This inspection took place on 31 October 2018 and was unannounced. This meant the staff and the provider did not know we would be visiting. Springfield Lodge Care Home was last inspected by CQC on 26 May 2016 and 1 June 2016 and was rated ‘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 risk 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.

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

Springfield Lodge Care Home accommodates up to 40 older people who require personal care. On the day of our inspection there were 38 people using the service. People who used the service and their relatives were complimentary about the standard of care at Springfield Lodge Care Home.

The home had a registered manager in place. A registered manager is a person who has registered with CQC 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 home was clean, spacious and suitable for the people who used the service. The provider had effective procedures in place for managing the maintenance of the premises and appropriate health and safety checks were carried out. Accidents and incidents were appropriately recorded and risk assessments were in place where required. The registered manager understood their responsibilities about safeguarding and staff had been trained in safeguarding vulnerable adults. Appropriate arrangements were in place for the safe management and administration of medicines.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. Staff were suitably trained and supported to provide care to people who used the service through regular supervision and appraisal. Staff said they felt supported by the registered manager.

Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Activities were arranged for people who used the service based on their likes and interests and to help meet their social needs, in the home and within the local community.

Care records showed people’s needs were assessed before they started using the service. Care plans were written in a person-centred way and were reviewed regularly. Person-centred is about ensuring the person is at the centre of any care or support and their individual wishes, needs and choices are taken into account. Care plans were in place that recorded people’s plans and wishes for their end of life care.

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. People had access to healthcare services and received ongoing healthcare support.

The provider had an effective complaints procedure in place and people who used the service and their relatives were aware of how to make a complaint. The provider had a quality assurance process in place. People who used the service, relatives and staff were regularly consulted about the quality of the service through meetings and surveys.

This inspection took place on 26 May and 1 June 2016 and was unannounced. This meant the staff and provider did not know we would be visiting.

Springfield Lodge Nursing Home provides care and accommodation for up to 37 people with personal care and nursing needs. On the day of our inspection there were 34 people using the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Springfield Lodge Nursing Home was last inspected by CQC on 31 July 2014 and was compliant with the regulations in force at that time.

Accidents and incidents were appropriately recorded and investigated. Risk assessments were in place for people who used the service and described potential risks and the safeguards in place. Staff had been trained in how to safeguard vulnerable adults. Medicines were stored safely and securely, and procedures were in place to ensure people received medicines as prescribed.

The home was clean, spacious and suitable for the people who used the service and appropriate health and safety checks had been carried out.

There were sufficient numbers of staff on duty in order to meet the needs of people who used the service. The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Staff were suitably trained and received regular supervisions and appraisals.

The provider was working within the principles of the Mental Capacity Act (MCA) 2005 and was following the requirements in the Deprivation of Liberty Safeguards (DoLS).

People were protected from the risk of poor nutrition and staff were aware of people’s nutritional needs. Care records contained evidence of visits to and from external health care specialists.

People who used the service were complimentary about the standard of care at Springfield Lodge Nursing Home. Staff treated people with dignity and respect and helped to maintain people’s independence by encouraging them to care for themselves where possible.

Care records showed that people’s needs were assessed before they moved into Springfield Lodge Nursing Home and care plans were written in a person centred way.

The home employed an activities co-ordinator and activities were arranged for people to help meet their social needs and protect people from social isolation.

People who used the service were aware of how to make a complaint. There had been only one formal complaint recorded at the service in the previous 12 months.

The service had links with the local community. Staff felt supported by the registered manager and were comfortable raising any concerns. People who used the service and staff were regularly consulted about the quality of the service.

The purpose of this inspection was to ensure improvements had been made since our previous inspection on 28 November 2013 and find out five key questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, seeking experience and views from people who used the service, their relatives, and the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and 'in good hands'. The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application for Deprivation of Liberty should be made, and how to submit one. There were effective systems in place where people did not have capacity and best interest decisions were made through a multi-agency approach.

The service was clean and hygienic. Appropriate guidance, equipment and facilities were in place for staff so people were safe and protected from the risks associated with cross infection. We found improvements had been made since our inspection in November 2013.

Is the service effective?

People's health and welfare was protected and promoted and we recognised the service had sought expertise and support from other health and social care services that people required, in order to meet their needs effectively.

People received appropriate care and support because there was effective systems in place to assess, plan, implement, monitor and evaluate people's needs.

Is the service caring?

We saw that staff had a good awareness of individual’s needs and treated people in a warm and respectful manner. We saw people were receiving care and support in a sensitive way during our visit and staff were able to manage behaviours that were complex or challenging.

The manager and staff were knowledgeable about people's lives before they moved into the home. There was interaction between staff and people in the home; everyone was relaxed, happy and comfortable in each other's company.

People were positive about their experiences. Comments included "They are all lovely and very kind", "It's not like being at home but it will do" and "The home is wonderful, I am very well looked after".

Is the service responsive?

Systems were in place to make sure that the manager, deputy manager and staff learnt from significant events including accidents and incidents. Audits helped determine why a particular incident may have happened and what further action was required to help prevent reoccurrence.

Is the service well-led?

The manager, deputy manager and staff continued to look at the needs of people who used the service and ways to improve these for people. It was evident the manger was committed to ensuring people received care which was safe and effective because a number of audits such as care planning had been introduced which meant people's needs were met in a safe and effective way.

We spoke with people who use the service and their relatives, looked at people's care records, talked with staff and the manager and observed how people were cared for. People we spoke with talked positively about the service making comments such as "it's a wonderful place, I have been here a while and I am happy." Another person told us "my relative has been here only a short while but the care is very good, I couldn't have picked anywhere better."

We also spoke with three health professionals who were visiting the service during our inspection who told us they did not have any concerns relating to how people were cared for and found the level of care to be "very good".

We looked at people's records in relation to consent to their care and treatment and also care planning and risk assessment and the care people received. We found improvements were required for example in relation to decisions about end of life care because important principles of involving people had not been followed.

Care plans we looked at did not contain sufficient information to ensure people's needs were fully met and when we observed how people were care for we found staff did not always have the right skills and there was an insufficient number of staff to ensure people were cared for appropriately.

We did find that people were protected from the risks of unsafe medication practices. We found the service carried out monthly audits and where concerns had been identified these were rectified immediately.

We observed the cleanliness of the home and found improvements were required. The service had recently appointed two infection control leads but they were still awaiting training, the physical state of bathrooms and toilets needed improving we found many areas to pose a risk of infection because of a lack of cleanliness.

We looked at the quality and monitoring system for the service and found although the service did do regular audits in relation to the care people received and the environment issues identified were not often addressed promptly and there was no information available about how improvements would be made.

We did not speak with people who used the service due to the nature of the compliance action set at the previous inspection. We spoke with the manager and some staff who worked at Springfield Lodge and looked at records kept by the provider to show how people were being protected.

All the people that we spoke with said they were happy at Springfield Lodge. One person said "It's got a pleasant atmosphere, it's comfortable and homely." People also said they were involved in their care, with their preferences being sought and taken into consideration. One person told us "They (the staff) have taken the time to get to know me."

People said they were happy with the care and treatment they were receiving. One person said "All of the staff take an active interest in me getting better" and another said "They look after me well."

People told us they felt safe at Springfield Lodge. One person said "When I first came in I was scared, but now I'm much more relaxed. I feel safe in the hands of the staff."

People told us they were happy with the staff employed by the service and the care that they provided. One person said "The staff in here can't help you enough."

People said they were aware of the complaints system. They also said they would be happy to raise any concerns they had with the staff and these would be listened to and acted upon. All of the residents that we spoke with said they hadn't had any reason to complain.