This inspection took place on 6 March 2017 and was unannounced.

Springwater Lodge Care Home provides nursing and personal care for up to 50 older people and people living with dementia. On the day of our inspection there were 31 people using the service.

Springwater Lodge Care Home is required to have 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 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 time of our inspection a registered manager had been in place since November 2013.

During our previous inspection on 8 September 2016, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the plans in place for people at the end stage of their life. Concerns were identified with the systems and processes in place to assess, monitor and improve the quality of service. This included how risks relating to health, safety and welfare of people were monitored and mitigated.

During this inspection we checked to see whether improvements had been made. We found improvements had been made and these breaches in regulations had been met. Some ongoing improvements were required in relation to care records to ensure consistency and the accuracy of information available for staff.

Staff understood how to identify and report allegations of abuse. Risks associated to people’s needs had mostly been assessed and risk plans were regularly reviewed. Accidents and incidents were appropriately investigated and assessments of the environment were carried out to ensure it was safe. The hoist and stand aid were found to be unclean and people did not have individual slings for the use of the hoist or a risk assessment in place for its use.

There were sufficient staff available on the day of the inspection and a new system had been introduced to monitor call bell wait time. The registered manager was closely monitoring staffing levels and reporting this to senior managers. Staff had been appropriately recruited; checks had been completed in relation to their suitability before they commenced their employment.

People received their prescribed medicines safely and these were stored and managed safely. Some concerns were identified with the recording of people’s allergies.

Improvements had been made to the cleanliness, hygiene and the prevention and control of infections but concerns were identified with some equipment that was unclean.

Staff received an induction and the ongoing training and support necessary to enable them to carry out their role effectively and safely.

The principles of the Mental Capacity Act (2005) had been followed when decisions were made about people’s care. However, some inconsistencies were found in how mental capacity assessments had been completed and best interest decisions made.

People’s nutritional needs had been assessed and planned for. People received a choice of what to eat and drink and independence was promoted. The staff worked well with healthcare professionals in meeting people’s health needs which they assessed and monitored for changes.

People were supported by kind, caring and compassionate staff that showed dignity and respect. Staff were knowledgeable about people’s needs, preferences and routines and responded well to their comfort needs.

People had access to independent advocacy information should they have required this support. People and their relatives, if appropriate, were involved in review meetings that discussed the care and treatment provided by staff.

People’s preferences and routines were recorded but they did not always receive care as they wished. People received opportunities to participate in activities including community visits.

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This comprehensive inspection was brought forward as a result of information received from the police about the way people were receiving medication. At the time of the inspection the police investigation was ongoing. The inspection did not look at the specific incidents being investigated but did look at whether medicines were being managed safely.

This inspection took place on 8 September 2016 and was unannounced.

Springwater Lodge Care Home provides nursing and personal care for up to 50 older people and people living with dementia. On the day of our inspection there were 36 people using the service.

Springwater Lodge Care Home is required to have 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 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 time of our inspection a registered manager had been in place since November 2013.

During our previous inspection on 3 and 4 March 2015, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how people’s medicines were managed.

We received an action plan from the provider to say they would complete the required improvements by August 2015.

During this inspection we checked to see whether improvements had been made. We found some improvements had been made and the breach in regulation had been met. However, further improvements were required to the administration of prescribed creams.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Staff had received adult safeguarding training and had available the provider’s safeguarding policy and procedure.

Although systems were in place to ensure people’s safety was effectively managed, these were not always followed. Risks to people's individual needs had not been completed for all people. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks. These were reviewed on a regular basis but some risk plans lacked specific detail to support staff. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. The internal and external environment was safe but some clinical equipment was identified as not fit for purpose.

People felt staff were too busy to spend time with them and some people felt this impacted on how long they had to wait for assistance. People’s needs were monitored and reviewed and this information was used to calculate the staffing levels required. Staff leave was covered by permanent or agency staff. We identified there to be sufficient numbers of staff but the deployment of staff required reviewing.

Concerns were identified with the cleanliness of the service and practice in relation to infection control measures and best practice guidance was not always followed.

