Springfield House is a residential care home that is registered to provide accommodation and personal care for up to 35 people who may be living with a physical disability and/or dementia. At the time of our inspection, there were 21 people using the service.

At our last inspection on 12 April 2016, we rated the service overall Good. The key questions Effective, Caring, Responsive and Well-Led were rated good. The key question Safe was rated Requires Improvement as medicines were not always managed safely and people were not always protected from the risk of abuse. At this inspection, we found that improvements had been made and sustained and now Safe is rated as Good. We found that that evidence continued to support the overall rating of Good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating has not changed since our last inspection.

Staff understood their responsibilities and knew how to keep people safe from harm and abuse. People had received their medicines safely, and on time as prescribed. There were enough suitably trained staff to meet people’s needs and risks were managed effectively in line with their care plans. People were protected from the risk of the spread of infection.

People were encouraged and supported to make choices about the way in which they received their care and staff supported people in the least restrictive way possible. People had their nutritional needs met and people had the necessary access to healthcare. People were treated with kindness and compassion and people had their privacy respected and dignity upheld.

People had their needs assessed and planned for and people received care that was personalised and responsive to their individual needs. People participated in meaningful activities and end of life wishes were considered and planned for.

The registered manager understood the conditions of registration with us and people felt that the registered manager was friendly and approachable.

Further information is in the detailed findings below.

We inspected this service on 12 April 2016 and it was unannounced. At the last inspection on 8 and 9 December 2014, we asked the provider to make improvements to ensure people’s consent was sought and people being supported in a person centred way. The provider sent us an action plan in May 2015 explaining the actions they would take to improve. At this inspection we found the required improvements had been made.

The service was registered to provide personal care for up to 35 older people. At the time of inspection 20 people were using the service.

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.

Some people were not protected from abuse as staff had not recognised all the categories of potential abuse. Where people received medicines on an ‘as required’ basis, safe systems were not always in place to ensure their needs were met.

People told us they felt safe. Risks to people were identified and managed to keep them safe from harm. The staff who worked within the service had checks to ensure their suitability to work with people. Staff received an induction and training that enabled them to support people effectively. There were sufficient staff to meet people’s needs.

People were treated in a caring way and were happy with the staff that supported them. People told us staff knew them well and had the skills to support them. People were encouraged to make choices about their day to day routine and remain independent.

People were supported to eat and drink sufficiently amounts to maintain good health and when people needed access to health professionals it was provided for them. We found that people had the opportunity to take part in activities they enjoyed.

We found that staff followed the requirements of the Mental Capacity Act 2005 and when needed, mental capacity assessments and best interest decisions were completed. People and relatives were involved with planning and reviewing their care.

Quality monitoring checks were completed to bring about improvements. The provider also sought the opinions of people who used the service and used this information to make changes. People liked the home and felt the management team was approachable. Staff felt listed to and had the opportunity to raise concerns. People knew how to complain and were confident this would be dealt with.

This was an unannounced inspection. During the inspection we spoke with people that lived at Springfield House, relatives, care staff, the manager and the regional manager.

We considered our inspection findings to answer the questions we always ask;

Is the service safe?

People told us they felt safe living at the home. One person said: "The staff are gold". Relatives told us they felt happy that their relatives were looked after.

Staff were trained in safeguarding adults and knew how to respond if they had any concerns. The home had a safeguarding procedure in place.

We looked at the home's recruitment procedures. We saw that appropriate checks were completed before staff started work. This meant that care staff were suitable to provide care to vulnerable people.

Is the service effective?

People said that they were happy with their care but said that they sometimes had to wait for support. We observed times when people had to wait for their care to be provided. We also saw that when people were in the lounges nurse call bells were not readily available to call for staff support. We have asked the provider to tell us how they are going to make sure that people receive the care they need in a timely way.

People were usually provided with choices about their daily lives. People could choose where to spend their time. People told us they were always offered a choice at breakfast but not at lunchtime.

People were assessed when they moved to the home and plans of care were in place. People were supported to receive health care support. People's nutritional needs were assessed and regularly evaluated. There were gaps in some of the daily records.

Is the service caring?

People said they liked living at Springfield House. They said they got on well with the staff although they were very busy. One person said: "The staff are kind but very busy". Another person said: "The staff are wonderful".

We observed that when staff spent time with people they treated them in a respectful manner. We saw there was a relaxed atmosphere in the home and people appeared comfortable with the staff.

A health care professional we spoke with told us that the care staff knew the people that lived at the home well.

Is the service responsive?

The home did not provide enough stimulating and interesting things for people to do. We have asked the provider to tell us how they are going to improve this aspect of people's care.

The home had a complaints procedure that was available to people. Records were not always kept when concerns were acted upon.

People had the opportunity to take part in a satisfaction survey but the outcome included the neighbouring home. This meant the outcome for this home was unclear.

Is the home well led?

The home has recently had a new manager and a new regional manager.

Systems were in place to monitor and check the quality of care but these were not being used effectively and actions identified have not always been followed up. Records keeping needed to be improved to ensure that people were receiving appropriate and safe care. We have asked the provider to tell us how they are going to improve these aspects of the service.

