We inspected this service on 11 July 2017 and it was an unannounced inspection. Our last inspection took place in July 2016 and we found that some improvements were needed. We found there were not enough staff available to offer support and risks to people were not manager in a safe way. We also found people were not always treated in a dignified way and they did not always receive care in their preferred way. At this inspection we found some improvements had been made, however further improvements were needed.

The service was registered to provide accommodation, personal care and nursing care for up to 36 people. At the time of the inspection 24 people were using the service.

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.

We could not be assured people always received their medicines as prescribed, as we found medicines in previous blister packs. The deployment of staff meant that some people had to wait longer than necessary for support.

People felt safe and knew how to recognise and report potential abuse. There were enough staff available to support people in a timely manner. Risks to individuals were assessed and managed in a safe way. Medicines were managed to ensure people were safe from the risks associated to them.

Staff received and induction and training that helped them offer support to people. Staff knew people well including their likes and dislikes. People enjoyed the food available and were offered a choice. When needed people received support from health professionals. When people lacked capacity to make decisions for themselves, capacity assessments had been completed and decisions made in the persons best interest.

People were supported in a caring was by staff they liked. People’s privacy and dignity was upheld. People were encouraged to be independent and make choices how to spend their day. Relatives felt updated by the home and people felt involved with their care. People were given the opportunity to participate in activities they enjoyed.

Staff felt listened to and had the opportunity to raise concerns. The registered manager understood their responsibilities around registration with us and notified us of significant events that occurred within the home. There were systems in place to drive improvements within the service. People and relatives had the opportunity to raise concerns and suggested improvements, we saw these were considered.

We inspected this service on 5 July 2016 and it was an unannounced inspection. Our last inspection took place in May 2015 and we found that some improvements were needed. We found not all principles of the Mental Capacity Act 2005 were followed. Medicine administration records were not countersigned when needed and there was no guidance for staff when people required creams to be applied At this inspection we found some improvements had been made, however further improvements were needed.

The service was registered to provide accommodation, personal care and nursing care for up to 36 people. At the time of the inspection 28 people were using the service.

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.

We found there were not enough staff available to support people and they had to wait to receive care. Risks to people were not managed in a safe way and recommendations that had been made to keep people safe were not always followed. Staff did not have time to spend with people and care that was delivered was not always provided in a dignified way.

People did not receive support in their preferred way and there were few activities they could participate in. People and relatives knew how to complain however they did not feel their concerns were actioned. Staff knew how to whistle blow but were not confident they would be listed to.

Quality monitoring systems were in place however these were not always effective in identifying concerns. When concerns were identified action was not always taken to bring about changes. We found care needs were not always recorded accurately to ensure the correct action was taken.

People were supported by staff they liked and who had an induction and training that helped them to support people. They understood about safeguarding and action to take if they suspected abuse. The provider completed checks on staff to ensure their suitability to work with people. People’s medicines were stored and administered in a safe way.

The principles of the Mental Capacity Act 2005 were followed and the provider had considered when people were being restricted. People enjoyed the food and when they needed support from health professionals they were referred appropriately. Relatives and friends felt welcomed and were free to visit at any time. People and relatives felt involved with reviewing their care.

There was a registered manager in place and people and relatives knew who they were. They notified us of significant events that occurred within the home.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We inspected Springfield House Nursing Home on 20 May 2015 as an unannounced inspection. Springfield House provides accommodation with nursing and personal care for up to 36 people. On the day of our inspection, there were 22 people living at the home.

There had not been a registered manager at the home since January 2014. 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. A new manager was working at the service on the day of our inspection and had started the process to register with us. We refer to the new manager as the manager in the body of the report.

At our inspection in September 2014 compliance actions were made as the provider was breaching legal requirements. These breaches related to the improvements needed regarding: planning and delivering people’s care and treatment; meeting people’s nutritional needs, the quality of recording and monitoring staffing levels to ensure they were sufficient to meet people’s needs. Following the inspection, we asked the provider to send us an action plan to demonstrate how they would meet the legal requirements of the regulations. At this inspection, we found that action had been taken but improvements were still needed.

