Springbank Rest Home

Springbank Rest Home is a residential care home situated in Heywood, Greater Manchester. The service is registered to provide care for 20 people. At the time of our inspection there were 20 people living at the home.

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

The provider had not ensured risks to people had been thoroughly assessed and reviewed. Medicines were not always managed correctly.

Improvements were needed with the oversight of the service, as governance processes, such as audits were not being carried out. This meant the concerns we found during our inspection had not been identified. Some areas of the service environment need redecoration and improvement.

People and relatives were very happy with the care and support given at Springbank Rest Home. People told us they felt safe and well looked after. We saw many caring interactions between staff and people during our inspection and there was a relaxed, welcoming atmosphere at the service.

People were safeguarded from the risk of abuse and there was a stable staff team with enough staff on duty to support people well. Appropriate checks had been carried out when new staff were recruited. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection

The last rating for this service was good (published 25 April 2018).

Why we inspected

The inspection was prompted due to some concerns received about the governance of the service and the management of medicines. A decision was made for us to inspect. We undertook a focused inspection to review the key questions of safe and well-led.

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 good to requires improvement. This is based on the findings at this inspection.

Please see the full report for further details. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springbank Rest Home on our website at www.cqc.org.uk

Enforcement

We have identified breaches in relation to safe care and treatment and the provider's oversight and management of the service.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Staff were seen to be following the current government guidelines in relation to the personal protective equipment (PPE) and were engaged fully in the testing for COVID-19. PPE was available in all areas of the home where staff may need to access it.

Staff had engaged with the Local Authority IPC team and completed their PPE training.

Residents completed isolation periods in their bedrooms after testing positive for Covid-19 and when returning to the home from hospital.

There was signage around the home to indicate the need to social distance and to wash hands regularly to ensure that visitors and staff were aware of current guidelines.

We found that the water pressure was not always consistent, ornaments and other homely items did not lend themselves to ensuring a hygiene environment and the IPC policy was incorrect. We raised these issues with the registered manager who agreed to look into these issues.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 manager had been in post since the service first registered in October 2010 but had managed the service for over thirty years.

At the last inspection of March 2016 the service were found to be in breach of two regulations. Regulation 15 HSCA RA Regulations 2014. Premises and equipment because of an absence of window restrictors on three upstairs windows and Regulation 19 HSCA RA Regulations 2014 Fit and proper persons employed. The recruitment of staff was not safe because satisfactory and suitable references had not been obtained. The service sent us an action plan to show how they intended to meet the regulations. We looked at both breaches during this inspection and found restrictors had been fitted to all windows and the staff files we looked at showed recruitment was safe.

People who used the service and family members said staff were consistently kind, caring and supportive.

The views of people who used the service were sought in meetings and surveys to help their wishes be known and we saw the registered manager responded to them.

There were safe systems in place for the storage and disposal of medicines. Staff received training in how to administer medicines and had their competency in this area assessed.

There were safe systems in place to protect people from abuse. Staff we spoke with said they would take action if they saw any poor care or support.

There were robust recruitment procedures to ensure new staff were safe to work with vulnerable adults.

Equipment was maintained regularly to meet the health and welfare needs of staff and people who used the service.

The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and worked to ensure people's rights were respected.

People were given a choice of nutritious food and they told us they enjoyed the meals

People were able to attend activities of their choice which were suitable to their age, gender, culture, ability and religion.

There was an accessible complaints procedure for people to raise any concerns if they needed to.

Policies procedures and audits helped the registered manager maintain and improve the service if possible.

Springbank Rest Home is a residential care home registered to provide personal care and accommodation for up to 20 older people. There were 18 people using the service at the time of the inspection. The home is situated in Heywood and is on a bus route leading to both Bury and Rochdale towns. It is a large detached property situated in its own grounds. There is off- road parking to the side and back of the home. Bedroom accommodation is provided on the ground and first floors and access to the first floor is via a passenger lift. The communal areas of lounges, conservatory and dining room are situated on the ground floor.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the 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.’

We found two breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014. We found that the premises were not as safe as they should have been because three of the upstairs windows were without restrictors. This placed the health and safety of people at risk of harm. The recruitment system did not ensure the safety of people because suitable references were not obtained for one person who had been employed by the service.

You can see what action we have told the provider to take at the back of the full version of the report.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. People who used the service told us they felt the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively of the kindness and caring attitude of the staff.

Staff we spoke with had a good understanding of the care and support that people required. We saw people looked well cared for and there was enough equipment available to promote people’s safety, comfort and independence.

We saw that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse. Staff were able to demonstrate their understanding of the whistle-blowing procedures (the reporting of unsafe and/or poor practice).

The system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social care professionals to ensure that people received timely, appropriate care and treatment.

All areas of the home were clean and procedures were in place to prevent and control the spread of infection. Systems were in place to deal with any emergency that could affect the provision of care, such as a failure of the electricity and gas supply.

People’s care records contained enough information to guide staff on the care and support required. The care records showed that risks to people's health and well-being had been identified, such as the risk of pressure sores and poor nutrition.

