The Springs Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from avoidable harm. At our last inspection this key question was rated requires improvement. At this assessment this key question remains at requires improvement. We identified continued shortfalls with medicines, infection prevention control and safe environments. Where people's needs had changed, this was not always reflected in their care plans. People’s daily care records did not always show how their risks were being monitored in line with their assessed needs. For example, fluid, bowel and weight monitoring, and repositioning charts were not always completed consistently. We found the environment was not always safe on 1 unit and some risks were identified around infection prevention and control (IPC), medicines and effective staffing. The service internal audits did not always identify the risks we found during our onsite visit, however, the provider had started to take actions during our visit.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff had not always had the opportunity to share their learning and development through regular supervisions and appraisals. However, they told us they felt confident to share their ideas with managers and would be listened to. The management had identified this needed to improve and had actioned regular staff supervisions to be commenced. The services accidents and incidents were reviewed which evidenced what actions had been taken. Care plans had been amended to reflect when a person’s support needs had changed. If a referral had been made for a person, where needed, additional training had been undertaken by staff.

The provider had systems in place to promote a learning culture. They held daily “huddle” meetings to discuss people’s current and changing needs and to reflect on any learning, additional monitoring, and improvements. Nurses met to discuss the service’s clinical oversight, where recent incidents and complaints were discussed in terms of lessons learnt and the policy and processes of incident reporting. People’s experience and safety were highlighted and emphasised as very important.

Whilst processes were in place to support safe pathways of care, and collaborative working with other agencies, these were not always followed. Where a person required additional support from external professionals, these were highlighted in people’s care plans but not always resourced consistently. However, the service had an admission’s policy in place, which included information regarding people’s consent, capacity, and support needs. We spoke with managers who started to review people’s care plans and re-referred a person to the necessary resources to support their care needs. The local authority had completed an assessment prior to our onsite visit and made recommendations to make improvements.

People and relatives told us they felt safe living at The Springs, and they could report any concerns to staff and management. One person told us, “I am very happy and safe, I love it here”. Relatives also confirmed this, comments included, “They are very safe here it was a real issue when they were at home” and “They are safe and comfortable not stressed and no issues".

Staff had received training in safeguarding adults and understood their roles and responsibilities to keep people safe. Staff told us they would report any concerns to managers if they suspected abuse. One staff member told us, "I would have no problem to raise any concerns, my residents come first, I treat them how I would want my mum to be treated”.

The provider had safeguarding policies and processes in place to protect people from the risk of abuse. Where people lacked capacity applications had been made to the local authority and the service’s tracker had been updated. Not all decisions to deprive people of their liberty had been documented appropriately and some best interest decisions had not been made. For example, where a person had restrictions of clothing in their bedroom, a best interest decision had not been carried out with the person's family member or representatives.

Care plans did not always detail people's support needs when managing anxious behaviours. This posed a risk to people should the service use temporary staff as they would not have access to the relevant information to support people effectively. One staff member told us how they support a person with anxious behaviours, and certain strategies they use to diffuse difficult situations, the detail of this information was not documented in the persons care plan. However, staff demonstrated good understanding of people’s risks associated with their support needs and health conditions. Staff were able to tell us when people’s needs had changed and had posed a risk to others living in the service. They told us what changes had been made to reduce the impact to others.

Whilst staff mostly undertook risk assessments for people, and documented these in people’s care plans, staff did not always ensure these risks were mitigated in practice. Managers had not identified this prior to our assessment; however, during our assessment we saw leaders were working to improve how policies and processes were used to manage risks to people. People and families were not always involved in planning and reviewing risks, and conversations with people confirmed this. The provider was aware they needed to make improvements to ensure people were more involved and had recently implemented a new process to discuss these more regularly through the resident of the day.

Staff feedback about the environment was mixed. There were some renovation works being completed on 1 unit during our onsite visit. A staff member told us they felt some of the recent redecoration had impacted on some people with cognitive impairments, as previously the doors were painted different colours to make it easy for people to recognise. For example, bathroom doors were always blue. However now all the doors are painted the same colour, so people had to relearn locations such as bedrooms and bathrooms. We shared this with the peripatetic manager, who told us they would review this.

We observed the environment was not always safe. One floor has recently had a door fitted to the kitchen area, the door posed a toppling risk to people and had not been risk assessed. The door was later removed to reduce the risk. On another floor, we identified medicines were not secured appropriately in several rooms, these included both oral and topical medicines. We additionally noted a broken plug socket which was changed during our onsite assessment. People had equipment in place to help mitigate risks, however the equipment was not always placed or used effectively to help reduce those risks. For example, we saw several people had fall’s mats, they were not always in the correct location. People had call bells in their rooms, these were not always connected or within reach of people, despite it being documented in their care plans. 1 person we spoke with was unable to use their call bell consistently due to their condition and said at times it was difficult to attract staff’s attention if they needed help or support. We shared our findings with managers who started to take action during the assessment.

