This inspection took place on 01 August 2018 and was unannounced. The last inspection was in June 2017 where we rated the Service as ‘Good’ but identified one breach of the legal requirements in relation to consent. At this inspection we found that action had been taken to address this but we identified two further breaches of the legal requirements relating to staff training and governance.

Springfield Manor Nursing Home 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.

Springfield Manor Nursing Home supports up to 30 people in one adapted building. The service provides support to older people with long term conditions, physical disabilities and people living with dementia. On the day of our visit there were 23 people living at the service.

There was not a registered manager in post, the manager was in the process of registering with CQC. 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.

There were shortfalls in governance and record keeping. A new manager had been recruited and had started to make improvements to the audits that were carried out. However, there had been a lack of audits previously and we identified shortfalls in record keeping.

Staff did not always have the right knowledge and expertise for their roles. Staff had completed a variety of training courses but we identified instances where staff knowledge in relation to dementia care was lacking. Staff told us that they did not always feel confident supporting people living with dementia and we observed instances where staff did not seem competent. The provider had a plan to address this, we will follow up on the impact of these improvements at our next inspection.

People’s consent was sought in line with legislation and where we did identify some documentation missing, this was addressed after our visit. People were involved in planning their care and care plans were person centred and reflected their needs. The provider encouraged people to express their individuality and where people had particular cultural or religious needs, these had been met. People’s wishes with regards to end of life care were recorded and regular reviews took place to respond to changes in people’s needs.

People’s medicines were managed and administered safely, by trained staff. Staff ensured people’s clinical needs were met and people had regular access to healthcare professionals. Where people had particular dietary needs, these had been planned for and responded to. People’s preferences in relation to food were known to staff and catered for.

Risks to people were assessed and managed appropriately. Where incidents occurred risk management plans were reviewed and new measures were identified to keep people safe. Staff understood their role in safeguarding people from abuse. Management analysed incidents to learn from them and had notified CQC appropriately where significant events had occurred.

People spoke positively about the activities on offer. People were supported by staff that got on well with them and we observed a number of pleasant interactions between people and staff. Staff supported people in a way that encouraged them to maintain skills. People’s dignity was maintained by staff who provided care in a way that was respectful.

There were sufficient numbers of staff working at the home to keep people safe and the provider had carried out appropriate checks on staff to ensure they were suitable for their roles. Staff had regular contact with their line managers through supervision meetings a

This inspection was carried out on the 3 May 2017. Springfield Manor Nursing Home provides residential, nursing and respite care for older people who are physically frail. It is registered to accommodate up to 30 people. At the time of our inspection 25 people were living at the service.

There was a registered manager in post that supported us on the day of the inspection. 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.

Care and treatment was not always provided with the appropriate consent from people and staff did always not work within the principles of the Mental Capacity Act 2005. People did say that staff asked them for consent before providing care.

There were sufficient numbers of staff to support the needs of people. People were protected from the risk of abuse and staff understood their roles and responsibilities. People told us that they felt safe with staff. Robust recruitment practices were in place before staff started work.

Staff understood the risks to people. Staff encouraged and supported people to lead their lives as independently as possible whilst ensuring they were kept safe. People’s medicines were managed in a safe way. Staff receiving appropriate training and supervision to provide effective care to people.

People told us that they liked the food at the service and said they had enough to eat and drink. Nutritional assessments were undertaken when people moved in and people's nutritional and hydration needs were monitored.

Staff were caring and considerate to people’s needs. People said that staff were caring and kind to them and treated them with dignity. People and relatives were involved in their care planning and the care that was provided was person centred.

Care plans were detailed and provided guidance to staff on best to support people. Staff communicated with each other the changes to people care. There were sufficient activities in place and people said that they enjoyed taking part in the activities.

Systems were in place if complaints and concerns were received. The provider had systems in place to regularly assess and monitor the quality of the care provided. The provider actively sought, encouraged and supported people's involvement in the improvement of the service.

People told us the staff were friendly and management were always approachable. Staff were encouraged to contribute to the improvement of the service. Staff felt that management were very supportive and staff felt valued.

The registered manager had informed the CQC of significant events at the service. Records were accurate and kept securely.

We carried out an unannounced inspection of this service on 28 October 2014. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the cleanliness and infection control, people’s consent to care and treatment, assessing and monitoring the quality of the service, how people were cared for and respected, requirements that related to the recruitment of staff and how staff were supported.

We undertook this inspection to check that they had followed their plan and to confirm that they have now met legal requirements. This report covers our findings in relation to those requirements and additional any other areas that we looked at on the day of the inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springfield Manor Nursing Home on our website at www.cqc.org.uk.

