were not being properly supported. Care plans did not show how to meet people’s needs and systems for monitoring the quality of the care and service were not being kept up to date.

We also undertook a focused inspection on the 15 February 2016. We inspected the service against one of the five questions we ask about services: is the service caring. This was because the service was not meeting legal requirements in relation to that question. At this inspection, we found that the requirements of the Warning Notice we issued had been met. We found that people were being supported by staff that were caring and kind towards them.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we found that the provider had taken action to improve safety around safeguarding. They had also taken action in the following areas: staff were now being properly supported in their work, care plans now showed how to meet needs and quality monitoring systems were up to date and effective.

Springfield Care Home is registered to provide care for up to 39 people. On the day of the visit, there were 35 people at the home.

There was a registered manager for 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.

The people we spoke with said they always felt safe and secure at the home. We observed that the staff were kind in their manner and respectful in the way they communicated with the people they supported.

When risks to people had been identified suitable actions were put in place to minimise the risk of people being harmed when receiving care. The risks of abuse to people were reduced as staff had a good understanding of abuse. The team were trained to know how to report concerns correctly.

People were supported with their needs by enough staff to provide individual care and to keep them safe. Staff were deployed in the home in a way that meant the needs of people were met in a timely way.

People told us that they were happy with the food and told us they were offered choices at each mealtime. People were provided with a varied diet that suited their needs. There was a programme of regular one to one and group activities taking place in the home. Activities were planned so that they were suitable for the needs of people who live with dementia. People told us they liked the entertainers who performed at the home on a regular basis.

Springfield is located in a spacious grounds with views of the surrounding courtside and the city of Bath .Some people told us how they liked the setting of the home and the views from their windows There was a purpose built secure garden This included a seating area and people were able to sit there and enjoy fresh air safely.

Care plans guided staff so that they knew what actions to follow to meet people’s range of care and support needs. Staff knew how to support people who had dementia and were confused and experienced memory loss. They knew how to provide care that was flexible and sensitive to each individual’s needs.

We saw that there were positive and warm relationships between people and the staff who supported them. Staff knew how to communicate effectively with people who experienced memory loss due to their needs.

The service was last inspected on 30 July 2015. We carried out a focused inspection on 17 February 2016 which was unannounced. We followed up a Warning Notice that we served at our last visit.

At the last inspection we had found that people were not always treated in a caring way by certain staff on one of the units. These staff demonstrated a lack of care and a lack of understanding about how to treat people who were living with dementia.

Care plans had not shown how to support people to meet their needs and they did not show how to take account of people’s individual preferences. This showed that there was a lack of guidance for staff to follow to ensure people were getting the care they required. People were put at risk because the provider’s own system for monitoring the quality of the care and service was not being used. This meant the service people received was not properly checked to ensure it was safe and suitable.

This failure to ensure that all staff treated people who used the service in a caring and respectful way at all times was a breach of Regulation 10.1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Springfield provides accommodation and personal care for up to 39 older people including older people living with dementia. There were 30 people at the home on the day of our visit.

Since our last inspection there was now a registered manager for 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.

At this inspection we found that the requirements of the Warning Notice had been met. People were well cared for and they looked relaxed and comfortable in the home and with the staff who supported him. Everyone we spoke with complimented and spoke highly of the staff who supported them. Comments included, “The staff are lovely” and “They can’t do enough for me”.

Staff had been trained in how to respect people’s privacy and dignity, and knew how to put this into practice. Throughout our inspection, we saw that staff respected people’s privacy when they were supporting people with personal care. Care plans and daily records included information about what people’s preferences were in their daily living as well as their general health and wellbeing. Care records were written about people in a respectful and objective way.

The inspection took place on 1 July 2015 and was unannounced. The previous inspection of Springfield was on November 2014. There were two breaches of the legal requirements at that time. These related to the following areas :

• Supporting staff
• Care planning.

Springfield provides accommodation and personal care for up to 39 older people including older people living with dementia. People are cared for on one of three units in the home. On the day of our visit there were 30 people living at the home.

There has been no registered manager for the service for over 12 months. On the day of our visit, there was a new manager in post from another service run by the provider. They had begun working at the home as manager one week before our visit. 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.

Safeguarding concerns were not being properly reported to the relevant organisations. Staff demonstrated a variable understanding about what abuse was and how to report it. Some of the staff were not clear about what abuse was or how to report it. This demonstrated people were supported by some staff who did not know what actions to take to keep them safe.

Suitable arrangements for supporting and supervising staff had not been in place since our last inspection in November 2014. At this inspection, a suitable system of staff support and supervision was still not in place. This demonstrated the staff were not properly supervised to ensure they provided safe and suitable care.

People were not always treated in a caring way by certain staff on one of the units. These staff demonstrated a lack of care and a lack of understanding about how to treat people who were living with dementia.

Care plans did not show how to support people to meet their needs and they did not show how to take account of people’s individual preferences. This showed that there was not clear and consistent guidance for staff to follow to ensure people were getting the care they required.

People were put at risk because the provider’s own system for monitoring the quality of the care and service were not being used. This meant the service people received was not properly checked to ensure it was safe and suitable.

Some of the staff were clear about what abuse was and how to report it. Staff had been on training about abuse to help them to try and understand what it was and how to keep people safe.

People were supported to eat and drink a varied diet. People were asked for their food preferences and these were included in the menus.

There were systems in place to ensure the requirements of the Mental Capacity Act 2005 were implemented. This law protects people who lack capacity to make informed decisions about their lives. One application had been completed under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards. This had been accepted and necessary safeguards were in place for the person.

Staff had received training and showed an understanding about their roles and responsibilities.

People were treated with kindness and respect by the remaining members of staff. These staff took time to speak with the people they were supporting and there were positive interactions between them.