Processes to monitor the safety, environment and equipment were carried out regularly. Whilst the provider completed the relevant external compliance checks, internal audits had not always identified where the environment was not safe. For example, we saw unsafe locations of some safety equipment and risks not being fully assessed for additional equipment used in a kitchen area. We shared this with the peripatetic manager who took action during the assessment to review the risks and relocate the equipment to ensure it was used effectively and safely for people.

We received mixed feedback from staff regarding staffing levels, this varied between the home’s different units. On 1 unit, staff told us there were enough staff to meet people’s needs, although some staff said they felt there had not been enough staff in the past. Staff members on the other 2 units shared some of their concerns, they felt a risk to the service was there was not enough staff to interact meaningfully with residents. They also shared there were 2 people who had been having falls and they were concerned they were not safe when there were not enough staff on shift. We shared this with the provider who told us they would review this. Staff told us they had completed their mandatory training and felt this was sufficient for their roles and were given opportunities to develop their roles further if they wanted. The provider offered professional development opportunities to staff such as funding training programmes. Nursing staff had completed additional training such as, catheterisation and phlebotomy training.

We saw some staff interacted well with people and were responsive to their needs. On 1 unit staff demonstrated good knowledge of how to interact when a person became distressed, and responded calmly with conservation of what the person’s interests were. However, this was not consistent throughout the home. We observed a person waiting for a long period of time, despite inspectors prompting staff. The person became distressed and had no way of alerting staff they needed assistance. We also observed a lack of interaction with people who were nursed in bed on 1 unit.

The provider completed a dependency tool which helped them determine how many staff were needed to provide safe care. Despite this, we asked the provider to review the dependency tool based on our observations and conversations where people had been waiting to receive support. Managers told us they would review this to ensure the service had the correct staffing levels. Staff were recruited safely and had received the relevant pre-employments checks prior to commencing their roles. Staff had received mandatory training, although we identified keys areas where staff had not completed training to meet people’s specific needs. For example, supporting people with anxious behaviours and privacy and dignity. Not all staff had received supervisions and appraisals, this had been identified by the provider who had already started implementing these.

People and relatives did not raise any concerns in relation to infection control at the home.

Staff told us they felt the home was clean and tidy. Staff understood their responsibilities to ensure people were cared for in a clean and hygienic home.

We found infection control procedures were not always followed on 1 unit. For example, we saw 2 people had dirty mattresses and furniture in their bedrooms. We also identified some cutlery required rewashing in the dining area. We shared this with the management team who took immediate action. However, this was not consistent throughout the home, the other 2 units were observed to be clean and following good infection control practice. We found items such as wheelchairs and stand aids were checked daily and were visibly clean with cleaning tags attached to let staff know when they had been sanitised. This protected people from the risk of the spread of infection.

There was an infection prevention and control policy available to staff to refer to. Staff had completed training in infection control and the use of personal protective equipment. Managers completed monthly infection control audits. We reviewed the most recent which scored 76% compliance. We saw actions had been identified to drive improvement. Managers monitored the action plan and recorded updates on these. However, staff or managers had not identified the concerns identified during this assessment such as dirty mattresses and furniture.

Generally, people were happy with the support they received with their medicines and felt they had been kept appropriately informed of any changes. Relatives said, “They are on medicine, staff always update us if it changes. I can’t fault this place at all’. "They are on eleven tablets a day, they have all kept me up to date on medication.

During our assessment we identified some concerns with medicines. PRN protocols did not always offer the required information. For example, 1 person was prescribed medicines for anxiety and sleeping problems. It did not state how the anxiety would present, when to administer and what the follow up procedure would be. Additionally, pain patch information did not specify a 4-point rotation and variable doses were not always clear as to why people were prescribed a variable dose medication and when to give it. Pain patch management was an area of improvement required from our last inspection. We shared this with the management team took action and responded to us by developing a more detailed protocols.

Staff ensured medicines were checked and audited and there were adequate medicine management procedures in place. We saw from records, stock checks were audited regularly to ensure safe medicine management. There were suitable arrangements for storing and disposal of medicines and temperatures were monitored to make sure medicines would be safe and effective. Staff had received suitable medicines competency checks to carry out their roles effectively. Controlled medications were locked safely and in accordance to guidelines. Controlled medications were counted and were correct in line with records.