People told us they felt safe. The manager and staff understood their responsibilities to protect people from harm or abuse. Risks to people’s health and wellbeing were identified and care plans were in place and followed to minimise risks to people. People had an individual plan of care that detailed the support they needed and how they wanted this to be provided.

There were enough staff on duty to meet people’s physical and social needs. The provider’s recruitment process ensured people were supported by staff whose suitability had been checked. Some staff had not received all the training they needed to meet people’s needs but we saw that a programme of training was in place to address this shortfall. The manager had introduced a regular programme of supervision to support staff.

Medicines were administered as prescribed and stored safely but improvements were needed to the way medicines were recorded.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. Where people did not have capacity, we found that assessments were not always completed accurately. The manager had identified the issues and told us they were taking action to ensure they were meeting the requirements of the Act and people’s rights were always upheld.

Risks to people’s nutrition were assessed and minimised because they were provided with meals which met their individual dietary requirements. People were supported to have sufficient to eat and drink and had a choice of meals and drinks daily. People were supported to maintain good health by accessing the services of other health professionals.

People felt involved in making decisions and planning their care. Staff were attentive and responsive to people’s needs. Staff knew people well and provided assistance in ways that maintained people’s dignity and promoted their independence. People were able to see family and friends as they wanted and visitors were always made welcome.

People told us the registered manager was approachable and they felt able to raise their concerns and were confident action would be taken. The provider sought people’s opinions on the service and the information was used to make improvements to the service.

We saw that people were supported to follow their interests. An activities co-ordinator tailored activities to meet people’s individual needs. People were able to take part in a pilot scheme which aimed to improve the mobility, social interaction and mental stimulation of people living at the home. We observed people taking part in a movement to music session.

This inspection was unannounced. That meant that the provider did not know that we were coming.

We carried out this inspection to see if the provider had made any improvements since our last inspection in July 2014. At that inspection we had identified five areas where the provider needed to make improvements for the people who used the service. As a result of our concerns we had issued the provider with four warning notices and a compliance action. The registered manager named in this report is no longer working at the home. Currently there is no registered manager at the home. The home currently has an acting manager in post.

Since then the provider had produced an action plan and had been sending us regular updates to inform us of the actions they had taken to bring about improvements to the service.

During the inspection we met with people who used the service, we spoke with visitors and staff who worked there. We also met with the acting manager.

As part of this inspection we asked the questions we normally ask:

Is the service Safe?

Risk assessments were in place for each individual person and these were reviewed regularly.

Staffing levels had improved but some people were still not receiving consistent care.

Is the service Caring?

Staff were caring and respectful with people who used the service

Is the service Effective?

The provider had made some improvements but records of care did not always contain the level of information required to ensure that care remained effective.

The provider had improved in this area and we saw that they had responded to the needs of people appropriately. People who used the service had been referred to relevant health professionals where required resulting in appropriate treatment and advice for people.

People were not always supported to have sufficient appropriate food and drink.

The staff team was not yet developed enough to ensure that all staff knew how to meet the needs of people using the service.

Is the service Well-Led?

Some improvements have been made to the monitoring of the quality of services but some areas required further monitoring to develop and improve the care for people.

We carried out this unannounced inspection to find out if the provider had made any improvements following a previous inspection. Two inspectors carried out this inspection arriving at 8am and finishing at 4pm.

During the inspection we met with four visiting health care professionals - the Tissue Viability Nurse (TVN) specialist , the Community Psychiatric Nurse Specialist (CPN) and two Speech and Language Therapists (SaLT).

We also spoke with 12 people who used the service and four staff. The registered manger had left since our last inspection and we met with the regional manager and the acting manager whom the provider calls "home manager."

As part of the inspection process we asked the questions we normally ask:

Is the service Safe?