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

Everyone we spoke with said they were happy living at the home. One person said: "I'm really happy here. They really care". Relatives said that they had seen improvements in their relative's health and welfare since they moved to live at the home.

People had their health and personal care needs attended to in the way they wished. People told us that they saw the GP when they felt ill and that they were supported to have health checks ups.

Although the home provided people with activities, this was an area that could be further developed. This would make sure that people had the opportunity to take part in activities they had chosen.

Care staff supported people to have their medication. Care staff were trained in administering medication. Managers at the home completed regular checks to make sure that medication was given correctly.

People received support from care staff that were trained and supported. There were adequate care staff on duty to provide people with the support they needed.

The provider has systems in place to check and monitor the care people received. People were asked for their views of the care they received. When issues were raised these were acted upon.

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

We spoke with eight people who lived in 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. They 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, these had been undertaken by the regional manager and the manager. There had also been yearly surveys undertaken by the home to provide assurance that people received safe and appropriate care.

We visited Springfield House Residential Home on 9 March 2012. On the day of our visit we spoke with five people who lived at Springfield House Residential Home and three relatives. We also spoke with five members of staff and the registered manager.

People we spoke with during our visit were overall happy with their care. People told us they were comfortable. People reported staff were caring and they could approach them with any concerns. One person commented the care was "very good".

People we spoke with said they were treated with dignity and respect. People told us there were activities they could be involved with such as exercise sessions and walks to the local village. People commented they had choice and did not have to take part.

Overall people said they enjoyed their meals and they were offered variety, one person told us the food was "lovely". We saw meal times were organised and relaxed. People were supported into the dining room and assisted by staff. Staff ensured people were comfortable and had an adequate meal.

All the relatives we spoke with were happy with the care received by their family members. Relatives said they felt involved and staff kept them informed of changes which occurred.

We saw staff attended to people in a caring manner, responding appropriately to their needs. People's health needs were known by staff and included in the delivery, of care for example one person required encouraging with fluids to maintain hydration. Staff were aware of the need to monitor the individuals fluid intake and this was recorded in their records.

Staff we spoke with showed understanding in areas of safeguarding, equality and diversity. Staff were aware of the management of falls and pressure sores. Staff told us they delivered care by team work. Staff felt trained and supported to provide suitable care. Staff told us when training needs had been identified appropriate actions was taken to address the issue. Staff understood what constituted abuse and how to escalate concerns. This demonstrated people were cared for by appropriately trained staff.

We found systems were in place to ensure the service was improving as a result of findings. In one example more activities were introduced as a result of feedback from questionnaires to relatives. The relatives we spoke with were happy with the range of activities available.

This inspection took place on the 8 and 9 December 2014 and was unannounced. Springfield House provides personal care to up to 36 older people. On the day of this inspection there were 23 people accommodated at the home.

There had not been a registered manager in post 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.

At the last inspection in June 2014 we asked the provider to take action to make improvements to people’s care and welfare, record keeping and the monitoring of the quality of care. Action had been taken but improvements were still needed.

People told us they felt safe. Staff knew the signs that may indicate people were abused and were clear of the action to take. They were aware of their responsibility to protect people from harm or abuse. They told us they were confident that any concerns they reported would be acted upon.

Risks to people were identified. Plans were in place and acted upon to minimise risk to people.

There were sufficient staff to provide people’s care in a safe way. The staffing levels were regularly monitored and adjusted to take account of people’s needs. The provider had a robust recruitment process that ensured people were supported by staff whose suitability had been checked. Staff were supported and trained to provide people with care to an appropriate standard.

People had an individual plan of care that detailed the support they needed and how they wanted this to be provided. However, we found that some people’s support was task based and was not provided in the way people wanted. We also saw that some people including those living with dementia did not have sufficient things to do. People were left for periods with no interaction or stimulation. Activities were not consistently taking account of people’s wishes.

Appropriate systems were in place to store, record and administer medicines. This supported people to have their medicines at the right time and in the right way.

Care staff were not consistently following the provisions of the Mental Capacity Act 2005. Mental capacity assessments were not always completed. When people did not have capacity there was no information to show that decisions were made in their best interest. This meant that people’s rights may not always be upheld.

People were supported to have sufficient to eat and drink. People could choose from a selection of meals and drinks. Where people needed support to eat and drink this was provided. The health care needs of people were addressed. People were supported to access health care services. When people were ill the doctor was called and when they needed specialist support this was provided.

People told us they found the staff caring and compassionate. People were able to see their friends and families as they wanted. There were no restrictions on when people could visit the home. All the visitors we spoke with told us they were made welcome by the staff in the home.

We observed and people told us that there were occasions when people’s dignity was not fully promoted. Some people were not able to wear their own clothes due to problems with the laundry facilities.

The provider had a range of checks and audits in place but these were not always effective. The checks had identified some shortfalls we saw and when actions were taken to address concerns these were not always effective.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond with 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 this report.