The last inspection took place in February 2018 and Spring House was rated as requires improvement in all domains except safe which was rated inadequate. We found continued breaches of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014 because the service had not kept people safe and was not effectively monitoring the quality of the service. We also found breaches of Regulations 11 Need for Consent, Regulation 13 Safeguarding service users from abuse and improper treatment and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took action and served a requirement notice on the registered provider in respect of these breaches. An action plan was received from the provider to show what actions would be taken to meet these regulations.This inspection took place on 19 July and was unannounced. A further visit was carried out on 20 July 2018. We undertook this inspection to check that the provider had taken action to meet legal requirements and to comprehensively inspect the service against all of the areas services are required to comply with. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Spring House Residential Care Home' on our website at www.cqc.org.uk.
Spring house is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Spring house accommodates up to 21 people in one building. There were 12 people living at the home at the time of this inspection.
The service had a manager who had registered with the Care Quality Commission in June 2018. 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.
During this inspection we found a number of significant improvements had taken place under the leadership of the new registered manager. The provider had taken action and implemented sufficient improvements to their systems, processes and practice which meant they had met the breaches of regulation imposed at the previous inspection. The overall rating has improved to good.
Care planning documentation had improved and focussed on what was important to the individual. People's likes and dislikes were recorded and the staff we spoke with knew people well. Risks to people had been assessed and measures put in place to reduce these risks.
Where people presented with behaviours that placed others and themselves at risk of harm, staff knew how to distract and divert people. The guidance contained in some care plans was not sufficiently detailed on how staff were to manage these levels of anxiety when people became frustrated. For example, what techniques were to be used to distract people. We have made a recommendation about this.
Further work was needed to embed the correct application of Mental Capacity Act legislation. Some people had assessments of capacity and records in their care files when restrictions were in place, but this was not consistent throughout the service. The registered manager acknowledged there was further work to do and was responsive, assuring us they would implement corrective actions to the concerns we raised. We have made a recommendation about this.
Staff were provided with the support, training and supervision they needed to deliver effective care. More training on how to support people with behaviours which posed a risk of harm to themselves or others had been provided to most staff. We found safeguarding referrals had been appropriately made. People using the service said they felt safe and that staff treated them well. There were policies and procedures in place to guide staff in how to keep people safe from abuse and harm. Staff had received further training in safeguarding adults since the last inspection and understood how to safeguard the people they supported.
The care staffing levels had been increased following the last inspection to support people’s dependency needs. Feedback from people, their relatives and staff, and duty rotas we reviewed confirmed these levels had been maintained. During this inspection, we observed the atmosphere in the home was calm and staff were not rushed when responding to people's needs. We were satisfied that there were enough staff on duty. Appropriate recruitment checks had taken place before staff started work.
The registered manager had reviewed and improved activities that were on offer to people.
Improvements had been made to the way that care and treatment of people who used the service was provided. We saw staff were more attentive and people received appropriate care and support in line with their wishes. Staff were visible in the communal areas of the home and promptly attended to people's needs.
Infection control practices had been reviewed and improved. The home was clean and free from unpleasant odours.
People were supported with their health and wellbeing. Drinks were provided throughout the day and a picture menu was provided to support people with a choice of food. People received additional support from diet and nutrition specialists where this was required.
Relatives told us there were no restrictions on the times they could visit their loved ones and that they were always welcomed by staff.
The provider had reviewed systems and processes in place to monitor and improve the quality and safety of the service. The registered manager had made improvements to the overall leadership of the home and both relatives of people using the service and the staff team told us there were opportunities to raise concerns and issues which were listened to.
There was a formal complaints system in place to manage complaints if or when they were received.