This inspection took place on 7 December 2017 and was unannounced.

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. The Spinney Care Home provides accommodation for up to 26 older adults who require personal care for

physical health needs or dementia. 26 people were living at the home at the time of our inspection.

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.

At our previous inspection in October 2016, we rated the home as Requires Improvement. At this inspection, we found improvements had been made as required, and the rating has changed to Good.

People were comfortable with the care staff who supported them and felt safe. Staff received training in how to safeguard people from abuse and were supported by the provider’s safeguarding policies and procedures. Staff understood what action they should take in order to protect people from abuse. Risks to people’s safety were identified, minimised and responsive towards individual needs so people could be supported in the least restrictive way possible and build their independence.

People were supported with their medicines by staff that were trained and assessed as competent to give medicines safely. Medicines were given in a timely way and as prescribed. Regular checks of medicines helped ensure any potential issues were identified and action could be taken as a result.

There were enough staff to meet people’s needs. Staffing was tailored to support people to maintain hobbies, interests and activities they enjoyed. The provider conducted pre-employment checks prior to staff starting work to ensure their suitability to support people who lived in the home. Staff told us they had not been able to start work until these checks had been completed.

The provider assessed people’s capacity to make their own decisions if it was identified people might lack the capacity to do this. Staff and the registered manager had a good understanding of the Mental Capacity Act and the need to seek consent from people before delivering care and support wherever possible. Where restrictions on people’s liberty were in place, legal processes had been followed to ensure the restrictions were in people’s ‘best interests’. Applications for legal authorisation to restrict people’s liberty had been sent to the relevant authorities in a timely way.

People told us staff were respectful and treated them with dignity. We observed interactions between people which confirmed this. Records also showed people’s privacy and dignity was maintained. People were supported to make choices about their day to day lives. People were supported to maintain any activities, interests and relationships that were important to them.

People had access to health professionals whenever necessary, and we saw the care and support people received was in line with what had been recommended by health professionals. People’s care records were written in a way which helped staff to deliver care that was based on each person’s needs. People were involved in how their care and support was delivered, as were their relatives if people needed support from a representative to plan their care.

People were able to raise any concerns with the registered manager. They felt these would be listened to and responded to effectively and in a timely way. Staff told us the registered manager was approachable and responsive to their ideas and suggestions. There were systems to monitor the quality of the support provided

This inspection took place on 13 October 2016 and was unannounced.

The Spinney Care Home provides accommodation for up to 26 older adults who require personal care for physical health needs or dementia. 24 people were living at the home at the time of our inspection.

We last inspected the home in June 2015 and found improvements needed to be made to the number of staff on shift at night and that risks were not always managed effectively in regards to people’s nutritional needs. At this inspection we found some improvements had been made but further improvements were still required.

There was a registered manager in post however they were absent from the home due to extended leave. 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 was an interim manager in post who was overseeing the day to day running of the home.

People told us they received their medicines when they needed them. However we saw that medicines were not always stored safely and it was not always recorded when people had received their medicines.

People felt safe using the service and there were processes to minimise risks to people’s safety. These included procedures to manage identified risks with people’s care.

Care workers understood how to protect people from the risk of abuse and keep people safe.

Care workers’ suitability and character was checked during the recruitment process to make sure they were suitable to work with people who used the service.

Environmental checks were completed to ensure that the home was safe for people who lived there, however we found that some areas were not always locked securely and could pose a risk to people.

Analysis of incidents and accidents were carried out to minimise the likelihood of them happening again.

Care workers received an induction when they started working for the service and completed regular training to support them in meeting people’s needs effectively. People told us care workers had the right skills to provide the care and support they required.

The provider and interim manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards.

Staff were kind and caring when providing personal care. However, staff interaction with people was mostly when supporting them with care tasks. We saw limited engagement between staff and people at any other time of the day.

People were supported in a way that promoted their privacy and dignity.

Group activities were offered by care staff however activities did not reflect people’s individual preferences.

Care plans and assessments contained information that supported staff to meet people's needs; however some had not been updated when there had been a change in people's condition. People and their relatives were not consistently involved in the planning of care being provided.

People received food and drink that met their nutritional needs however people were not always aware that alternative meals were available if they did not want a meal that had been offered.

The interim manager completed quality checks of the care provided however these checks had not identified some of the issues we had raised.

This inspection took place on 25 June 2015 and was unannounced.

The Spinney Care Home provides personal care and accommodation for up to 26 older people who do not require nursing care. The accommodation is over two floors with a communal lounge and dining room on the ground floor. There were 20 people living in the home on the day of our inspection.