Springfield Manor Nursing Home is a privately owned care home for people who require long

term and respite care, nursing, or palliative care for up to 30 older people some of whom were living with dementia.

The service did not have a registered manager. 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. This was because a new manager had been recruited to work at the service who was submitting their application to the CQC.

There were not enough suitably skilled staff deployed around the service. One person said “I don’t feel there are enough staff as I always have to wait for staff to come and answer my call bell.” We found that the nurse on duty only had time to complete their medicine rounds and undertake wound care on the day of the inspection. They told us that they feel they do not have time to be more pro-active in the clinical care that they wanted to provide. Some care was not being provided in a timely way.

We found during this inspection that there had been sufficient improvements to the cleanliness and infection control at the service. Staff had received updated infection control training to improve their understanding and knowledge. People and visitors said the service was a lot cleaner now.

On this inspection we found that the recruitment practices had been addressed. Recruitment files contained a check list of documents that had been obtained before each member of staff started work and these were all present.

The provider and the manager have contacted us since the inspection. They have provided us with a dependency tool to assess the needs of people living at the service and are looking to recruit additional staff including a nurse.

Assessments were undertaken to identify risks to people. When clinical risks were identified appropriate management plans were developed to reduce the likelihood of them occurring.

We reviewed people’s medicine charts and found no gaps or discrepancies. All medicines had been recorded appropriately. All medicine was stored, administered and disposed of safely.

Staff had knowledge of safeguarding adult’s procedures and what to do if they suspected any type of abuse. One said “I have never seen abuse here, but if I did then I would inform the manager and the nurse.”

In the event of an emergency such as a fire each person had a personal evacuation plan and at each handover staff discussed these.

Arrangements were now in place in relation to Mental Capacity Act 2005 (MCA). There were mental capacity assessments present in people’s care plans. These included care being provided and the use of bed rails.

People confirmed that consent was sought from them before care was given. We saw examples of staff gaining consent from people throughout the visit.

CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS). This aims to make sure that people are looked after in a way that does not inappropriately restrict their freedom. We saw that where people’s liberty may have been restricted applications had been submitted to the local authority.

At this inspection staff told us that training had improved. We saw that all staff were up to date with the service’s mandatory training.

People were happy with the care that they were receiving at the service. One person said “I’ve been here a while. It’s wonderful, no problems.”

People had access to a range of health care professionals, such as the GP, nutritionist and physiotherapist.. One health care professional said they worked well with the staff at the service and felt that people were receiving the health care they needed.

We found on this inspection that all people that wanted to were sitting in new lounge chairs which were arranged in little clusters around the service to promote privacy and independence.

When asked if they thought staff were caring one person said “Yes, staff help me with my make-up and finish getting me ready”. Another person told us that staff were kind and considerate. We saw staff took the time to acknowledge people either with a smile and there was plenty of laughter between staff and people.

People’s family and friends were able to visit at any time and we saw this happening throughout the visit. Health care professionals said that the staff were caring. One said “It’s a lovely home, think the care is excellent.”

Residents and relatives meetings took place regularly. This was a way of involving people and family’s in the running of the service.

Staff showed they were knowledgeable about people in the service and the things that were important to them in their lives.

People’s care plans detailed what people need to support them. The equipment provided to people was appropriate and up to date and where specialist needs had been identified support was given

Since the last inspection activities have increased in the service. An activities coordinator had been recruited. There were CD’s, various jigsaws and games. There were areas of interest for people around the service including large pictures, sensory items and hamsters which we saw people enjoying.

People were also able to access the community. One member of staff said “I’ve organised an outing to Wisley (gardens)” and a Father’s Day barbeque had been arranged on the Sunday following our inspection.

People said they would know how to make a complaint but had not needed to. There was a service policy available for people and staff said they would support people who wanted to make a complaint.

People who used the service and relatives said the management of the service had improved recently. Comments included “Things are a lot better since the new manager started, there is still a way to go” and “A lot of work has been done on the home, they are in the process of redecorating.”

The provider gained staff feedback through periodic meetings and surveys. The survey completed in 2015 identified that staff were generally happy and identified a few areas they felt could be improved. An action plan had been devised to address areas needing improvement.

The manager said “Springfield remains upon the top of my priorities; I am actively working towards improving things.”

We saw various audits had been used to make sure policies and procedures were being followed and to improve the quality of the service provided. This included health and safety, care records, accidents and incidents, falls and medication practices.

Services that provide health and social care to people are required to inform the Care Quality Commission (CQC) of important events that happen in the service. The manager had informed the CQC of significant events in a timely way. This meant we could check that appropriate action had been taken.

During the inspection we found one breach 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.

