Spring House Residential Care Home

We carried out an unannounced comprehensive inspection on 15 and 21 November 2018. On the first day of the inspection there were 22 people living at Spring House.

At the last inspection in February 2016, the service was rated as 'Good' overall, with the key question caring rated as 'Outstanding'. At this inspection, we found the service had developed further and was now 'Outstanding' as two key questions, caring and responsive are now rated as 'Outstanding'.

There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. Some parts of this inspection report are written in a shorter format because the rating of some key questions have not changed since our last inspection.

There was a registered manager working at the home. A registered manager is a person who has registered with the CQC 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. The registered manager has been in post since November 2017. Prior to this they worked as the deputy manager at the home. People and visitors commented on the warm and welcoming atmosphere of the home. People said, "I'm so well looked after, we are treated as people" and "I don't have to think about it, the care is good."

Since our last inspection, the registered manager and the staff group have continued to develop how they respond to people's individual needs. For example, staff recognised people's different responses to moving to a care home and tailored routines for people's social and emotional needs. Staff went the extra mile to ensure people had a varied social life and still felt part of the local community. One person said these types of activities "Make me feel part of society, I'm not separate…I'm useful."

People received an exceptionally personalised and responsive service. One person was very active and liked to be kept busy. The registered manager and staff established when the person became frustrated and worked out an individual routine to keep them occupied, which included going out for a walk each day. We met with the person and saw they looked contented and fulfilled, chatting and laughing with other people and helping around the home, such as laying the tables.

People living at the service and their relatives said staff had outstanding skills and had an excellent understanding of people's life history. People's care plans were created with them, and where appropriate their friends and families. Their social history had also been recorded in their care plan. We saw staff used

this information to connect with people and make them feel valued.

The service continued to provide an outstanding level of care that was person-centred. The service sustained its strong culture of supporting people as individuals and people continued to be provided with support that was kind and compassionate by a caring and dedicated team. People and relatives were consistently positive about the caring approach of the registered manager and staff. People's well-being was valued. For example, one person said, "I feel I am among friends, staying with friends and given everything I want." Relatives said how much they valued "the kindness and friendliness" of the staff.

The service continued to be well-led. People visiting or living at the home said, "Oh yes they are very well led", "I think this place [Spring House] deserves a lot of praise", "Yes, I do think they are well led", "Well yes it's very well managed" and "It must be well managed; the staff are always good so it must be." We saw how visitors, people living at the home and staff came into the registered manager's office and were welcomed. People told us staff were approachable and they felt confident concerns or complaints would be addressed.

The registered manager had a clear understanding of their responsibilities; they were organised and knowledgeable about meeting the emotional, social and physical needs of the people living at the home. They had worked in care all their working life and had strong role models in their team to ensure less experienced staff were well supported. This meant new staff learnt the values and ethos of the service of person centred care displayed by the staff team. Staff said they felt valued and appreciated and this in turn was reflected in their own practice in the way they treated people living at the home. Training opportunities took place regularly. Staff said they loved working at the home and shared how much job satisfaction they gained for their role.

There were good quality assurance systems in place to monitor the standard of care and the running of the home. A satisfaction survey completed by people living and visiting the home in 2018 contained positive feedback, including "The care and attention provided by the team at Spring House are consistently of a very high standard and contribute to the welcoming and friendly atmosphere which surrounds residents there." Other comments included "The care provided by staff is very evident and much appreciated" and another person stated staff were "always patient and kind."

People were supported by a staff team who had the skills to support them effectively. People's rights were upheld when staff were making decisions in their best interests. People were supported appropriately to ensure their nutritional needs were met. Medicines and recruitment were well managed. Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns and to report them in a timely manner. There was always sufficient staff available to meet people's needs. People said they felt safe because there were enough staff on duty who knew how to support them, which was reflected by the staff rotas.

People's day to day health needs were met. People benefited from a catering team who recognised their role in supporting people to keep well and healthy. In addition, the catering team knew their role was also vital to help people feel comforted and at home. There was positive feedback from people living at the home on the standard of the food, such as "The food is very nice, there's plenty of choice" and "I'm a fussy eater but the food is nice." Staff knew people well so this meant they recognised the changes in people's long-term health care conditions. Staff worked closely as a team.

Risks to people were recorded and reviewed with measures put in place to reduce assessed risks. Environmental checks were completed to help keep people safe, such as covering radiators with a hot

surface temperature, restricting windows to help reduce the risk of falls, servicing equipment and fire drills.

Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (2005) (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Further information is in the detailed findings below.

The five questions we ask about services and what we found