The inspection took place on 9 and 10 June 2015 and was unannounced.
At our last inspection on 14 August 2014 we identified breaches of Regulation 11 and Regulation 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Regulation 13 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that people had not been assessed under the Mental Capacity Act (MCA) 2005, which meant that people might not have their rights and freedoms protected. Staff appraisals and personal development plans were not up to date.
Following the inspection in August 2014 the provider wrote to tell us what they would do to make improvements to meet the legal requirements. The inspection in June 2015 was undertaken to make sure that the provider had followed their action plan, to identify that the provider met the legal requirements, and to provide a rating under the Care Act 2014.
Springfield Garth is a purpose built home on two floors situated on the outskirts of Boroughbridge, with local amenities and transport links with Harrogate, Ripon and York. Springfield Garth is owned and operated by North Yorkshire County Council. It is registered with the Care Quality Commission to provide accommodation for 28 people who require personal care and support. When we visited the manager informed us that they only admitted up to a maximum of 26 people and 14 people were living there.
There was a registered manager in post. 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 this inspection we found improvements had been made to staff training and development. Staff had access to a range of training through distance learning and classroom based training. Some staff told us that they would like to have the opportunity to undertake additional training. However, records showed us that not all staff were taking advantage of the training opportunities that were on offer.
We identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risk assessments had not always included sufficient information to evidence how the decision was reached. For example, staff had not taken one person’s psychiatric history into account when assessing their ability to manage their own medicines safely. This meant that staff might not monitor whether the person was taking their medicines according to the prescribed instructions, which could put them at potential risk of harm. Not all risk assessments had been updated in a timely way. We found that the provider had not put appropriate measures in place following an accident in the home. This meant that action had not been taken to make the situation safe and prevent a similar incident reoccurring. There was incorrect information in the file which held the people’s emergency evacuation plans, which meant that essential information might not be readily available in the event of an emergency. You can see what action we told the provider to take at the back of the full version of the report.
Action had been taken to assess people in relation to the Mental Capacity Act (MCA) 2005. However, people’s care plans needed updating to ensure they included key information about deprivation of liberty safeguard authorisations that were in place. This would alert staff to the need to monitor changes in the person’s care or treatment, or their overall situation, which may mean that they may no longer require such measures in place. We found that the provider had failed to submit two notifications to CQC as they were required to do. This meant that the provider had not complied with the specific duty placed on them to inform CQC where a standard authorisation was approved under deprivation of liberty safeguards. Not all of the staff had completed training on the MCA and DoLS. We have made a recommendation about staff training on the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards to ensure they understand their role and responsibilities under the Act. This will help to ensure people receive safe, consistent care that protects their rights and freedoms.
People who used the service and managers and staff confirmed that staffing difficulties had impacted on the home’s ability to drive forward improvement. However, we saw that the staff team had worked well together to minimise the effects of the reduced staffing levels to keep people safe.
Information about people’s life history and their likes and dislikes was not fully reflected in their support plans. However, people told us they were well cared for and we observed staff were kind and patient throughout our visit.
Mealtimes were well organised and we identified that people received nutritious food that met preferences.
People’s daily records were maintained and referrals were made to healthcare professionals when necessary. The local GP practice held a surgery each week in the home. This meant people’s healthcare needs were kept under review and changing healthcare needs were identified and met. Care plans included individual assessments in relation to falls, mobility, skin integrity and nutrition and we saw that appropriate referrals had been made to community healthcare and social care professionals as needed.