<Sum

This was an unannounced inspection which took place over two days on the 28 October 2014 and the 4 November 2014. Springfield Manor Nursing Home is a privately owned care home for people who require long term and respite care, nursing, or palliative care for up to 30 older people some of whom were living with dementia. At the time of the inspection there were 23 people using the service.

There is 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 and associated Regulations about how the service is run.

There were documents missing from recruitment files for some members of staff. This included one person references from their previous employer and professional registration for clinical staff. This meant that the provider could not be satisfied that only suitable staff were working at the service.

Some areas of Springfield Manor were clean including people’s bedrooms and the living rooms. However the walls in the hallways were dirty and the reception toilet and chefs toilet were not clean. There were aspects to the infection control that needed improvement in relation to staff knowledge. There was a risk of cross contamination in the areas where the bed pans were cleaned and sterilised.

Staff did not have the appropriate knowledge of the Mental Capacity Act 2005 and they had not received any training. Where people were unable to consent and decisions were made about their care we could not find evidence of ‘best interest’ meetings.

Some people thought that staff were caring and they were treated with dignity and respect. Some also felt that if they needed privacy then this would be given. However, through our observations staff did not always take the time to communicate with people in a meaningful way.

People felt that staff understood their care needs. One person said that they felt very involved in the care and staff consulted them in every way. However we found that there were times when staff had not responded to people’s needs specifically around those who had dementia. Not all staff understood the emotional and psychological needs of people with dementia. There were times where people were left for long periods of time without any interaction with staff.

Some activities were on offer and we saw board games being played with some people. However, there were few activities provided specific to the needs of individuals. One person told us that they were not asked what interests they had.

People understood how they could make a complaint and felt comfortable to do so. However, there was no system of recording and learning from complaints and how these were dealt with. There was a copy of the complaints procedure for everyone to see in the reception area.

People and their relatives told us that they felt they were safe at the service. All of the staff had received safeguarding adults training and had knowledge of the procedures and what to do if they suspected abuse.

There were enough staff to meet people’s needs and people received personal care in a timely way. People’s call bells were being answered quickly and there was always a member of staff around when needed.

There were processes in place in relation to the correct storage and audit of people’s medicines. All of the medication was administered and disposed of in a safe way.

People thought the food was good and felt that their needs were catered for. People were encouraged to make their own decision about the food they wanted. We saw that there was a wide variety of fresh food and drinks available for people.

People had access to other health care professionals when required . The health care professionals said that people’s clinical needs were being met by staff.

People, relatives and staff were not routinely asked for their opinion and feedback on what they thought of the service. We were told that this was done through one to one conversations. Some people completed surveys but these were not used to make improvements to the service where concerns had been identified.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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

During our visit we spoke with four members of staff, the manager, a visiting healthcare professional, three people who lived in the home and two relatives. One person told us "I am happy; staff are very nice and always help me". Another person told us “The food is good and there is plenty of it”.

People were provided with a healthy and nutritious diet and had dietary plans in place to meet their individual needs.

One relative told us "I feel listened to by the manager and staff and am involved in the development and review of my relatives care plan".

We observed the atmosphere in the home it was relaxed and calm. People were cared for in a respectful and dignified way. People who lived in the home were seen listening to music, talking with staff and each other. People appeared happy and relaxed in the home.

People's bedrooms were clean and hygienic and personalised to meet people's individual needs. People had their own pictures and photographs placed up in their bedrooms as well as other personal items of their choice.

The home was clean, hygienic and smelt fresh throughout the day.

Staff had a good understanding of people's needs and were observed supporting people in a sensitive and respectful manner.

We carried out a follow up inspection in order to ensure that actions taken to address the concerns we had noted at our inspection 7 August 2012 had been addressed.

We spoke with five people using the service and three staff members including the registered manager.

The people we spoke with told us they were satisfied with the level of cleanliness in the service. They told us they felt their private rooms and communal areas were well cleaned. They said the equipment they used, for example chairs and hoists was kept clean.

Two people told us that the staff ‘worked very hard’ and that they felt well cared for.

We looked at a variety of areas in the service including the communal lounge, dining room and several bathrooms and toilets. We found all of these areas were clean and hygienic at the time of our visit.

We sampled documents that had been developed and maintained which showed us that there was an effective system in place to monitor the level of cleanliness and hygiene in the service.

We used a number of different methods to help us understand the experiences of people using the services these included observing how people were supported, spending time with people and talking with them.

We also gathered information by talking with a visiting healthcare professional who was visiting the service and some of the staff on duty.

People who use the service that we spoke to confirmed that staff involve them in decisions about the care they will receive and offer them choices in their daily lives. We were told that staff were kind to them. They always knocked on their bedroom door before entering and addressed them by their preferred name.

People felt they were involved in the running of the home as meetings were held regularly every week and they could voice their opinions. We were told that people knew how to raise a concern.