Springwater Lodge Care Home

Springwater Lodge Care Home is a nursing home providing personal and nursing care to up to 50 people. The service provides support to people living with dementia as well as people with physical health needs, both over and under 65 years of age. At the time of our inspection there were 31 people using the service living across 3 units.

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

People were kept safe from the risk of abuse by the processes in place. Risks were managed well, both environmental and those associated with people’s health and wellbeing. People were supported with their medicines safely. There had been some concerns over the number of staff available to support people, however this had been recognised by the provider and they had increased the number of staff on each shift.

People’s needs were regularly assessed to ensure they continued to be met effectively. Staff were supported with training to ensure they had the skills to meet people’s needs. People’s nutritional and hydration needs were met. Staff supported people to access appropriate healthcare in a timely way. People were able to decorate and personalise their rooms how they wished. People had access to outdoor space and were encouraged to utilise this.

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.

There were systems and processes in place to monitor the running of the home and ensure safe quality care was delivered.

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 16 June 2022).

Why we inspected

We received concerns in relation to staffing and access to information. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Springwater Lodge Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Springwater Lodge Care Home is a nursing home providing personal and nursing care to up to 50 people. The service provides support to people living with dementia as well as people with physical health needs, both over and under 65 years of age. At the time of our inspection there were 25 people using the service living across two units.

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

People were cared for by staff who really knew them well and treated them with the utmost respect. People were empowered to make their own decisions and remain as independent for as long as possible. Without exception, people, relatives and visiting professionals described how kind and caring staff were.

People were looked after in a safe way by staff who understood their needs. There were enough staff on each shift to ensure people did not have to wait for care. People were supported to take their medicines in a safe and timely way. Risks related to people and the environment were managed well.

People were supported in line with nationally recognised guidance and tools. Staff were trained to provide excellent care and felt supported in their roles. People spoke highly of the meals and were supported to keep hydrated. People’s healthcare needs were met and staff supported people to achieve good outcomes.

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.

People’s care was planned and delivered in an individualised way. People were encouraged to recommend and participate in a variety of activities. People and their relatives were supported in a compassionate way as they came to the end of their life. People had very few complaints but knew how to raise any concerns and were confident they would be dealt with promptly and effectively.

The service was run by a passionate and dedicated management team who understood and confidently carried out their duties and responsibilities. The service actively engaged staff and people to be involved in the service. Visiting healthcare professionals and other agencies spoke about the positive experiences they have had working with the service.

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 1 June 2020) and there were breaches of regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

Follow up

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.

The Springwater Lodge Care Home had robust arrangements for visitors which reflected government guidelines. There was a prominent signage on the front door informing visitors about COVID-19 outbreak. Visitors were screened for symptoms of COVID-19 and were required to show negative Lateral Flow Test (LFT) result before they were allowed to enter the service. Personal protective equipment (PPE) was available for visitors.

The registered manager understood and was meeting staff’s and visitor COVID-19 vaccination requirements. This included checking professionals working in care homes vaccination status upon entering the service.

Essential care givers and end of life visits were facilitated in a safe way. There was a designated visiting area where relatives could meet up with their loved ones prior to the outbreak.

During the COVID-19 outbreak people were self-isolating in their own rooms to prevent the spread of infection to other people. There were multiple PPE stations located throughout the key areas of the home.

Staff had completed online training on infection prevention and control and donning and doffing their PPE. Their competencies were regularly assessed. We saw staff wore appropriate PPE throughout our inspection

The home looked clean and hygienic. Domestic staff carried out regular cleaning with additional cleaning and disinfection of high touch points such as door handles or hand rails.

Springwater Lodge 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. It provides accommodation for older people including people living with dementia. The home can accommodate up to 50 people. At the time of our inspection there were 37 people living in the home. Accommodation is provided in three separate units, including a specialist unit for people living with dementia.

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

Arrangements were in place to monitor and manage medicines. However, medicine records were completed inconsistently.

There was not access to a range of activities and leisure pursuits. Due to staffing issues.

We observed occasions when people’s dignity was not respected. We saw evidence of caring relationships in place. Staff were aware of people's life history and preferences and they used this information to develop relationships. People felt well cared for by staff.

Care records were personalised and had been regularly reviewed however they had not been consistently updated to reflect people’s changing needs. People were supported to make choices.

