This unannounced inspection was conducted by one adult social care inspector on 9 and 11 January 2019.

Springfields is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection.

Springfields is in Waterhead, Oldham. The home provides care and accommodation for up to 24 older people, younger adults, people living with dementia, people with physical disabilities and those living with enduring mental health conditions. Bedrooms are situated over three floors of the home. Access between floors is via a passenger lift and staircase. The building is situated in its own grounds with gardens and some off-road parking. At the time of our inspection 21 people were living at Springfields.

At our last inspection in December 2017 we rated the service ‘requires improvement’. At that inspection we found one breach of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to quality assurance processes.

Following the inspection, the provider sent us an action plan which showed how the breach would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection, we found that the service had improved and was now meeting all the regulations.

There was a registered manager in place. 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 said staff protected their privacy and their dignity was respected. People were supported to be independent.

Detailed assessments of people’s support needs and preferences were made. Risks to people had been assessed. Care records were person centred, detailed and reflected peoples support needs and what was important to them. All care records had been reviewed regularly and changes made when needed.

People said staff treated them with kindness and compassion and there were enough staff to meet their needs.

People received care from staff who were appropriately trained to effectively carry out their job roles. People were supported to have maximum choice and control of their lives. The service acted in accordance with the Mental Capacity Act (2005).

People's nutritional needs were met and they were supported to maintain good health and receive ongoing healthcare support.

Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

Staff were aware of their responsibilities to safeguard people from abuse. Safe recruitment practices were in place and the service followed national and local safeguarding guidance.

Risks to people's safety were assessed.

Medicines were managed safely. Staff had received training in medicines administration and had their competency checked regularly.

We found that records were written in a positive and respectful way and provided guidance on how to support people.

Springfields had arrangements in place to receive feedback from people that used the service, their relatives, external stakeholders and staff members about the services provided.

Springfields is a care home that provides 24-hour residential care for up to 24 people. At the time of our inspection there were 20 people living at the home. It is a detached building providing accommodation over three floors and is situated in the Waterhead area of Oldham. It is surrounded by a large garden.

This was an unannounced inspection which took place on 19 and 20 December 2017. We last inspected the service in October 2016. At that inspection we found breaches of three of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to medicines management, infection control, procedures for consent, and quality assurance.

Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

At this inspection, although we found some improvements had been made, we identified a continued breach of Regulation17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Good governance.

We have made two recommendations. These are to replace the carpet in one of the lounges and to review the protocols for ‘when required’ medicines.

We also found that the service was not displaying the quality rating awarded at the previous inspection. It is a legal requirement that ratings are displayed legibly and conspicuously 21 calendar days from the date the inspection report is published on the Care Quality Commission (CQC) website. Despite explaining this to the provider, they failed to make the necessary arrangements. We will deal with this matter outside of the inspection process.

The service had a registered manager. 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 a 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 systems in place to help safeguard people from abuse. Staff understood what action they should take to protect vulnerable people in their care. Recruitment checks had been carried out to ensure staff were suitable to work in a care setting with vulnerable people. At the time of our inspection there were sufficient staff to respond to the needs of people living at the home.

All maintenance checks on services and equipment were up-to-date, apart from the calibration of the weighing scales. Although the home was clean there was a strong, unpleasant odour coming from one of the lounge carpets. Procedures were in place to prevent and control the spread of infection.

Medicines were stored safely. However, we found there was not always sufficient detail to guide staff contained in the ‘as required’ medicines protocols.

New staff received an induction. All staff received regular training and supervision. This ensured they had the skills to carry out their roles.

Staff encouraged people to make choices where they were able. The service was working within the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS).

We received a mixed response when we asked people about the quality of food. However, we found there was a choice of food on offer. Where people were found to be at risk of malnutrition they had been referred to a dietician for specialist help. People had good access to other health professionals when needed.

People were complimentary about the caring nature of the staff and our observations during the inspection confirmed this. Care plans, which were reviewed regularly, were detailed and reflected the needs of each individual.

There were a range of policies available for staff to refer to for guidance on best practice. Systems were in place to monitor the quality of the service and drive improvement, alth

The inspection took place on 25 October and was unannounced. We made telephone calls to relatives on 14 November to seek their views and opinions on the service. This meant the provider did not know we were coming. Springfields was last inspected on 30 September 2014 and was found to be compliant with the regulation we inspected at that time.

Springfields is a care home with accommodation for 24 people who require personal care, some of who are living with dementia. At the time of the visit 14 people were using 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.’

