CQC report explained · a nursing home
What the CQC found at Spring House
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Some risks were not fully assessed, including access to unsafe laundry products and an unlocked clinic room door. Medicines oversight was incomplete, and staff were not always wearing masks correctly.
- Effective?
- Requires improvement
- Some mental capacity assessments did not clearly show how decisions had been reached. Staff training, supervision, care planning and access to health professionals were otherwise described positively.
- Caring?
- Good
- People were treated with kindness, compassion, dignity and respect. Staff supported choice, independence and privacy.
- Responsive?
- Good
- Care plans were individualised and people were supported with communication, relationships, activities and complaints. People could choose how to spend their time.
- Well-led?
- Requires improvement
- The home had a positive culture, but its quality systems had not identified or dealt with several safety, medicines and mental capacity shortfalls.
What inspectors found, November 2022
Rated Requires Improvement; inspectors found kind, personalised care but gaps in risk checks, medicines oversight and management systems.
This was the home’s first inspection. It was unannounced and took place on 16 August 2022. One inspector spoke with people, relatives and staff, and checked care records, medicines records, recruitment files and quality checks.
People were treated kindly and their care was tailored to their needs. Staff supported people to make choices, stay independent, communicate in ways that suited them and take part in activities. The caring and responsive questions were rated Good.
There were important safety and management weaknesses. Some risks were not fully assessed, medicines checks were incomplete, staff did not always use masks correctly, and some mental capacity assessments were not properly supported by evidence. The safe, effective and well-led questions were rated Requires Improvement.
The overall rating means the home was not consistently meeting the expected standard and there was limited assurance about safety. The provider was asked to send an action plan, and CQC said it would monitor progress and take further action if needed.
Kind and respectful care
People were treated with kindness and compassion. Their privacy, dignity and independence were respected.
“People were treated with kindness and compassion. During the inspection we observed positive interactions between people and staff.” from the report
Personalised support
Care records contained detailed information about individual needs and preferences. People could choose how to spend their time.
“People received care that was tailored to their specific needs. People's care records were individualised for each person and contained detailed information about people's needs and preferences.” from the report
Choice and independence
People were supported to make choices about food, activities and daily life, and were encouraged to be independent.
“People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.” from the report
Staffing and training
There were enough staff, with a stable team and little agency use. Staff received training, supervision and competency checks.
“There was a stable staff team who knew people well with minimal agency staff used to ensure consistency.” from the report
Risks not fully assessed
seriousSome safety risks were missed or not controlled. Washing liquid and capsules were kept in an unlocked cupboard despite a known risk to one person.
“Risks had not been properly assessed in relation to the laundry room. Liquid and capsules for washing clothes were in an unlocked cupboard.” from the report
Medicines oversight
seriousStaff did not always refer to the medicines record before giving medicines. The home could not provide completed medicines audits, so errors could not be confirmed as rare.
“A member of staff told us medicine errors were rare, however, due to the lack of quality assurance oversight, this could not be confirmed.” from the report
Mental capacity assessments
seriousSome assessments did not show clearly how staff had decided whether a person had capacity for specific decisions. This created a potential risk.
“The assessment stated the person had capacity for both the decisions, but staff had not evidenced how they came to that conclusion.” from the report
Weak quality checks
seriousManagement systems had not identified several problems with risks, medicines, mental capacity decisions, storage and mask use.
“The governance systems were not robust enough to identify and address shortfalls we found during this inspection.” from the report
PPE was not always used correctly
needs fixingInspectors saw staff wearing masks incorrectly. The manager said staff would be reminded about the latest guidance.
“We were not assured that the provider was using PPE effectively and safely.” from the report
- 01What has been done to keep washing liquids and capsules locked away and to control access to the clinic room?
- 02How are medicines audits now completed, and who is responsible for checking medicines are administered and stored safely?
- 03How are mental capacity assessments checked to ensure they explain the evidence for each specific decision?
- 04How do managers now identify and act on problems with risk assessments, medicines, PPE and storage?
- 05What progress has been made against the action plan requested by CQC?
This was the first unannounced inspection of the newly registered home and covered all five key questions, including infection prevention and control under Safe. This explanation was written from the published report of 10 November 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 Spring House
Each visit the CQC has published, newest first, back to the day the home was registered.
- November 2022Requires improvementcurrent ratingSafe: Requires improvementEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- April 2021
Registered with the Care Quality Commission on 29 April 2021.
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.
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17 live-in carers within about an hour of Devon
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 £1,020 to £1,270 a week. 15 can care for a couple. 13 years' experience on average.
“She is such a warm and gentle person while being professional and competent at the same time.”
“She looked after my mum, who can be incredibly challenging, so well and so gently, and we always felt confident that my mum was getting the best care available.”
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.