About the service: The Spinney Care Home provides accommodation at ground floor level for up to 37 people who require personal care. At this inspection there were 21 people living and receiving care at the service. Accommodation comprises of level access to four separate living areas, each providing single use bedrooms, communal living, dining, bathroom and toilet facilities. There is also level access with handrails to a tidy garden area with seating.

People’s experience of using this service: At our last inspection in January 2018 we found the provider did not operate effective systems and processes to fully ensure the quality, safety and effectiveness of people’s care. This was a breach of Regulation 17 – Good Governance. We asked the provider to tell us what action they were taking, which they provided. At this inspection, although we found a number of significant care and service improvements were made and in progess. This was not sufficient to rectify the breach.

Further improvements were required, to consistently ensure timely service improvement; good leadership and culture; and to continually support the assured delivery of safe, high quality person centred care. As such the service remains rated as Requires Improvement for the second consecutive time. Provider’s should be aiming to achieve and sustain a rating of ‘Good’ or ‘Outstanding.’ Good care is the minimum that people receiving services should expect and deserve to receive.

The service was not always safe. Identified remedial measures for medicines and fire safety at the service, were not yet fully assured by the provider. Revised staffing and safeguarding arrangements helped to ensure people’s safety at the service and protected them from the risk of harm or abuse. Improvements had been made for cleanliness, infection prevention and control at the service. Risks to people’s safety associated with their health condition, any equipment used for their care were safely managed and accounted for.

The service was not always caring; People’s preferred daily living routines and emotional support needs were not always respected or met. People had good relationships with staff and felt they were treated fairly and free from discrimination at the service. People’s privacy, dignity and independence needs and wishes were promoted by staff.

People received effective informed care as agreed with them from staff who were trained to provide this. Staff sought people’s consent or appropriate authorisation for their care and ensured least restrictive care practice, when they needed to ensure people’s safety in their best interests.

People were supported to maintain and improve their health and nutrition and protected from the risk of malnutrition. This was done in consultation with relevant external health professionals when needed. Action was in progress to address people’s views regarding the variable quality of meals provided.

Extensive environmental refurbishment had been made and was in progress since our last inspection.This helped to ensure people’s needs were fully met by the design, adaptation and decoration of the premises.

People’s received timely, individualised care that was responsive to their needs and interests. Arrangements were on place to support people’s end of life care and ensure their related dignity, comfort and choice.

Complaints information and handling arrangements were identified and effectively accounted for. People’s views about their care and home life were sought and used to inform related service improvements

Lines of accountability and responsibility were revised and re-established. This included improved communication, reporting and record keeping for people’s care. Staff understood their role and responsibilities for people’s care. Comprehensive operational policy and related procedural guidance helped to inform and ensure this.

The provider often worked in partnership with people, their representatives and relevant external heal

The inspection took place on 29 January 2018 and was unannounced. The Spinney is a care home that provides accommodation with personal care and is registered to accommodate 37 people. The service provides support to older people who may be living with dementia. The accommodation at The Spinney is on the ground and there are four separate lounge and dining rooms for people to use. There is a smoking rom for people to use and outside garden areas. The home is in Chesterfield and has a car park for visitors to use.

The Spinney 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. At the time of the inspection there were 31 people using the service.

The service had a registered manager although they were not currently working in the service. The service was being managed by a registered manager from within a nearby home, managed by the same provider. 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.

The Spinney was last inspected on 22 October 2016 and the service was rated as Good. On this inspection we found the service was now rated as Requires Improvement. This is the first time the service has been rated Requires Improvement. This was because improvements were needed with how people received their care and support. The quality assurance systems carried out by the provider had not been effective and had not identified where improvements were needed to ensure people received safe care. The provider had not ensured that staff recognised where people may have been harmed and action had not been taken to keep people safe. Medicines had not always been managed safely; people had not received a nutritious diet to keep well and related risks had not been identified or managed to keep people safe. As a result of safeguarding investigations, improvements were now being made, although assurances are needed to identify that lessons have been learnt and systems have been reviewed to promptly identify any concern.

People’s care records were being reviewed to reflect how they wanted to receive their care and support. Risks to people were now being identified and staff understood the support needed to reduce the risk of preventable harm. Staff understood how to raise any concerns and were working alongside the safeguarding team to ensure investigations were carried out. A training programme had been developed to give staff opportunities to develop the skills they needed to provide the care for people. Medicine management systems had been reviewed and people were now receiving their medicines at the right time and this was recorded.