Staff spoke positively about having a new manager who they described as “very approachable”. and someone who, “listens”. The new manager had already identified a number of the concerns that we found at this inspection.

We found six breaches of the regulations during our inspection.

You can see what action we told the provider to take at the back of the full version of the report.

We carried out a follow-up inspection to check the provider had achieved compliance on two outcomes. At the previous inspection we said outcomes on care and welfare of people who use services and management of medicines were not being fully met.

The people who lived permanently in the home were not able to tell us about their care or their medicines because they were living with dementia. We asked relatives for their opinions on the provisions of care they observed from the staff. We used SOFI to make judgements on the level of interaction between staff and the people who lived in the home.

The two relatives we spoke with told us their relatives living in the home were well looked after by the staff. They told us they were invited to care plan review meetings and their suggestions were considered by the staff. We were told the staff informed them of important events such as accidents and GP’s visits.

When we observed the lunchtime meal we heard staff ask people to choose their preferred meal from the two choices given. We saw staff gave visual choices to encourage people to make decisions about the meals they were to eat. We saw staff use a calm approach with people which had a settling effect on one person who was becoming anxious. We observed people undertaking in –house activities. For example making Christmas decorations.

People’s medicines were kept in lockable cabinets kept in their bedrooms. Staff administered medicines from a monitored dosage system. We observed staff administering medicines during the lunchtime meal and we saw staff supervise people taking their medicines from a discreet distance. Relatives told us the staff told them about medicine changes.

Not all people were able to express their experiences of living at the home because they were living with dementia. We used SOFI to observe how these people engaged with each other, their surroundings and the staff.

There was an activities coordinator employed to organise activities and at the time of the inspection there was a quiz and 11 people participated. One person showed us their bedroom and it was evident people made decisions on how to arrange their belongings.

We spoke to six people and their comments included “I like not having to share my bedroom,” “the staff knew when I was ill, they got the doctor and I am ok now,” “The staff are friendly and I enjoy living here” and “I am a strict vegetarian and they make the food I like to eat.”

We spoke with two relatives of people who lived at the home. Both relatives told us they had looked around the home before a decision was reached for their relative to live at the home. One relative told us an assessment of need had occurred before their relative’s admission.. Another relative told us a meeting had taken place with the family to discuss the needs of their relative.

We saw people refuse their medicines. Staff encouraged but did not force people to take their medicines. Staff knew how people showed they were anxious with their surroundings or not happy with the way their care was delivered. We saw staff spoke to people at eye level when they explained what was about to happen. Staff used a gentle approach to manage behaviours that others found difficult.

People were given choices of refreshments and meals.

Care plans did not direct staff on how to deliver care to people living with dementia.

Medication systems did not ensure the safe management of medicines.

There were 15 people living at Springfield when we carried out our inspection.

We met 13 people who used the service. We met the registered manager, two care staff and the cook.

We were not able to speak with all of the people using the service because some of them had dementia which made it harder for them to express their views. To find out what daily life was like for people who hade dementia at Springfield we used the short observational framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

People who we did speak with made a number of comments about the service and the staff. “The staff are very good they are polite and prompt”. “I’m very happy; it’s relaxing”. “It’s fine; you can get help from anyone”. “The food is very good”. “This is very caring”. “The staff are always happy”. “It’s lovely to live here”.

We saw people were supported by staff with their different personal care needs in a caring and attentive way. We saw that care plans showed in detail how to meet people’s care needs.

People were helped to stay safe in the home. There were systems in place for staff to know how to keep people safe from abuse.

People were supported with their needs by staff who were properly supervised in their work. Staff had training and development opportunities to help them gain insight about what care and support people needed.

We saw there were effective systems in place to check, monitor and improve the quality of the service people received.

This inspection was unannounced and took place on 18 and 19 November 2014. At the last inspection in March 2013, we found the provider had breached Regulation 13 Management of Medicines and Regulation 21 Requirements relating to workers. We asked the provider to tell us how compliance with these regulations was to be achieved. The provider wrote to us with an action plan of improvements that would be made. At this inspection we found medicine management systems had improved and recruitment procedures were robust.

Springfield offers accommodation and personal care for up to 39 older people living with dementia.

The manager was not registered with the Care Quality Commission and the staff told us there had been two managers in 12 months which had a de-stabling effect on morale and consistency. 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 safe at the home. The staffing levels that were in place allowed for staff to spend time talking to people. There was a vacancy for a deputy manager on the second floor (there was a deputy manager on each of the three floors) to manage shifts and provide leadership to the staff on duty. The staff told that this created inconsistency and low morale with staff.

People were protected from the risk of unsafe medicine systems. There were safe systems of medicine storage, administration, recording and disposal. Medicines were administered by a senior care assistant.

Staff attended training to meet the needs of people living with dementia. New staff received an induction to prepare them for the role they were to perform. However, supervision of staff was not happening regularly. Individual supervision provides an opportunity for discussion about staff performance, issues of concern and personal development.

People were supported by the staff to make daily decisions. Deprivation of Liberty Safeguards (DoLS) applications were in progress for some people. This was because people were subject to continuous supervision and lacked the option to leave the home without staff supervision.

People told us the staff were caring and their rights were respected. We saw staff using a kind and gentle manner towards people. While we saw activities taking place they were not available on a regular basis for all the people living at the home.

People had access to social and healthcare professionals. We spoke with a social worker who said “they [staff] take people’s preferences on board. The care is person centered.” People and their relatives told us they would approach the manager if they any complaints.

The manager sought the views of relatives about the service provided through an annual survey. There was a system of audits to ensure the quality of care. Staff told us the manager was approachable, they were encouraged with their personal development and the leadership at the home was strong.