Springfield Care Home

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

During our assessment we found people were at increased risk of harm because risks associated with people’s support needs had not always been assessed, monitored or mitigated safely. This resulted in a breach of Regulation. Systems were in place to ensure consent to care and treatment, assessment of people’s needs and support to live healthier lives. Staff teams and external services usually worked well together. The majority of people, family members and external health and social care professionals told us they felt the service was effective. However, not all staff we spoke with were aware of the assessments in place to meet people’s needs.

This service scored 71 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Assessing needs during this assessment. The score for this quality statement is based on the previous rating for Effective.

People told us they had plenty to eat all times of the day, sometimes too much which they said could be overwhelming. We saw copies of menus and people told us they could choose their meals.

Not all senior staff were aware of RESTORE2 (a physical deterioration and escalation tool for care/nursing homes), although it was referenced in the provider’s policies. Not all staff supporting people to eat, were aware of people's dietary requirements. This meant that all people who had been assessed as being at risk when eating had pureed food. Whereas other options may have been more appropriate for their needs.

Staff did take people's routine observations regularly. Staff used a range of other recognised tools to assess and manage risks to people. Actions had been taken to protect people from the risk of falls, development of pressure ulcers, behaviours, malnutrition, choking, risks associated with blood thinners and continence and constipation. Safety alerts were shared with staff. However, there was a lack of clear guidance for staff in relation to people's nutritional risks and records. Staff were not recording on a person's food and fluid charts whether the meal served met the person's IDDSI requirements, as per the guidance from a SALT (Speech and Language Therapist). For example, if they had difficulty swallowing, staff had not documented the consistency of the meal served. There was a failure to ensure a person living with diabetes received appropriate intervention in line with good practice standards. This was due to a lack of written guidance for staff. This placed the person at potential risk of serious harm. We asked staff to seek clinical advice during our site visit to ensure the person's immediate safety which they did. After the site visit written guidance was put in place to mitigate the risk further. However, staff were not using RESTORE2, which is based on nationally recognised methodologies. This allows staff to consistently assess and escalate any deterioration for people. RESTORE2 includes the observation of blood sugar levels which are significantly different from the person's normal range which would have supported the escalation of concerns about the person with unstable blood sugars.

We did not look at How staff, teams and services work together during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Supporting people to live healthier lives during this assessment. The score for this quality statement is based on the previous rating for Effective.

We did not look at Monitoring and improving outcomes during this assessment. The score for this quality statement is based on the previous rating for Effective.

Where people had capacity to make decisions, we saw they consented with the proposed care and support. For example, if people had capacity but made what was considered to be an unwise decision, staff spoke with the person, checking they understood the risks of this decision. Staff were heard providing people with choices in relation to where they spent their time, what they wanted to do and if they wanted to be involved in activities.

Staff told us they sought people's consent for their care.

People's consent for their care had been sought where they had capacity to provide this or the relevant Power of Attorney, had been consulted. The use of any potential restrictions had been assessed and where people lacked capacity to consent to their use, legal requirements had been met.