There were limited opportunities for people to participate in activities that interested them. The staffing had been reviewed, but staff were not always available to support people in the different areas of the home, or had the opportunity to regularly engage with people.

People felt the staff were kind and treated them with dignity and respect. However, some interactions were not dignified or respectful as staff did not always ensure that people’s individual needs were met.

People were now supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff now knew how to respond if people no longer had capacity to make some specific decisions.

People received support from health care professionals where they needed this to keep well. Staff supported people to attend healthcare appointments and liaised with their GP a

This inspection was unannounced and took place on 16 June 2016.

The Spinney Care Home provides accommodation and personal care for up to 37 older people, including some who may be living with dementia. At the time of our visit, there were 37 people living at the service. There was a registered manager at this 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 our last inspection in October 2014 we found that some improvements had been made but people’s medicines were not always being safely managed. This was a breach of Regulation 13 of the Health and Social Care Act (Regulated Activities) Regulations 2010, which corresponds with Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. Following that inspection the provider told us about the action they were taking to rectify the breach. At this inspection, we found that the required improvements had been made.

People’s medicines were safely managed and people were safely supported at the service. Risks to people’s safety associated with their health condition, environment or care equipment were assessed before they received care and regularly reviewed. Staff understood and followed the care actions required for the mitigation of known risks to people’s safety. Equipment used for people’s care was regularly assessed and checked to ensure safe use.

Emergency contingency planning and staff recruitment, training and deployment arrangements helped to ensure that people received safe care at the service. People felt safe and both they and staff were informed and confident to raise any concerns they may have in relation to people’s care and safety. This helped to protect people from the risk of harm or abuse.

People were happy with their care and enjoyed their meals provided at the service. People were supported to improve and maintain their health and nutrition in consultation with external health professionals when required.

People were provided with personal care in line with legislation and guidance in relation to consent. Staff understood the Mental Capacity Act 2005 and followed this to obtain people’s consent or provide care in their best interests when required.

Staff were trained, informed and supported to provide people with the care they needed. Staff understood people’s health, dietary and related care needs and the provider’s care planning arrangements helped to inform people’s individual care and health requirements.

Staff were helpful, kind and caring. They understood and actively promoted people’s rights, choices and involvement in their care. People and relatives were complimentary about staffs’ kind, caring and respectful approach towards them. People were supported to maintain their preferred contacts with family and friends, who were appropriately informed and involved in their care.

People received individualised, timely care that took account of their cultural and religious beliefs and their known lifestyle preferences and daily living routines. Staff understood people and knew how to communicate with them in a meaningful way.

A number of environmental aids, adaptations and equipment helped to promote people’s independence, orientation and inclusion in home life. Planned improvements aimed to create a more tailored and supportive environment designed for people living with dementia.

Peoples’ views about their care were regularly sought. People and their relatives knew how to raise any concerns or complaints they may have about the service and were confident these would be listened to and acted on. People’s views and complaints received were used to inform service improvements when required.

People, relatives, staff a

One inspector carried out this inspection. At the time of our inspection 37 people were using the service. Below is a summary of what we found.

We spent time speaking with people who lived at The Spinney Care Home as well as speaking with staff and relatives. We reviewed records and spent time observing people in the home. If you want to see the evidence that supports our summary please read the full report. We used the evidence to answer five questions.

Is the service safe?

People were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. There were enough staff on duty to meet the needs of the people who lived there. We spoke with people who said that they felt safe and secure. One person said, "I waited a long time to come and live here because of its reputation for being so nice. It was worth the wait - this is my new home and I wouldn't have it any other way. We're all well looked after and protected against harm."

Staff records demonstrated that mandatory training was up to date and that staff were trained to meet the complex needs of people. Staff were trained in caring for people with complex nutritional needs, mobility restrictions and dementia.

We found that the provider did not have an effective system in place for administering lotions and creams. This meant that it was not always clear whether or not a person had been given their medicine.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While 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.

Is the service effective?

A care worker told us that staff all worked well together to make sure that people were looked after in a way that protected them from harm and enabled them to live how they wished. It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well. A person who lived at the home told us that they felt supported and looked after and that they enjoyed being able to make their own decisions with support from staff. For example, they said that they were pleased that staff would get them whatever newspaper they wanted and that they could get up and go to bed whenever they wished.