Safe recruitment practices meant that, as far as possible, only suitable staff were employed. Staff received an induction, training and appropriate support. However, not all staff were sufficiently trained in end of life care. Not all nursing staff had received appropriate training in the use of some clinical equipment. This process of monitoring training needs and development was not as robust as it should have been.

People were supported to maintain good health. People's healthcare needs had been assessed and were regularly monitored. New care plan documentation was in the process of being introduced. This period of change found some care records incomplete and information difficult for staff to follow. The provider worked with healthcare professionals in meeting people’s healthcare needs.

People received sufficient to eat and drink and their nutritional need

The previous registered manager had left the home but had not yet cancelled their registration, so their name is still displayed on this inspection report. A new manager was in post and had applied to become the registered manager.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and asked them for their views. We also spoke with four care workers, the regional manager and the manager. We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and received care and treatment that met their needs. A person told us, “I am asked what I want to wear when I get up.” Another person told us, “I am looked after very well.”

We found that suitable arrangements were in place to manage people’s medication and ensure they received any medication they needed. A person who used the service told us, “Staff bring me my tablets at the time to take them.”

We found there were sufficient staff to meet people’s needs and the provider assessed and monitored the quality of the service. A person who used the service told us, “There always seem to be enough (staff) around to me.”

This inspection was carried out to ensure the provider had complied with actions we took following our last inspection where we found the provider was non complaint. Prior to our visit we reviewed all the information we had received from the provider including the action plan they sent us following our last inspection detailing how try would become compliant. During the visit we spoke with three care staff, the relief and quality assurance managers. We also looked at some of the records held in the service. We were unable to get any views from people whom used the service about the areas we were inspecting.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with four people who used the service and three relatives and asked them for their views. We also spoke with three care staff, a registered nurse, the administrator and a visiting manager from another home owned by the provider who was providing support whilst the registered manager was on leave. We also looked at some of the records held in the service including the care files for four people. We did not inspect the separate dementia unit as we concentrated on issues we found in the remainder of the home.

We noticed one person we spoke with had very dirty fingernails on one hand. We checked the personal care chart which showed they had been washed that morning by a member of staff. This could occur when staff completed the form without ensuring the person had received all the personal care they required.

We spoke with some relatives who had concerns about some of the care their relations received. They all praised the staff saying they worked extremely hard and their complaints were not about their commitment to their work.

We asked people if they felt safe in the home and they told us they did.

People told us they were well cared for and felt safe. A person told us they could get up whenever they wanted to. A person said, “I am getting good care.” Another person said their care was, “Very good.” A person told us that their privacy was respected by staff.

A person said they had not seen their care plans and staff had not talked with them about the plans. They told us that they would talk to staff if they had any complaints or comments to make about the service.

A person told us they could get medication when they needed it. A person told us there were enough staff and said, “They come quickly if you need help.” People told us staff were well trained and good at their jobs.

We inspected the service on 3 and 4 March 2015. Springwater Lodge is registered with the Care Quality Commission to provide accommodation for up to 60 older people with varying support needs including nursing needs and dementia care. On the day of our inspection there were 38 people living at the home.

The home 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People could not be assured their medicines would be managed effectively and they would be given these as they were intended to be given. There were some areas of the home where improvements regarding cleanliness were needed.

Staff knew how to keep people safe and to raise any concerns if they suspected someone was at risk of harm or abuse. Staff understood the risks people could face through everyday living and how they needed to ensure their safety. There were sufficient staff on duty to meet people’s needs and any absences from work were covered.

Staff received training to ensure they had the knowledge and skills to provide people with safe and appropriate care. People’s right to make decisions for themselves when they were able to was protected.

People were provided with sufficient food and drink to maintain their health and wellbeing, and they praised the standard of food provided. People were supported to receive any healthcare they needed and any healthcare advice provided was acted upon.

People were treated with dignity and respect and they felt staff were always kind and respectful to them.

People’s care plans did not provide staff with all the information they needed to support people appropriately. People felt they could raise any concerns they had and we saw when they did these were acted upon.

People living at the home and the staff team had opportunities to be involved in discussions about the running of the home and they felt the registered manager provided good leadership. There were systems in place to monitor the quality of the service and identify what was working well, and if any improvements were needed.