There was not enough staff to support people. Appropriate employment checks had been carried out to ensure staff were suitable to work with vulnerable people. People, their relatives and staff expressed concerns about staffing. We observed occasions when there were insufficient staff available to meet people’s needs and wishes.

There was a process in place to carry out quality checks. These were carried out on a regular basis however they had failed to address the issues found at inspection.

The home was not consistently clean. Staff understood how to prevent and manage infections.

People said they felt safe. People enjoyed the meals and their dietary needs had been catered for. This information was detailed in people’s care plans. Staff followed guidance provided to manage people's nutrition and pressure care.

People were supported by staff who had received training to ensure their needs could be met. Staff had begun to receive regular supervision to support their role.

People had good health care support from professionals. When people were unwell, staff had raised the concern and acted with health professionals to address their health care needs. The provider and staff worked in partnership with health and social care professionals.

The environment was adapted to support people living with dementia.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the systems in the service did not support this practice. Best interests decisions were not always in place.

The provider had displayed the latest rating at the home and on the website. When required notifications had been completed to inform us of events and incidents.

More information is in the detailed findings below.

Rating at last inspection

The last rating for this service was good (6 March 2017).

At this inspection the rating was requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective, caring, responsive and well led sections of this full report.

Enforcement

You can see what action we have asked the provider to take at the end of this full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Springwater Lodge Care Home provides nursing and personal care for up to 50 older people and people living with dementia. On the day of our inspection there were 31 people using the service.

Springwater Lodge Care Home is required to have 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 the time of our inspection a registered manager had been in place since November 2013.

During our previous inspection on 8 September 2016, we identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the plans in place for people at the end stage of their life. Concerns were identified with the systems and processes in place to assess, monitor and improve the quality of service. This included how risks relating to health, safety and welfare of people were monitored and mitigated.

During this inspection we checked to see whether improvements had been made. We found improvements had been made and these breaches in regulations had been met. Some ongoing improvements were required in relation to care records to ensure consistency and the accuracy of information available for staff.

Staff understood how to identify and report allegations of abuse. Risks associated to people’s needs had mostly been assessed and risk plans were regularly reviewed. Accidents and incidents were appropriately investigated and assessments of the environment were carried out to ensure it was safe. The hoist and stand aid were found to be unclean and people did not have individual slings for the use of the hoist or a risk assessment in place for its use.

There were sufficient staff available on the day of the inspection and a new system had been introduced to monitor call bell wait time. The registered manager was closely monitoring staffing levels and reporting this to senior managers. Staff had been appropriately recruited; checks had been completed in relation to their suitability before they commenced their employment.

People received their prescribed medicines safely and these were stored and managed safely. Some concerns were identified with the recording of people’s allergies.

Improvements had been made to the cleanliness, hygiene and the prevention and control of infections but concerns were identified with some equipment that was unclean.

Staff received an induction and the ongoing training and support necessary to enable them to carry out their role effectively and safely.

The principles of the Mental Capacity Act (2005) had been followed when decisions were made about people’s care. However, some inconsistencies were found in how mental capacity assessments had been completed and best interest decisions made.

People’s nutritional needs had been assessed and planned for. People received a choice of what to eat and drink and independence was promoted. The staff worked well with healthcare professionals in meeting people’s health needs which they assessed and monitored for changes.

People were supported by kind, caring and compassionate staff that showed dignity and respect. Staff were knowledgeable about people’s needs, preferences and routines and responded well to their comfort needs.

People had access to independent advocacy information should they have required this support. People and their relatives, if appropriate, were involved in review meetings that discussed the care and treatment provided by staff.

People’s preferences and routines were recorded but they did not always receive care as they wished. People received opportunities to participate in activities including community visits.

The provider's complaints policy and procedure were available. People were confident that the registered manager and staff would respond to concerns raised.

The systems used to assess the quality and safety were being used more effectively and some new audits and checks had been implemented. A continuous action plan for areas requiring improvement was in place.

People who used the service, relatives and staff were positive about the leadership of the service. People received opportunities to share their experience and views about the service if they wished.

This inspection took place on 8 September 2016 and was unannounced.

Springwater Lodge Care Home provides nursing and personal care for up to 50 older people and people living with dementia. On the day of our inspection there were 36 people using the service.

