Archived: Springfields Residential Home

Updated 10 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 23 and 26 June 2015 and was unannounced.

The inspection was conducted by an inspector and an inspection manager.

We usually ask the provider to complete a provider Information return or PIR. Because we carried out this inspection at short notice we did not have a PIR.

Before the inspection we looked at previous inspection reports and notifications received by the Care Quality Commission (CQC) and information from the local authority and safeguarding team. A notification is information about important events, which the provider is required to tell us about by law.

We spoke with or observed most people living at the home. We spoke with the provider, the manager and four staff. We spoke with two relatives or visitors; we had information from the local authority case managers, commissioning officers, visiting nurses and the safeguarding team.

We looked at records relating to three care staff, four care plans, audit and monitoring records, medication records, staff rota, policies and procedures and training records.

The last inspection was carried out on 11 and 12 March 2015 when we found several breaches of regulations which had major impact on people at the home. We are taking enforcement action against the provider.

Updated 10 February 2016

This inspection took place on 23 and 26 June 2015 and was unannounced.

The home provides accommodation and personal care to up to 20 older people. Bedrooms are on the ground floor and first floor, the first floor is accessed by a stair lift. There are communal lounges and a dining room. There were 10 people living at the home when we inspected.

There was no registered manager; there has been no registered manager since July 2011. 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 our inspection of 2 and 3 September 2014 we found breaches of seven regulations, most of these breaches had a major impact on the people at the home.

We carried out an unannounced comprehensive inspection of this service on 11and 12 March 2015 and found that most of the breaches continued and there were new breaches of other regulations. On 22 June 2015 we received information of serious concern from the local authority. We were told that people were at serious risk of not receiving the care and support that they needed because there were not enough staff on duty at the home to look after them safely. As a result we undertook an urgent focused inspection to look into those concerns. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Springfield’s Residential Home on our website at www.cqc.org.uk

We found there were not enough staff available throughout the day and night to give people the care and support that they required to make sure their needs where met and they were safe. At times there were only two staff on duty for ten people and four people required the support of two staff. Some staff ignored people when they were distressed and in need of comfort.

Serious risks to people were not recognised, assessed and managed. People were at risk of choking and falling and of being neglected. These risks to people were not being managed leaving people at further risk. People did not get the care and support that they needed. Staff did not always follow the instructions of doctors and nurses to support people’s health needs. When risks had been identified the provider had not followed the guidance given by professionals to keep the risks to a minimum.

Individual risk assessments were not in place to prevent or reduce the likelihood of harm. When risks had been identified, like the risk of choking or risk of developing pressure sores the provider had failed to take action to reduce the risks to make sure people were safe and receiving the care and support that they needed. When people’s health had deteriorated the staff had not recognised this and had not contacted a doctor until they were prompted to do so by external professionals including the CQC inspector. People were at risk of not receiving enough drinks to remain hydrated and healthy.

Care plans were not up to date. People‘s needs had changed but care plans had not been updated so staff were following out of date information. Care plans had not been reviewed and evaluated so staff could not be sure that the support they gave was right for the person.

The provider had not assessed risks posed to people by the environment. Shortfalls in the fire safety precautions had been identified following the last inspection in March 2015 by Kent Fire and Rescue Service (KFRS). The KFRS made several recommendations to ensure the fire safety systems were effective. There were still outstanding recommendations and requirements from the KFRS. The provider did not have an understanding of the key risks and challenges of the home. They had not carried out audits and checks to make sure the home was safe. Risks and hazards to people posed by the environment and equipment had not been checked since April 2015. The registered provider had not given the manager or staff any information about the identified risks found at this check. No action had been taken to address the shortfalls that had been identified in April 2015 and following our previous inspections.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. However, all the checks that needed to be carried out on staff to make sure they were suitable and safe to work with people had not been completed by the provider. One staff was from overseas, outside of the European Union, there was no evidence that they were in the UK legally.

Staff did not all have the skills and competencies needed to give safe, good quality care and support. Staff were not regularly supervised and had not had a yearly appraisal. When concerns had been raised about the conduct of a staff member no action had been taken to make sure their practise was safe. The induction was not thorough and some staff had not completed it. Staff had not received the all the training they needed look after people safely. Staff had not all received training in protecting people from abuse. Staff knew what abuse was and said they would report to the manager. Some staff did not know that they could report abuse or suspected abuse to outside organisations like the local social services safeguarding team. The manager was not fully aware of their responsibilities about safeguarding people from abuse.

There continued to be imposed restrictions that had not been assessed, consented to and reviewed to be the least restrictive option. People were deprived of the liberty, as the external doors were locked, with no assessment and agreement to make sure this was lawful.

We found a number of breaches and persistent breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We took urgent enforcement action against Macari Homes Limited to protect the health, safety and welfare of people using this service and cancelled the provider's registration with immediate effect.