People were cared for by staff who were supported to deliver care safely and to an appropriate standard. Staff had received training to meet the needs of the people living at the home Staff told us that they were able to put their training into practice and would like training that was more in-depth and specialised.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people, when they needed help moving around, were confused or wanted to sit down and chat. Staff took into account the complex needs of people when planning activities so that they could take part in these safely. We spoke with a person who said, "The garden is lovely and I do sometimes use it but really they've made the home so comfy and homely that I rarely want to leave. There's always something going on but quite often its nice just to sit and have some peace and quiet."

Staff said that they were very happy with the level of professional and emotional support they received from managers. They said, "Staffing levels aren't always ideal and we are sometimes very busy but managers tell us we're appreciated and they show it by looking after us well. They're always ready to listen if we have a problem."

Is the service responsive?

People's needs had been assessed before they moved into the home and these were checked by regular reviews, in which they were involved. People's needs assessments included consideration of their dietary and nutritional requirements as well as their need for stimulating activities that helped them to feel part of their community. A person said, "I remember having lengthy conversations with the manager before I moved in and then just afterwards. They wanted to make sure they could provide what I needed. Actually that was something that made me want to live here - I liked that they took such an interest in me."

People's preferences and interests were acted on by staff who used monthly meetings to support people to meet their needs and goals. People had access to activities that were designed to stimulate them and they were able to influence the running of the home. We spent time speaking with a member of staff who showed us how menus were put together with the help of people and how they were able to accommodate special requests as well as meet complex dietary needs.

Is the service well led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place. Staff told us that they were clear about their roles and responsibilities and that management support helped them to do their job effectively. One person told us, "They seem really well staffed here. I've never had to wait around for anyone and if I just want to sit and have a chat and a cuppa, there's always someone here."

At our visit there were 37 people accommodated. We observed how people were supported and cared for, looked at six people’s care records and spoke with eight people and eight staff about their experiences of the service. This helped us to understand people’s experience of the service.

At this inspection people told us they were mostly happy with their care, support and meals provided at the Spinney, but said that meals were often late. We received many positive comments from people. They included, "The staff all work really hard to make sure I get the care I need,” “Staff are helpful and treat you kindly with respect,” and, “There’s always enough to eat; drinks are routinely offered or given on request.”

We saw where improvements were made since our last visit to ensure that people received care that protected their needs and ensured their rights. We also saw that people were supported to eat and drink sufficient amounts to meet their needs.

However, people were not cared for in a clean and hygienic environment or fully protected from the risk of infection. We also found that although the provider had either made improvements or taken steps to do so, people were not fully protected from unsafe medicines practices and sufficient numbers of staff were not always provided.

We found that people were generally happy with the care they received at The Spinney. One person told us, "I think it's pretty good. The staff are nice and they are patient and kind."

We found that the premises were suitable for people living at the home. We also found that staff were recruited using appropriate procedures and that they were trained and supported to deliver people's care. We found, however, that staffing arrangements were not always adequate at the home.

We saw that a complaints procedure was in place and we found that people's concerns were responded to.

We found that people's care was not always planned and delivered in a way that ensured that they received safe, appropriate care and also that people's consent was not always being obtained for their care.

We found that systems for managing medication did not ensure that people received their medicines as prescribed and that they were protected from risk.

At our visit discussions held with five people, told us they received the information they needed about the home, to assist them in their admission and for living there. They said they were satisfied with the arrangements for consulting with them about their care and daily living arrangements. Telling us that their rights to privacy, dignity, choice and independence, were well respected.

People told us that seasonal celebrations, activities, entertainments and outings were regularly organised, which they could choose to join. They told us about some of the regular opportunities for them to be involved in agreeing and planning these, for example by way of residents’ meetings and a suggestion box. They also told us about regular opportunities for worship in accordance with their chosen religious beliefs.

All people that we spoke with expressed satisfaction with the care and support they received. We received many positive comments from people about their experiences of the service. Examples of these included,

I get all the care and support I need, it’s second to none,’ ‘Staff, are caring, you don’t usually have to wait long for help when you need it,’ ‘There are plenty of activities and entertainments.’

All said they enjoyed the choice of meals provided, were regularly consulted about these, with drinks and snacks readily available. People particularly liked the smaller group living arrangements, with each wing having its own communal facilities. They said they were satisfied with their own rooms and were able to personalise these. All people asked, said the home was always kept fresh and clean and with a reliable laundry service.

All five people described suitable arrangements for their medicines and for their ongoing health monitoring and ill health prevention. The latter included for their access to outside health care professionals for the purposes of their routine health screening.

People we spoke with said they were confident in raising any concerns or complaints they may have and that these would be listened to and acted on. They confirmed they felt safe in the home and that staff were usually available when they needed them.