Archived: The Spinney Care Home

The Spinney Care Home is a residential care home providing accommodation for persons requiring personal or nursing care to up to 37 people. The service provides support to older people, younger adults, people with dementia, people with mental health needs, people with a physical disability and people with a sensory impairment. At the time of our inspection there were eight people using the service.

People’s experience of using this service and what we found

The Spinney Care Home was an older home which required significant maintenance, renovation and refurbishment. People and their relative or representatives had been asked by the provider, Derbyshire County Council, to share their thoughts about the options for the future of the care home. People felt safe and happy at the home whilst awaiting the outcome of the consultation.

Systems were in place to reduce the risk of harm to people. People and their relatives knew how to raise a concern and who to.

Staff understood people’s health care needs and how to meet these. Monitoring was in place using nationally recognised tools to ensure good outcomes for people.

People were supported by enough staff to meet their needs. Staff knew people’s preferences and supported them to make choices. People were supported to have contact with family and friends.

People received their medicines as prescribed.

Measures were in place for the safe emergency evacuation of people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 May 2019) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from this concern.

Please see the Safe section of this full report.

We carried out an unannounced comprehensive inspection of this service on 5 March 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

As part of this focused inspection we were able to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Spinney Care Home on our website at www.cqc.org.uk.

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 health, educational and social care agencies. This helped to inform and improve people’s care experience. Legal obligations were met by the provider in relation to notifications about important events when they happened at the service and display of their most recent inspection rating.

More information is in the full report.

Rating at last inspection: At our last inspection we rated the service as Requires Improvement. Report published 20 March 2018.

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: As this is the second consecutive rating of Requires Improvement. We have asked the provider for a written report, to show how they will comply and any plans they have for improving the standard of services provided to people, to ensure their health and welfare. We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

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 and other healthcare professionals as required to meet people’s needs. Infection control standards had been reviewed to ensure suitable hygiene standards were maintained in the home. People were now being offered a choice of foods to keep well. Specialist diets were catered for and alternative meals could be provided upon request.

People knew how to make complaints. They were confident that the staff and the manager would respond to any concern and they could approach them at any time. Complaints were managed in line with the provider’s complaints procedure and people were informed of any investigation and actions.

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

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 and visiting professionals were confident about the management of the service. The management culture was open, visible and approachable with a strong ethos of ‘teamwork.’ Staff understood their roles and responsibilities for people’s care and they were encouraged and supported to raise concerns or make improvements to this when required.

The provider had sent us written notifications when required, telling us about important events that occurred at the service, in accordance with their legal obligations to us.

Management arrangements to check the quality and safety of people’s care helped to inform improvements that may be needed. Improvements made and assured from this helped to ensure the quality and safety of people’s care.

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 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 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.