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 registered manager had left the service. A new manager had been appointed in November 2014 and was in the process of submitting their application for registration.

People told us they felt safe living at the home and staff understood their responsibilities to keep people safe and report any concerns. There were systems and processes in place to protect people from the risk of harm. These included a procedure to identify risks to people’s care and an effective procedure for managing people’s medicines safely. However, some identified risks in the environment had not been addressed in the timescales identified.

There were enough staff to provide the care and support people required during the day. However, at night the provider's own identified staffing levels were not always being met because of staff vacancies. Staff received training in areas considered essential to meet people’s needs safely and effectively.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and staff understood the importance of obtaining people’s consent before providing care. Where potential restrictions on people’s liberty had been identified, the manager had submitted the appropriate applications under the Deprivation of Liberty Safeguards (DoLS) to the local authority. This ensured that people who lacked capacity continued to live their lives safely and in the least restrictive way.

People were supported to access external healthcare professionals although some of the risks around people eating and drinking were not always effectively managed. People were not always offered food choices that met their individual preferences.

Staff were caring and responsive to people’s requests for support. Staff were aware of people’s needs and demonstrated concern if people looked uncomfortable or needed reassurance. People were supported to make choices about how they spent their day and given opportunities to engage in activities. The manager was keen to give people more opportunities to take trips outside the home and some outings had been arranged.

The service had been through a challenging time, but everyone we spoke with was happy with the positive impact of the new manager within the home. The manager had identified areas where changes needed to be made to improve the quality of service provided. Some changes had already been made to the environment and further improvements were planned. Staff told us they felt more supported and able to discuss their issues and concerns. The manager told us staff were more engaged and happy to make suggestions that were beneficial to the wellbeing of the people who lived at The Spinney Care Home.

We visited unannounced and spoke with the manager, staff and with people who lived there. We spent the morning and some of the afternoon there, looked at records and observed interactions in the home.

People we spoke with who lived at the home were very complimentary about the care and the staff. “A lovely place” and “I wouldn’t live anywhere else” were amongst the comments people made to us. Throughout the home there was a lively good natured atmosphere, with much joking and jollity between experienced staff and residents. Staff ensured that the needs of the less vocal and frailer residents were also met. Staff were very busy throughout our visit but did not rush people. One person told us, “They don’t rush you getting up and about.”

We looked at the care of two people who were less able to speak up for themselves. We saw that their needs were effectively recorded and monitored. Staff understood their needs and tended to these regularly.

We looked at medication and saw that this was being administered effectively. We saw staff were well supported and the manager and the wider organisation audited and monitored the service being provided. During our visit the hall was being redecorated. The manager told us of proposed environmental improvements.

The current manager told us they were in the process of applying to register as the manager. The name of the previous manager appears on this report as their registration had not yet been cancelled.

We visited the home without advance notice. We spoke with the manager, staff and people who lived at the home. We also spoke with three visiting relatives and a health professional. We observed interactions between staff and people who lived at the home. Although there were quiet periods, notably after lunch, the home had a lively and friendly atmosphere with staff much in evidence helping people and checking on them.

People who lived at the home were very complimentary about the home and the staff. We spoke with a person who spent much of their time in bed. They told us staff were “very friendly” and were always “bobbing in and out to see if I’m alright.” They told us “food is good” and that they were “very happy.”

One visitor we spoke with told us they were very happy with the care provided and that the home had responded when they had raised issues. Another visitor commented favourably on the “homely” nature of the home. They said their family member had been “calm and relaxed since coming here.” They added “we are very satisfied.” Another visitor noted that people were happy, clean and staff were “usefully employed.”

We heard one dissenting view to these favourable comments from a visitor who felt the home had “gone downhill”. Her concerns were being addressed by the manager.

The current manager told us they were in the process of registering as manager.

People who spoke with us about the home were generally positive. Appreciative comments included ‘lovely garden,’ ‘staff have time to talk,’ ‘for me, it’s a nice place to be,’ and ‘no problems.’ One person praised the service for making them feel so ‘at home’.

Others were accepting, if not wildly enthusiastic, with comments such as: ‘it’s OK’, ‘I’m OK’ ‘I get a choice’, ‘staff have been here a long time.’

Others regretted the loss of independence and activities since leaving their own home. One person compared the home unfavourably with their own home. One person said they would like to go out now and again, giving the impression they never go out. Staff later advised that this person went out regularly with their family. Another person said they ‘would like to watch old films, but don’t see many.’ We spoke to a member of staff who told us that DVDs were available and people watched them. Similar examples of mismatches between what staff were saying was happening and what individuals said they experienced occurred a number of times during our visit.