This inspection took place over two days; 20 and 21 November 2018, the first day was unannounced.

Springfields 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.

The service accommodates up to 37 people, providing nursing, respite, dementia care, end of life palliative care, and supporting people with complex health conditions. Springfields Nursing Home normally supports older people. However, at the time of the inspection the service was providing nursing care for 24 people, one of whom was under 65 years, as their needs could be accommodated.

The purpose built, single storey accommodation, is set in 12 acres of gardens, and offers single, en-suite bedrooms. The provider also has a second registered service within the same grounds, which was providing residential care.

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.’

People told us they felt safe in the care of staff and were happy living in the service. There were systems in place to safeguard people from abuse and staff had been recruited using safe recruitment practices. Staff were aware of their responsibilities and knew how to report concerns.

Systems were in place to reduce or eliminate any risks. People received their medicines as prescribed and were supported to access healthcare professionals. Staff were prompt in referring people to health services when required.

People were being supported by staff who received training and supervision to enable them to provide effective support in meeting their needs.

Meal times were relaxed. People were given choice and supported to eat and drink enough as part of meeting their nutritional needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Staff understood their responsibilities in relation to the Mental Capacity Act (MCA) 2005 and people's consent was sought appropriately.

Staff were respectful and caring, supporting people to maintain their dignity and independence. The culture within the service had improved. Views of the people living in the service, their relatives, and staff were being sought, listened to and used to drive improvements. We saw improvements in the range of activities to support people’s emotional and social wellbeing.

People, and where applicable, their relatives were being involved in care planning to ensure it reflected their current needs. People were being consulted over their end of life care needs, which were documented and acted on by compassionate, caring staff.

People spoke about the approachability of the management, and told us the service was well run, and had good reputation locally. The managerial oversight in the service had improved. Audit and quality assurance systems were in place to ensure that the quality of care was consistently assessed, monitored and improved.

Springfields Nursing Home is a care home with nursing for up to 37 older people. The service provides nursing, respite and end of life care. Some people had complex health conditions and some people had dementia.

There were 27 people living in the service when we inspected on 29 November 2016. This was an unannounced inspection.

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

People are not always supported to have maximum choice and control of their lives and staff do not always support them in the least restrictive way possible; the policies and systems in the service do not always support this practice. While the service had made reference to people’s ability to consent within some care records, there was conflicting information regarding people’s capacity to make decisions. Where decisions were to be made in people’s best interests, these were not recorded.

Improvements were needed to ensure that all risks to people’s health, safety and welfare were effectively assessed and actions that were needed to reduce risks were followed by the staff and monitored by the management of the service.

Systems were in place which safeguarded people who used the service from the potential risk of abuse and staff understood the various types of abuse and knew who to report any concerns to.

Although audits were completed on medicines, improvements were required to ensure that these included all aspects of medicine processes including stock held in the service to ensure that effective checks could be completed.

There were sufficient numbers of staff who had been recruited safely and who had the skills and knowledge to provide care and support to people in the way they preferred.

People received care that was personalised to them and met their individual needs and wishes, however, records did not always focus on the person’s whole wellbeing, for example, how their mood had been or any activities that they had been involved in. People were encouraged to be as independent as possible by a staff team who knew them well and where additional support was needed this was provided in a kind, caring, respectful manner.

The provision of activities to ensure that people had enough stimulation and interaction required review to ensure that it met people’s needs.

People had sufficient amounts to eat and drink to ensure their dietary nutritional needs were met and people’s care records showed that, where appropriate, support and guidance was sought from healthcare professionals.

There was an open and transparent culture in the service. There were some processes in place to monitor the quality and safety of the service provided and to gather feedback. However, the management team needed to improve how they used this information to implement changes and to provide them with oversight of the service.

Our inspection team was made up of one inspector who answered our five questions. There were 30 people using the service at the time of the inspection.

Below is a summary of what we found. The summary is based on our conversations with the manager, three staff, three people who used the service, three relatives, the maintenance person, a visiting specialist nurse and from looking at records. Where it was not possible to communicate with people who used the service we used our observations to gather information.

Is the service safe?

People were cared for in an environment that was safe, clean and well maintained. A visiting specialist nurse told us, "The home is very good, staff follow instructions and advice we give to them relating to people’s health care needs, I would be happy to place my mother here.”