At this inspection we found that there were breaches of three of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, dignity and respect, person centred care, consent and the overall oversight of the home.

There were anomalies in the recording of the administration of medicines. Records for stock balances were not accurate. Medicines were not being stored securely. People’s personal records were not stored securely.

Care plans did not set out how to support people with covert administration of medicines. There was a lack of mental capacity assessments and best interest documents to support such activity.

People’s individual risk assessments did not contain specific detail on how to minimise risk.

The registered provider had ineffective systems for monitoring, assessing and reviewing the service; they failed to identify gaps in recording and lack of specific care plans and assessments. The system did not give an overall view of the service to aid improvement or development.

Staff failed to respect people’s personal belongings. We made a recommendation that the service considers current guidance on dignity and respect when supporting people.

Infection control processes were not followed in respect of the transporting of laundry.

We found evidence in care records to suggest referrals were made to community services when necessary and of visits by health care professionals including dieticians and community psychiatric nurses.

Staff had a clear understanding of safeguarding and whistleblowing. They were confident any concerns would be listened to and investigated to make sure people were protected.

Systems were in place for recording and managing safeguarding concerns, complaints, accidents and incidents. Relatives we spoke to knew how to make a complaint.

Recruitment practices at the service were thorough, appropriate and safe so only suitable people were employed. Staff had received regular supervisions and appraisal. Staff received appropriate training to meet the needs of the service.

We viewed historical and current staffing rotas. Enough staff were employed to make sure people were supported.

Relatives made positive comments about the service. They described the service as being safe for their family members. One relative told us, “They are safe here, they do a tremendous job and are professional. We sleep easy now we know she is OK.” One visiting health care professional told us, “I feel that people are safe here.”

We carried out this inspection to follow up on concerns we found during our previous inspection in June 2014. During that inspection we found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received. This meant that it was difficult for the service provider to come to an informed view that the service was of an adequate standard. It was also difficult for the service to identify areas which may have required improvement. We judged that to have had a minor impact on people who used the service.

During this inspection we spoke with the manager and looked at the quality monitoring (QM) and quality assurance (QA) processes and records which were in place.

We considered the evidence collected under this standard and addressed the following question, is the service responsive?

Below is a summary of what we found. Please read the full report for the evidence supporting our summary.

Is the service responsive?

In addition to the positive indicators of a responsive service identified at the last inspection, the service had structured QM and QA systems in place. When implemented over a period of time these would assist the service provider to identify both good and less good aspects of the service. This would help to enable the service provider to respond to any identified areas of weakness which would further improve the service.

Springfields is a detached, stone built house which had been converted to offer accommodation and support for up to 24 people, all in single rooms. At the time of our visit there were 11 people living at the home.

The inspection was undertaken by one inspector. This summary addresses five key questions: is the service safe; is the service effective; is the service caring; is the service responsive and is the service well led?

This summary is based on a visit to the home where we spoke to the manager and observed staff interactions with people using the service. We looked at records and talked in private with four visiting relatives, two people who used the service and four members of staff. We also spoke with the manager.

It is a legal requirement that a manger is registered with us for this service. Registration ensures a manger shares legal accountability for the service with the service provider. At the time of our visit to Springfields the manager was not registered with us. However, their application to us for registration was being processed.

The full report contains the evidence to support this summary.

Is the service safe?

The people we spoke with during our inspection visit were positive about the care provided by the home. Visitors told us they thought their relatives were safe. We asked visitors if they believed their relative was safe living at Springfields. Replies included “definitely” and “no question”.

Staff who we spoke with told us they believed people who used the service were protected from abuse or exploitation. Comments from senior staff included “I can leave any staff and I know they [people who used the service] are looked after”.

Staff who we asked told us that complaints would be listened to. They also told us they understood their responsibility to ‘blow the whistle’ if necessary.

During a brief tour of the building, including communal areas and a selection of bedrooms, we saw no obvious risks to people’s health and safety. Staff confirmed that they were provided with personal protective equipment such as disposable gloves and aprons, to minimise the risk of cross infection.

Kitchen staff maintained the records in the ‘Safer Food Better Business’ folder. These checks and records helped to ensure that food was stored, and meals were prepared, safely.

People were provided with ample food and drink.

Is the service effective?

Each individual’s care needs were assessed and reviewed. A care plan was developed on the basis of the assessment. People told us they believed they could contribute to discussion about the way their care needs were being met and they would be listened to. People told us the staff were competent. One visitor, when talking about their relative’s experience of the home told us “since moving here she is much improved”. They also said “she loves it, she absolutely loves it”.

