Spencefield Grange

We found the following examples of good practice.

People were supported by staff to keep in touch with those important to them. Relatives and friends visiting the service were required to complete a COVID-19 test, had their temperature check and wore Personal Protective Equipment (PPE).

We saw PPE was accessible within the service and staff used it in accordance with the most up to date guidance.

Information about the correct use of PPE and handwashing guidance was displayed throughout the service. Staff had undertaken training on infection prevention and the correct use of PPE.

A regular programme of testing for COVID-19 was in place for staff and people who lived the service. This meant swift action could be taken if anyone received a positive test result.

Staff and visiting professionals were asked to provide evidence of their vaccination status against COVID-19 prior to entering the service.

Isolation and cohorting were used to manage the spread of infection. This meant people self-isolated in their rooms when necessary.

Management conducted regular checks and audits to ensure the service was kept clean and tidy.

Spencefield Grange is a care home providing personal and nursing care to 57 people aged 65 and over at the time of the inspection. The service can accommodate up to 60 people in a purpose-built building.

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

The systems in place to audit and monitor the service were not always effective and information was not always kept up to date, this meant staff were not always provided with the up to date information they needed to provide the care for people.

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; however, the provider needed to ensure staff consistently followed the policies and systems in place to fully comply with the principles of the Mental Capacity Act and Deprivation of Liberty Safeguards. This was specifically in relation to seeking authorisation when administering medicines hidden in people's food in their best interests.

People’s experience of mealtimes differed. Those who required more assistance at mealtimes sometimes had to wait for the support they needed, and staff did not always have the time to be as attentive to them as they required. People had a choice and meals were prepared to meet both people’s dietary and cultural needs.

People could be assured they were cared for safely. Staff had background checks before they started to work at Spencefield Grange which ensured they were of suitable character to care for people. Staff understood the needs of people and followed the guidance given to mitigate any risk identified for people and keep people safe from harm.

Staff were kind and caring and people looked relaxed and comfortable in their company. They had the skills and knowledge to support people and worked well as a team.

People were respected, and their dignity protected. They were involved in developing their care plans and relatives were kept informed. Visitors were welcome at any time, several relatives commented how supported and welcomed they felt. There was a complaints procedure in place and people were confident if they did have any complaints that these would be addressed.

People, relatives and staff were encouraged to share their feedback and the registered manager was open to suggestions and approachable.

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 18 October 2016)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 10 August 2016 and was unannounced. At the time of our inspection there were 50 people in residence.

This report covers our findings in relation to the breach and other areas that required improvements at our last inspection visit. It also covers related information gathered as part of this inspection visit. You can read the report from our last comprehensive inspection visit, by selecting the 'all reports' link for Spencefield Grange, House on our website at www.cqc.org.uk

A registered manager was in post. 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.

People’s care needs were assessed including risks to their health and safety. Plans had been put into place where potential risks were identified along with clear guidance for staff as to their role in promoting people’s safety. Care plans were updated and centred on people’s needs, which included the measures to help promote their safety and independence. Care plans provided staff with clear guidance about people’s needs which were monitored and reviewed regularly.

People received their medicines at the right times. We found there was clear guidance for staff to follow and the systems to store, manage and administer medicines safely were safe.

People felt safe at the service. Staff were trained in the safeguarding procedure and understood their responsibility in protecting people from the risk of harm.

People lived in an environment that was safe, which people could use safely and promoted the lives of people living with dementia. The premises and equipment were routinely serviced and maintained.

People told us they were provided with a choice of meals that met their dietary needs and preferences. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

People’s consent had been appropriately obtained and recorded. Staff understood the principles of the Mental Capacity Act and made appropriate referrals to the local authority when people had been assessed as being deprived of their liberty.

Staff were recruited in accordance with the provider’s recruitment procedures. People’s needs were taken into account to ensure there were sufficient numbers of staff to promote their safety and wellbeing. Staff were supported through regular supervisions and meeting to ensure they had the knowledge and skills to support people.

Staff received support and guidance from the registered manager, through supervision and meetings. Staff confidence and knowledge has increased through the provision of further training, which has increased their confidence and knowledge in the support of people.

People told us staff were kind and caring towards them. Staff knew how to support people living with dementia and recognised when people used non-verbal communication to express how they could be feeling. People had developed positive relationships with staff and were confident that they would address any concerns or complaint they might have.

People were involved and made decisions about their care and support needs. Care plans were focused on the person and incorporated advice from health and social care professionals. People’s care records were organised and easily accessible to review people’s care needs. People were supported to maintain their independence and take part in hobbies, activities that were of interest to them and observe their faith.

The views and opinions of people who used the service, their relatives and staff were sought in a number of ways including meetings and surveys. Staff felt supported by the management team and understood their role and what was expected of them in providing quality care to people who used the service.

