CQC report explained · a nursing home
What the CQC found at Speirs House
Rated Good: inspectors found the home performing well and meeting their expectations.
What inspectors found, March 2024
Overall Requires Improvement; inspectors found kind and effective care, but safeguarding and management checks were not always reliable.
This was a focused inspection. Inspectors visited on 3 January and 21 January 2024, spoke with people, relatives, staff and health professionals, and reviewed care records, medicines, recruitment files, audits and policies.
The home was rated Requires Improvement overall. Safe and Well-led were also Requires Improvement. Effective was rated Good. Inspectors found enough staff, suitable care plans, medicines given as prescribed, good infection control and staff with relevant training.
There were important weaknesses. Some safeguarding incidents involving police and safeguarding investigations were not reported or investigated promptly. The home also did not repeatedly confirm some staff DBS checks. Records about mental capacity and cultural or religious preferences needed review.
The home had improved since the previous inspection and was no longer in breach of Regulation 17. However, it breached Regulation 13 because safeguarding systems were not always effective. The CQC will ask for an action plan and continue to monitor progress.
Enough regular staff
Staffing levels met people's care needs. The home had a stable team that knew people well and had not used agency staff for six months.
“The service had not used agency staff for the last 6 months.” from the report
Kind and respectful care
Inspectors observed positive interactions. Staff listened to people, used their preferred names and respected their choices and dignity.
“We observed positive interactions between staff and people.” from the report
Medicines and infection control
Staff had relevant medicines training, audits checked medicines were given as prescribed, and the home was clean and hygienic.
“Regular audits were undertaken to check that people received their medicines as prescribed and in good time.” from the report
Relevant staff training
Staff training covered areas including safeguarding, medicines, manual handling, dementia and infection control. Staff also received regular supervision and appraisals.
“The service ensured that staff were provided with training relevant to their job.” from the report
Improvement since the last inspection
The provider had addressed the earlier governance breach. Inspectors found enough improvement for the home to no longer be in breach of Regulation 17.
“At this inspection we found that some improvement had been by the provider to address the issues identified and they were no longer in breach of Regulation 17” from the report
Safeguarding incidents
seriousSome incidents involving police and safeguarding investigations were not reported or investigated promptly. Records did not show clearly how lessons were put into practice.
“There had been more incidents resulting in police and safeguarding investigations that were not reported and /or looked into appropriately by the staff team in a timely manner.” from the report
DBS checks
needs fixingAlthough recruitment checks were completed before staff started, some staff DBS checks had not been repeatedly confirmed by the Disclosure and Barring Service. In some cases, the last check was from 2000.
“In some instances, staff had their DBS check carried out last in 2000 when they started working for the provider.” from the report
Mental capacity records
needs fixingSome mental capacity assessments were based on a standard format when people moved in. They were not specific to the particular decision or time.
“These assessments were not time or decision specific.” from the report
Cultural and religious preferences
minorCare plans did not record discussions about people's cultural or religious preferences, even though the manager said this would be addressed.
“The care plans had not included information in relation to the discussions staff had with people regarding these preferences.” from the report
Oversight of care quality
needs fixingThe management team had improved governance, but safeguarding incidents and DBS checks showed that oversight was still not reliable enough to prevent avoidable harm.
“More improvement was needed to oversee the quality of care being provided and management of the home.” from the report
- 01How are safeguarding incidents now reported, investigated and escalated, especially where police or the local authority may need to be involved?
- 02What evidence can you show that lessons from recent safeguarding incidents and complaints have been put into practice?
- 03How often are staff DBS checks now reviewed and confirmed by the Disclosure and Barring Service?
- 04Have all mental capacity assessments been reviewed so they relate to a specific decision and time?
- 05How have you recorded and acted on each person's cultural and religious preferences?
This was a focused inspection of Safe, Effective and Well-led; Caring and Responsive were not inspected, and the overall rating used ratings from the previous inspection for those questions. This explanation was written from the published report of 15 March 2024 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, June 2022
Speirs House was rated Requires Improvement; inspectors found caring and responsive support, but concerns about safety, staffing and management oversight.