People who used the service were not always kept safe. Some people were left alone and with no means of calling for assistance. People did not always have access to call bells and were left unsupervised in bedrooms and in communal areas. People's nutritional needs were not effectively monitored, leaving people at risk of dehydration and malnutrition. The safety and welfare of people who used the service was compromised by a lack of staff supervision.

Is the service Caring?

Staff interacted with people who used the service in a caring and respectful way. People who used the service and visitors told us that staff were kind and caring towards them. One person said: "The staff here are lovely. They are kind and very caring, there just aren't enough of them."

Is the service Responsive?

The service did not respond to people in a timely way. People had to wait long periods of time for the care and support they needed. One person told us: "You often have to wait for a long time to be taken to the toilet and sometimes it is too late and this is very undignified".

Is the service Effective?

The service is not effective in the respect that people did not receive the right care and support at the right time. People did not receive care and support according to their individual preferences and care was not delivered in a person centred way. People were left for long periods of time with no stimulation or interaction from staff.

Is the service Well-Led?

There has been a lack of consistent management since the registered manager left. The home manager had been in post since April 2014 and had not yet registered as manager for the service. Staff felt that they were not listened to and felt unsupported by the manager. There was a quality monitoring system in place but this was ineffective in bringing about positive changes and improvements for the people who used the service.

When we completed our inspection in December 2013 we found that the provider was not meeting all of the regulations. We visited again to check the progress the home had made. During this inspection we spoke with people that lived at the home, relatives and staff. We spoke with the regional manager following the inspection. The person named in this report as the registered manager was no longer working at the home when we completed this inspection.

People told us they were happy living at the home. Comments included: "On the whole good" and "They are looking after me alright. Most of the carers are nice". People were treated with respect and their privacy and dignity was promoted. People told us that they had good relationships with care staff and that they took account of their wishes.

People told us they liked the meals and they were always offered a choice. We observed that some people were awake approximately two hours before they were offered their breakfast. Plans that the provider had put in place following our inspection in December 2013 to address this had not been effective. People's nutritional intake was not effectively monitored as the records of the food and drinks people consumed were not always accurately completed.

The staffing levels at the home were not sufficient to ensure people always received care in a prompt and timely way.

This was an unannounced inspection. The provider did not know we were visiting. During the inspection we spoke with the manager, care and nursing staff, relatives and people that lived at the home.

People gave us mixed views about the care provided. Some people were extremely happy whilst some other people were less satisfied. Relatives we spoke with were very pleased with the care their relative received.

The home assessed people's nutritional needs and plans were in place to check and monitor the food and fluids they consumed. The home made sure that specialist diets were catered for. There were mixed views about the quality of the food provided at the home. Some people found it bland. We observed that mealtimes were not well organised. For some people there could be either too long or too short a period between meals. The choices of food were not made known to people.

Equipment used at the home was checked and serviced to make sure people were kept safe.

The provider had appropriate recruitment procedures in place to make sure that staff were suitable to work with vulnerable people.

Checks were in place to review and monitor the quality of care that people received. People were asked for their views about the care they received. When complaints were raised these were acted upon.

We visited the service to check on the care and welfare of people who were living at Springfield Nursing Home.

During our visit we used different methods to help us understand the experiences of people using the service. We spoke with people living at the home, staff members, the manager and the regional manager and we spent time observing the care provided in the home.

We spoke to eight people living at the home and two visiting relatives. People we spoke with were positive about the care and support that they or their relative received. There was a planned programme of activities each week.

The environment was well maintained by the provider.

We checked the administration of medication, and found that people had their medicines at the times they needed them, and in a safe way.

Individual care plans and risk assessments were comprehensively and clearly documented, and provided detailed information for care staff on actions that were needed to minimise risks to people.

We found that staff were safely recruited and supported into their role and responsibilities. Staff supervision and training was taking place.

We saw that there had been regular audits of the service, undertaken by the regional manager and the manager, and there had been yearly surveys undertaken by the home to provide assurance that people received safe and appropriate care.