We were told that many of the staff had worked at the home for several years. This consistency would help to provide appropriate and effective care to people using the service.

Staff had access to training opportunities and felt competent to undertake the tasks expected of them. Staff told us the systems for keeping them up to date with the changing needs of people using the service were effective.

There were not robust, structured, quality monitoring procedures in place at the home. The absence of these procedures weakened the service’s ability to demonstrate its effectiveness fully, or to identify risks in a timely manner.

Is the service caring?

All the people using the service who we asked and visitors who we spoke with spoke positively about the attitude of the staff. Comments from visitors included “all the carers are wonderful”; “[I have a] good relationship with the staff” and “[they are] good staff … down to earth … and very caring”.

People using the service told us “they [staff] are very good, you can’t fault them” and “they [staff] don’t leave you unclean or unfed”.

Staff themselves also spoke positively about the caring attitude of their colleagues. We asked staff what they thought was the best thing about the home. Comments included “it’s a happy home now. Staff and residents”,” [it is] dead homely with staff and residents” and “I just enjoy working here. Staff are nice and you can have a laugh with the residents.”

Observations of staff interactions with people using the service indicated calm and relaxed relationships.

Is the service responsive?

We did not look specifically at the service’s complaints procedure. However, people using the service and visitors who we asked during our visit said they believed they would be listened to if they had a complaint. This view was supported by people’s comments about the relaxed and positive relationships with the staff team.

People’s preferences were recorded.

People told us they would be listened to if they wanted to comment on any aspect of the care provided. Staff also told us they involved people in discussion about how best they could meet the person’s needs. However, the absence of records to confirm people’s involvement in the care planning process, and the absence of robust, structured, quality monitoring procedures weakened the service’s ability fully to demonstrate its responsiveness.

Is the service well led?

The lines of accountability within the home were understood by the staff who we asked. Staff told us they knew to whom to report any incidents.

Everybody who we asked spoke positively about the manager. They were described as approachable and supportive. Staff were encouraged and supported in their personal development through training opportunities. This ethos applied equally to staff who had many years of experience at the home.

However, the lack of priority given to quality monitoring, undermined the service’s ability to demonstrate that it was well led. This was exacerbated by the length of time taken to ensure the process for registering the manager with us was completed.

At the time of our visit 13 people were using the service, but there were no visitors while we were in the building. We spoke to three people in private. Everybody who we asked spoke positively about their experience of care in the home.

People told us that they could discuss their care needs with the staff members. One person told us "if you ask them to do anything for you they do it for you". Another person using the service, when asked about the competency of staff said "most of them are [competent], if not I have to tell them and then next time they do it okay".

Everybody who we spoke to told us that they felt safe living at Springfields. One person said they felt safe because "everybody is the same and everybody is good". Another person told us, when asked what the best thing about the home was, "I like it because the staff are friendly".

People told us they liked their accommodation. One person said "the rooms are spotless, done every day". Another person cited the home being "nice and clean" as amongst the best things about it.

People who used the service and the visitors we spoke to were positive about their experience of care offered by Springfield House. People told us they could influence the way their care needs were met.

People who we asked all told us they were treated with respect and their dignity was maintained. They also told us that they believed this was also the case for everyone who lived at Springfield House.

People who used the service told us that they felt safe and were confident they could talk to staff if they had any concerns or complaints. One person said "Staff are never rude to us, we have a joke and a laugh but never rude".

People told us they thought the staff were competent and responded well when assistance was needed.

One person who used the service told us Springfield House was a "very happy house and they are all very good to us. I love it here“. A visitor described their relative as being "immaculately cared for".

During this inspection we spoke in private to three people who used the service, three members of staff and one visitor. We also spoke to the manager of the service and the person nominated by the service provider as being the main point of contact with us.

People were treated with respect and had their dignity maintained. Comments made to us included "I wouldn't work here if I thought there was anything wrong with the care", "it's a happy home" and "it's the way they [staff] attend to you and treat you [that makes the home] very nice".

People were able to influence the way in which their care needs were met. Staff were kept up to date about the changing needs of the people using the service.

Medication was stored and administered safely.

Staffing was provided on the basis of the dependency levels of the people living at the home. At the time of this inspection there were sufficient numbers of staff to meet the needs of the people using the service.

Systems were in place to help ensure that the quality of the service was monitored. Mechanisms were in place to help ensure that the service provider maintained an awareness of the quality of the service experienced by people living in the care home.