We saw that appropriate arrangements were in place to assess whether people were able to consent to their care and treatment. We found the provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions.

Food stocks were good and people were offered a choice of meal. People we spoke with told us they enjoyed the food, there was always enough and they could have second helpings if they wished.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and there were systems in place for receiving, handling and responding appropriately to complaints.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and looking at records. We also obtained a report produced after a quality monitoring visit from Rochdale Local Authority commissioning team in October and November 2013.

If you want to see the evidence supporting our summary please read the full report.

Is the service caring?

We were able to speak with five of the people who used the service and two family members. All of whom told us that they were happy with the service being provided and had no complaints. One of the people who lived at the home told us, "The home has a good reputation in the area and that was one of the reasons I chose to come and live here". Another person who lived at the home told us, "I can't fault it at all". They also went onto say that they were always given a choice at meal times and could choose when they got up and went to bed. Their family member told us that they had been waiting for a bed at the home to become available.

We spoke with a family member whose relative had lived at the home for over two years. They told us, 'The staff can't do enough for you and they keep 'on top' of things. They also said that the staff 'are lovely', 'work hard' and "I looked at quite a lot of homes but as soon as I walked in I liked it; it was homely and I was made to feel welcome".

Everyone we spoke with said that they were happy with the care they received and had no complaints.

We were able to observe during our visit that the staff team were friendly and spoke to people in a caring and friendly manner.

Is the service effective?

We saw notes on the care plans when other healthcare professionals had been contacted such as the GP, district nurse or chiropodist. One of the people we spoke with told us, "They always get the GP when necessary and tell the family".

We saw in the care plan for one person guidance notes regarding their treatment. We were told by the person that the care workers were assisting them daily with their treatment which had been prescribed by the physiotherapist.

We saw that the district nurse attended people who lived at the home as and when someone required nursing care such as vaccinations or medical dressings.

We saw that a mental capacity assessment had been completed to ensure that people's best interests were being met.

People we spoke with said that if they had any concerns they were comfortable with talking to the manager or the care workers.

A passenger lift assisted people to reach the upper floor. There was equipment available such as hoists and assisted baths to help the care workers meet people's care needs.

We saw that activities were organised and people took part in crafts; which were displayed throughout the home.

Springbank Rest Home was clean, and apart from one bedroom, was free from unpleasant odours. The manager told us that carpets were cleaned regularly, monitored and replaced when necessary.

There were hand wash dispensers and paper towels available in all bedrooms and toilets in the interests of infection control.

We also saw that various safety checks had been completed. These included gas, electricity and passenger lift safety certificates. Some work had been required after the electric inspection which had been completed.

Is the service responsive?

We saw that people's health, personal and social care needs were assessed before they were admitted to the home to ensure that they could be met. We saw that risk assessments and care plans were in place that reflected their needs to ensure that they received appropriate care. The care plans and risk assessments were reviewed regularly by the manager.

The two family members we spoke with told us that they were kept informed of their relative's health and that the GP was contacted straight away if they were not well.

We were told by people who used the service, their family and the staff team that they could talk to the manager if they had any concerns about the care being provided.

We saw that an audit had been undertaken in October 2013 by a member of the Rochdale Local Authority Quality Monitoring team. There had been a number of recommendations made within the action plan. We saw from the action plan that recommendations had been completed by December 2013.

An infection control audit had also taken place by Rochdale Council. The recommendations such as replacement of some of the chairs in the lounge, replacement of some of the mattresses and mattress covers had been actioned.

Is the service well-led?

The registered manager had worked at the home for 28 years; 19 of which had been as the manager. The manager had a National Vocational Qualification Level 4 in Management.

Training was in place to protect the people who lived at Springbank Rest Home such as moving and handling, safeguarding adults and first aid.

Training was provided through Rochdale Local Authority, distance learning training companies and in house by the manager. This helped to ensure that the staff team had the qualifications and skills to meet people's needs.

We saw that National Vocational Qualifications (NVQ) in Health and Social Care had also been obtained by the staff team.

We were told by the manager that questionnaires were distributed to the people who used the service in order to obtain their views and opinions about the service. The last survey held was in 2012 and a small number in 2013. The responses received were positive. Comments received were, 'The staff are very caring and compassionate'; 'The home is clean and homely'; 'People are always dressed nicely'.

Arrangements were in place to help ensure people were treated in a respectful, dignified way and were involved in the making of decisions about their care, support and treatment.

People's care records contained enough information to show how they were to be supported and cared for.

We saw that appropriate arrangements were in place to help safeguard people from abuse. People we spoke with told us that they felt safe and trusted the staff.

People were cared for by staff that were properly trained, supported and supervised.

Regular monitoring of the services and facilities provided was in place to help protect people against the risks of inappropriate or unsafe care.

The people we spoke with told us they were very happy at the home. One person told us they enjoyed the food and liked to read a newspaper. Another person told us the staff were excellent and the home was clean.

The people we spoke with told us they always received their medication on time. They told us that the staff were always around when they needed them.

The people we spoke with told us they were happy with the staff at the home.

They also told us that they had no concerns about the care they received and would speak to the Registered Manager is they had any concerns