Springwater Lodge Care Home is required to have 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 the time of our inspection a registered manager had been in place since November 2013.

During our previous inspection on 3 and 4 March 2015, we identified one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to how people’s medicines were managed.

We received an action plan from the provider to say they would complete the required improvements by August 2015.

During this inspection we checked to see whether improvements had been made. We found some improvements had been made and the breach in regulation had been met. However, further improvements were required to the administration of prescribed creams.

Staff were aware of their responsibilities to protect people from abuse and avoidable harm. Staff had received adult safeguarding training and had available the provider’s safeguarding policy and procedure.

Although systems were in place to ensure people’s safety was effectively managed, these were not always followed. Risks to people's individual needs had not been completed for all people. Staff had information available about how to meet people’s needs, including action required to reduce and manage known risks. These were reviewed on a regular basis but some risk plans lacked specific detail to support staff. Accidents and incidents were recorded and appropriate action had been taken to reduce further risks. The internal and external environment was safe but some clinical equipment was identified as not fit for purpose.

People felt staff were too busy to spend time with them and some people felt this impacted on how long they had to wait for assistance. People’s needs were monitored and reviewed and this information was used to calculate the staffing levels required. Staff leave was covered by permanent or agency staff. We identified there to be sufficient numbers of staff but the deployment of staff required reviewing.

Concerns were identified with the cleanliness of the service and practice in relation to infection control measures and best practice guidance was not always followed.

Safe recruitment practices meant that, as far as possible, only suitable staff were employed. Staff received an induction, training and appropriate support. However, not all staff were sufficiently trained in end of life care. Not all nursing staff had received appropriate training in the use of some clinical equipment. This process of monitoring training needs and development was not as robust as it should have been.

People were supported to maintain good health. People's healthcare needs had been assessed and were regularly monitored. New care plan documentation was in the process of being introduced. This period of change found some care records incomplete and information difficult for staff to follow. The provider worked with healthcare professionals in meeting people’s healthcare needs.

People received sufficient to eat and drink and their nutritional needs had been assessed and planned for. People received a choice of meals but did not always receive the support they required at mealtimes. Staff did not promote people’s independence to eat and drink.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and report on what we find. We found appropriate applications had been made to the authorising agencies for some people who needed these safeguards. However, the registered manager had not progressed with further applications in line with their action plan. In addition we found that although staff had received training in the MCA, they lacked knowledge in this area.

People could not be assured that their end of life needs, wishes and preferences would be understood and met. This was because staff did not have this information available.

Staff were kind, caring and respectful towards the people they supported. Staff’s knowledge about people’s needs, routines and preferences was variable.

The provider enabled people who used the service and their relatives or representatives to share their experience about the service provided if they chose to. However, not all people were aware of these opportunities. People were involved as fully as possible in decisions about their care and support.

The provider’s complaints policy and procedure was available. People were confident that the registered manager and staff would take any concerns they raised seriously. People had access to information about independent advocacy service should they have required this information.

People received opportunities to participate in activities but there were limited opportunities for people to pursue their hobbies or interests.

The provider had checks in place that monitored the quality and safety of the service. However, these were not effective. The concerns and shortfalls identified in this inspection had not been identified. One safeguarding incident was found not to have been reported in a timely manner to the local authority who have responsibility for investigating safeguarding incidents .

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take at the back of this report.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with six people who used the service and asked them for their views. We also spoke with four care workers, the regional manager and the manager. We looked at some of the records held in the service including the care files for five people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found people gave consent to their care and received care and treatment that met their needs. A person told us, 'I am asked what I want to wear when I get up.' Another person told us, 'I am looked after very well.'

We found that suitable arrangements were in place to manage people's medication and ensure they received any medication they needed. A person who used the service told us, 'Staff bring me my tablets at the time to take them.'

We found there were sufficient staff to meet people's needs and the provider assessed and monitored the quality of the service. A person who used the service told us, 'There always seem to be enough (staff) around to me.'

We noticed one person we spoke with had very dirty fingernails on one hand. We checked the personal care chart which showed they had been washed that morning by a member of staff. This could occur when staff completed the form without ensuring the person had received all the personal care they required.

We spoke with some relatives who had concerns about some of the care their relations received. They all praised the staff saying they worked extremely hard and their complaints were not about their commitment to their work.

We asked people if they felt safe in the home and they told us they did.