People were confident in how the service was managed and the abilities of the management team to ensure the service provided was effective. The provider monitored the quality of care effectively. That helped to assure people who used the service, their relatives and the provider that the quality of care provided at Spencefield Grange was monitored and people’s views influenced the development of the service.

Is the service safe?

We found the provider had safe systems and procedures in place for the ordering, receiving and storage of medicines into the service; and the administration and disposal of medicines. People told us they received their medicines on time. The relatives we spoke with were confident that their family member received their medicines reliably. One relative said 'I haven't got any concerns about this place. I know the staff will call me immediately if he's not well.' This showed that people who used the service and their relatives were confident that people's health and wellbeing was protected.

Is the service safe?

People told us they felt safe and secure because they were cared for in an environment that had been well maintained. Communal areas were furnished and decorated to a good standard to promote people's wellbeing and safety and individual rooms were personalised to reflect each person's interests.

People's needs were met as staff had been trained to look after people safely. One person said, 'I've stayed here on a number of occasions and know staff try to keep us all safe.' Staff we spoke with were able to describe the different ways to support people with dementia and understood what action to take to meet their needs safely and reliably.

Staff rotas we checked showed there were sufficient staff on duty to meet people's needs at all times. Staff we spoke with had the knowledge, skills and training required to support people to ensure they received a consistent and safe level of support.

Is the service effective?

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS), which applies to care homes. Staff training records showed that relevant staff had been trained in Mental Capacity Act 2005 and DoLS. The registered manager had acted in accordance with their responsibilities and referred people to the appropriate authority when they had a concern about a person's capacity to make decisions. This meant that people could be confident that their best interests would be represented and that their wellbeing would be met reliably.

People told us that they were happy with the care that had been delivered and that their needs had been met. Records we looked at showed people's care needs were met and that they had access to a range of health care professionals. One person said they preferred to remain in their room and that they used the call bell when they needed any assistance from staff. It was clear from our observations that staff had a good understanding of people's care and support needs and that they knew them well.

Staff told us they were trained for their job role to help ensure people's needs were met reliably. Staff training certificates and training matrix we looked at confirmed the provider had taken steps to ensure staff kept their knowledge and skills up to date in line with current best practice.

Is the service caring?

People were supported by kind and attentive staff. We saw staff supporting people to do things at their own pace and saw they were not rushed. Staff offered encouragement and praise when supporting people. People told us that staff were caring and supported them in a manner that respected them as a person. One person said, 'I'm quite lucky that my family visit me and I enjoy that.' Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Staff were aware of people's preferences, interests and cultural needs. This included supporting people to continue to observe their religious or spiritual beliefs and to go out on other outings. One person had a daily newspaper delivered which they read in the privacy of their room. Another person who enjoyed doing arts and crafts said, 'I'm very happy with the care I get which is just as important as keeping my brain active by doing lots of different things that I enjoy.'

People were given information about the advocacy service when they moved to the home. This meant that people could access additional support and/or advice when required. Staff had received ongoing training to help ensure the needs of people living at the home would be met.

Is this service responsive?

People's needs had been assessed before they moved into the home. People told us they were involved in reviewing their plans of care when their needs changed. People had access to health care professionals such as the doctor and/or the community nurse to meet their specific health needs. Records confirmed people's preferences and expectations had been recorded and care and support had been provided in accordance with people's wishes.

Is this service well led?

People's personal care records and other records kept in the home were accurate and up to date. People's care and support needs were reviewed regularly to make sure any new needs could be met reliably. Records showed the home's staff worked with other agencies and services to help ensure people received their care and support that was joined up.

The home had a system in place to assure the quality of service they provided and act on any feedback and comments received. This included surveys to gather the views of people who lived at the home, relatives and/or representatives. Regular meetings were held at the home where people could share their views and experiences. The complaints policy and procedure was effectively used for the benefit of people living at the home and for making continued improvement to the quality of service provided.

Regular checks were carried out to ensure people's health, safety and wellbeing was protected. Information from analysis of incidents and accidents had been used to identify changes and improvements to minimise the risk of them happening again. Prompt action had been taken to improve the service and put right any shortfalls that were found.

We observed lunch being served in the dining room. People told us they liked the food. One person said, 'The food is fine ' I've no complaints.' Another told us, 'Good food. We get a choice at every meal.' The menu was written up on a large board for people to see and both English and Asian dishes were served.

The home was purpose-built and had four lounges, an activity room, a conservatory, and a large dining room. This meant the people who used the service had a choice about where they spent their time. One person told us, 'There lots of space here if you need it and quiet places to go if you prefer a bit of solitude.'

People told us they liked the staff at Spencefield Grange and were satisfied with the care provided. One person said, 'The staff are really good ' I wouldn't be here if they weren't.' Another person told us, 'The staff are very kind.' Staff were warm and friendly in their approach to people and had a good understanding of their needs.