Inspectors visited without notice on 10 May and 18 May 2022. They spoke with people, relatives and staff, observed care, and checked care records, staff files and management records.
The overall rating fell from Good at the previous inspection to Requires Improvement. People were not always protected from avoidable harm. Concerns included delayed action about a person's injury, inconsistent care from agency staff, staffing shortages and weak oversight by the provider.
There were also positive findings. Care plans were detailed and updated, people were treated with dignity, medicines were generally managed safely, and infection control arrangements were good. Effective, Caring and Responsive were rated Good, while Safe and Well-led were rated Requires Improvement.
The provider breached Regulation 17 on good governance. CQC asked for an action plan and said it would work with the provider and local authority to monitor progress.
Kind and respectful care
People and relatives generally described staff as kind and respectful. Staff supported privacy, dignity, independence and personal choices.
“Staff treated people equally and respected their privacy and dignity.” from the report
Personalised care plans
Care plans included people's needs, histories, likes and dislikes. They were reviewed and updated to guide staff.
“Care plans were reviewed, regularly and updated with people's history, likes and dislike.” from the report
Infection control
Inspectors found good hygiene practices and appropriate use of protective equipment. The provider's infection control policies were up to date and in line with national guidance.
“Staff were trained in infection prevention and control (IPC) including COVID-19 and followed good hygiene practices.” from the report
Medicines management
People received their medicines when required. Records were signed and audited, and identified concerns were resolved promptly.
“Medicine Administration Records (MAR) were signed and audited which ensured concerns identified were resolved in a timely manner.” from the report
Safeguarding and delayed escalation
seriousInspectors found that action about an injured person was delayed. Staff did not fully understand when and how to escalate safeguarding concerns.
“People were not always protected from the risk of abuse.” from the report
Staffing and agency care
seriousShortages, high turnover and changing agency workers meant care was not always consistent. Some agency workers did not receive enough induction or handover information.
“People did not always receive care from a consistent care staff team.” from the report
Weak management oversight
seriousThe provider did not monitor the quality of agency care effectively. There were several management changes and no registered manager was in post during the inspection.
“The provider had not ensured adequate oversight in quality performance.” from the report
Activities were limited
needs fixingPeople did not always have meaningful activities that matched their interests. Activities had reduced after the activities coordinator left.
“People had not always been supported to have meaningful activities of their choice.” from the report
Complaints not always resolved quickly
needs fixingMost people and relatives felt able to raise concerns, but some said their concerns were not resolved quickly or taken seriously enough.
“However, some people and their relatives told us some of their concerns were not resolved in a timely manner.” from the report
- 01How many permanent care staff are now in post, and how often are agency staff used?
- 02What induction, handover and supervision do agency staff receive before caring for residents?
- 03How are changes in a person's health or injuries escalated, and how quickly are healthcare services contacted?
- 04Who is currently responsible for managing the home, and what is the progress on appointing a registered manager?
- 05What activities are now available for people with different interests and abilities?
This was an unannounced inspection covering all five key questions and infection prevention and control; the previous overall rating was Good, published on 9 January 2019. This explanation was written from the published report of 29 June 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Speirs House
5 rated inspections over 9 years: the service has slipped, from Good to Requires improvement.
- March 2024Requires improvementcurrent ratingstayed Requires improvementSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- June 2022Requires improvementSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- January 2022Inspected but not ratedSafe: Inspected but not rated
- January 2019Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2016Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2015GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- March 2014
Report published without a new overall rating.
- October 2013
Report published without a new overall rating.
- September 2013
Report published without a new overall rating.
- November 2012
Report published without a new overall rating.
- August 2012
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 7 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Kingston upon Thames
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 82 can care for a couple. 11 years' experience on average.
“Without his support we wouldn't have been able to navigate bringing and keeping Dad at home.”
“We cannot speak highly enough of the care that Angelique gave, and would recommend her to anyone else needing a live-in carer.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.