Springfield Grange Pontefract: Care home near Leeds put in special measures over ‘lack of strong leadership’

Inspectors visited Springfield Grange, on Grove Lane, and found there was a “lack of strong leadership”.

They described in one incident a resident being given medication in their food without their knowledge, while in another a person had 13 incidents when medical assistance was needed but staff failed to seek medical guidance.

Portland Care 6, which runs the home, said in response that a “robust action plan” is already in place to address concerns.

The home provides personal care to up to 80 people. At the time of the inspection in January, there were 49 people using the service.

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The inspection was prompted in part due to concerns over the quality of care people were receiving, medicines administration and leadership of the service.

It saw the home’s overall rating drop from ‘requires improvement’ to ‘inadequate’.

The service has been placed in special measures, which means it will be kept under close review by the CQC. If the commission does not see rapid and widespread improvements, further action will be taken.

Sheila Grant, CQC’s deputy director of operations in the north, said: “When we inspected Springfield Grange, it was concerning to see the lack of strong leadership displayed by the provider, Portland Care 6 Limited and the culture they created didn’t provide high-quality care.

“We found that the provider didn’t identify, review or action risks to people. One person had 13 incidents where medical assistance was needed, but staff didn’t seek medical guidance. There were no details in the person's care plan to explain why this didn’t happen. This put people at risk of avoidable harm.

“We saw staff giving someone medication without their knowledge by putting it into their food. There was nothing in their care records saying this was safe. Following a conversation we had with the member of staff, the manager confirmed with a pharmacist that the person should know when they’re taking medicine.

“We found that people weren’t always treated well or supported with personal care. One person’s care plan said they needed support with oral care; however, staff hadn’t done this for eight days. A relative of another person was concerned their loved one’s hair looked like it hadn’t been washed in some time.

“Additionally, we found people weren’t supported to develop and maintain relationships. There weren’t any activities scheduled for people to take part in, instead people were sat around, not communicating with others. A relative said the provider promised regular activities when people came to the home, but this hadn’t happened.

"We have told Springfield Grange where we expect to see rapid and widespread improvements and will continue to monitor them closely to keep people safe while this happens. We will return to check on their progress and won’t hesitate to take action if people are not receiving the care they have a right to expect.”

A spokesperson for Portland Care 6 said that a plan is already in place to address the concerns and that a senior clinical manager is overseeing the home to make improvements as quickly as possible.

They added: “Portland Care 6 acknowledges this January 2024 CQC inspection report and is working immediately to address the individual issues and details raised at Springfield Grange, Pontefract.

“The team is committed to providing the highest quality of care for residents, with care plans tailored to individual medical and social needs, managed by interdisciplinary teams of professionals.

“We are revisiting and reviewing our processes at Springfield Grange with immediate effect, following a robust action plan to return service to the high standards we expect.”

Inspectors said: 

• We found people were not supported to have maximum choice and control of their lives and staff supported them in a restrictive way and not always in their best interests.
• Medicines administration was not safely recorded, and medicines were not always stored safely.
• Complaints received were not always investigated, and the necessary and proportionate action was not taken in response to any failure.
• We found systems or processes were not in place and operated effectively to monitor and improve the quality and safety of the services provided. Risks were not always assessed, monitored, and mitigated.
• We found staff had not had regular supervisions and appraisals had not been completed in 2023.
• Not all staff had completed all mandatory training.
• We received mixed feedback about the quality of care provided from both people who lived at the service and relatives.

The full report will be published on the CQC’s website in the next few days.