Care and treatment records contained detailed assessments of people's needs that had been regularly reviewed and updated to ensure that they received safe and appropriate care and treatment. People were involved in developing and reviewing their care and treatment plans.

Where people did not have the mental capacity to provide consent the provider complied with the requirements of the Mental Capacity Act 2005. Staff had received training in this area. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. This ensured that the staff had the relevant skills and knowledge required to meet the individual's identified needs.

The provider had clear policies and procedures regarding medication, we saw that medication was stored, administered and disposed of in line with their policies and procedures. Staff received annual refresher training in administering medication. The provider carried out regular audits of medication.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. One person said, "I am happy here."

Is the service effective?

It was clear from what we saw, and from speaking with staff, that they understood people's care and support needs and that they knew the people well. A person who used the service told us, "The staff are polite, caring and they treat me with respect."

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Where people were unable to be involved staff had spoken to their relatives or friends to gain their views. Specialist dietary needs had been identified in care plans where required.

Is the service caring?

People were supported by kind and attentive staff. We saw that staff showed patience and gave encouragement when supporting people. People's preferences, interests, religious and faith needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

Where people's health and care needs had changed appropriate referrals to the doctor, district nurse, end of life team, falls team and dentist had been made and any recommendations had been acted on. The manager had regular contact with the relatives of people who used the service and health care professionals.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way. One health care professional we spoke with told us “The referrals we receive from the manager are appropriate and the staff follows our advice and guidance very well.”

People who used the service and their relatives that we spoke with had commented positively about the quality of the care provided to the people who lived in the home. The service had a quality assurance system in place. Records seen by us showed that identified shortfalls were addressed promptly. As a result the quality of the service was continuously improving.

The three staff we spoke with told us they were clear about their roles and responsibilities and they received very good training, support and supervision from the manager. They told us that this enabled them to provide excellent care and support to people who used the service. We saw that staff had a good understanding of the aims of the service. This helped to ensure that people received a good quality service at all times. Staff had received regular supervision and refresher training.

During the inspection we followed up on non-compliance with care and welfare of people who use the services which was identified at an inspection November 2012. We found that the required improvements in providing care that was safer to people had not been made. We found that although the care had improved there were still some shortfalls which meant the people were not always as safe as they could be. We found that the service had an effective management system in place for the administration of medication, with people receiving their medicines safely.

We viewed the staffing levels at the service and observed the staffing levels of both Nurses and support staff during our inspection. We found there to a sufficient number of staff available on duty to meet the needs of people who used the service.

The service had not been submitting statutory notifications to the Care Quality Commission as required by the Health and Social Act of 2008. This meant we were unable to monitor how the service was managing significant events.

We found that the service had not regularly assessed and monitored the quality of the service in order to identify concerns and improve. We found this effected areas such as staffing and care and welfare.

Daily record keeping of people’s care were not maintained to a standard that detailed the level of care that had been provided for each person. However we found that the maintenance records for the service were fit for purpose.

People told us they had been getting the care they required. However we found that people’s safety and welfare was not ensured as risk assessments were not reviewed regularly. We found that care plans had not been signed by the person receiving the care or their families. We found that the risk of using latex gloves on people who use the service had not been assessed.

The premises were clean, tidy and recently refurbished to a good standard. The gardens were well maintained. People told us they liked the decorative style, one person told us, “It’s very colourful and British.” Another person told us, “The gardens are lovely I really like looking out at the scenery.”

Arrangements for safeguarding of vulnerable adults were in place. People told us there were enough staff to provide care and the staff were adequately trained.

Some of the people who use this service were highly dependant and had difficulty responding to verbal communication. During our visit we were able to hold a conversation with three people. Most of the information about people's experiences of Springfields Nursing Home was gathered through our observations.

We saw that people were supported to make decisions about their care and their care and treatment options were discussed with them.

We saw staff were respectful when speaking to people, taking time to explain what they were going to do.

People told us that the staff supported them to manage their health care needs and said they saw the GP regularly and received visits form specialist nurses and therapists when needed.

We saw that people had their nutritional needs assessed and monitored. Most people living at the home told us that the food was good and there were choices offered.

We saw that people benefited from a safe and pleasant environment. One person told us that they liked living at the home and enjoyed the view to the surrounding gardens.

What we found about the standards we reviewed and how well Springfields Nursing Home was meeting them