Springfield Residential Home

Contract Monitoring Report

  • Name/Address of Provider: Springfield Residential Home
  • Date/Time of Visit: Tuesday 17 October, 2023,10.45 am – 2.15 pm
  • Visiting Officer(s): Andrea Crahart, Contract Monitoring Officer, CCBC
  • Present: Claire Taylor, Registered Manager


Springfield Care is a residential home accommodating younger adults who have a learning disability.  The service is owned by My Choice Healthcare South Wales Ltd. and the Responsible Individual is Bethan Evans.  The Registered Manager is Claire Taylor, who is registered with Social Care Wales (social care workforce regulator).

Springfield residential home is a very large detached house, situated in attractive and well maintained grounds. The Home is registered with Care Inspectorate Wales (CIW) to provide accommodation and support to six people.

As in recent years, no complaints, issues or safeguarding referrals have been received.

The most recent CIW inspection report dated August 2023 did not identify any areas for improvement but provided a very positive overview in all areas of the service.

Dependant on the findings within the report, corrective and developmental actions will be given to the provider to complete. Corrective actions are those, which must be completed (as governed by legislation), and developmental actions are good practice recommendations.

Previous Recommendations

Corrective actions

DBS check information to include whether the check had been clear or not, and if Not, and the person is deemed suitable to appoint for a risk assessment to be In place, as appropriate.  Timescale:  Ongoing.  RISCA Regulation 35.  Action met.

Photographs of staff members to be present on staff files.  Timescale:  Immediately and ongoing.  RISCA Regulation 35.  Action met.

Training matrix to be updated with the dates when the manager has attended training to bring this up to date.  Timescale:  Within 1 month, and ongoing.  RISCA Regulation 36. Action met.


Staff written references to be sought from different providers/organisations as best practice.  Timescale:  Ongoing.  Action met.

Responsible Individual

The Responsible Individual (RI) is required to produce quarterly and six monthly reports to provide pertinent information relating to the service’s quality and performance.  The most recent reports indicated that visits to the Home continue to take place at regular intervals and that comprehensive feedback and analysis is gathered e.g. feedback is obtained from stakeholders, documentation is viewed, systems are monitored etc.

It was evident that the Home’s Statement of Purpose was dated April 2023 and was therefore up to date.  This document is required to be updated on an annual basis, or more frequently if there are changes. The Service User Guide had been produced as an ‘easy read’ version also and was current.

The contingency plan in the event that the RI and the Registered Manager are unavailable would be that senior care workers would cover the service in the interim, in addition to there being an Operational Manager.

Mandatory Policies/Procedures relating to the service were viewed and the majority had been reviewed this current year.  However, there were some amendments that were brought to the manager’s attention to ensure the policies concerned were reflective of the service being delivered, and some updates are required regarding current registration processes with Social Care Wales.  

File and Documentation Audit

Two resident files were viewed, which were filed in an orderly way. Information included a  photograph of the person, a content section, personal profile of useful contact details e.g. next of kin, social worker, GP etc.  Documentation from Caerphilly County Borough Council (CCBC) were present (Care & Support Plan, Integrated Assessment and Complex Risk Assessments).  There were health and epilepsy profiles which were both detailed.  Another person had a CCBC manual handling plan to enable staff to provide safer handling practices to assist the person with their mobility.

‘Personal Plans’ have been developed and clearly outlined the person’s care and support needs, ‘their Story’, important life events, their likes/dislikes etc. ‘A typical day’ had been written for one person which was detailed, although it was suggested that this could be split into times of the day to make it easier for the staff member to read and follow.

People’s information is being reviewed/evaluated on a monthly basis by the key worker, with the aim of updating the ‘Personal Plan’ where there are changes to be made to it.

Other information captured on the files included e.g. bowel chart information, menu charts, sleep patterns etc.  There were risk assessments in place, however these are still to be developed for the newer resident once more is known and understood about this person’s needs.

Daily recordings had been made named ‘About my day’ which had been written comprehensively and often captured key concerns etc. These had been completed on a regular basis and signed/dated by the staff member.

Medical appointment letters were present to indicate that appointments had been organised with the doctor, nurse, consultant etc., and there was evidence of good follow up conversations having been held with the Learning Disability Community Nurse in relation to reducing someone’s anxiety/agitation.

Service user and stakeholder feedback

Quality Assurance information had been gathered and the most recent quality of care review had been undertaken in May 2023 by the RI.  Questionnaires inviting feedback had been sent to key stakeholders e.g. residents, staff, families etc. All of the feedback received was positive and the report was very comprehensively written.

The manager confirmed that there had been no complaints in the previous year, although a number of compliments had been received from family members etc. who were very appreciative of the care that they had provided to their relatives.

The contract monitoring officer spoke to one of the gents during the visit who was in good spirits and appropriately dressed for the colder weather.  He indicated that he enjoys going to a number of activities on set days of the week e.g. meeting family, eating out etc.


The staff team benefit from a large range of training on offer e.g. safeguarding, infection control, moving and handling, medication, food hygiene etc. and it was evident from the training matrix that staff were up to date with their training.  

The majority of training is undertaken via E-learning, however some are held face to face e.g. fire safety, and there are plans to hold more training via a class room setting as this is preferred by the staff team.

The manager is aware of the All Wales Induction Framework which is a requirement for new carers to complete, and familiar with the requirements for carers to register with Social Care Wales.  All apart from one member of staff has successfully registered, as required.    

Documentation relating to the Social Care Wales registration process was present which evidenced the Employer Assessment that had been undertaken along with a certificate of registration.

Support workers have either have gained their NVQ/QCF Level 2 or 3 in social care or are working towards their qualification.  The manager holds a relevant qualification also.


Additional staff have needed to be recruited due to another person being resident at Springfield in recent weeks. The Home benefits from a stable staff team which provides consistency to the residents.

Two staff files were viewed which were well organised and included indexes and a personal details sheet.  It was evident that a robust recruitment process had been undertaken as all relevant information was present on the files i.e. an application form, with no gaps in employment noted; 2 written references, identification, interview questions, a signed Contract of Employment, job description, offer of employment, DBS information and a photograph of the staff member.

Probationary assessments had been undertaken for both staff members which provided a thorough overview of what they had achieved to date, with any areas that they needed support with.

A staff induction had taken place which illustrated the areas covered on the first day of work, first week and thereafter.

Supervision sessions had been held on a regular basis and discussions covered areas such as, the individual’s performance in the role, any issues being experienced, absence/timekeeping, health and safety, team work (rota, communication etc.), residents, learning and development, compliance (DBS, driving), any other business and actions to follow up on.  These showed that a two way dialogue was taking place between the staff member and senior carer/manager.

The supervision/appraisal matrix showed that appraisals had either been held or were being planned for during the year.

Managing residents’ funds

Residents’ monies are managed by Springfield Home and there are suitable records in place to manage this effectively i.e. a spending record which includes the transaction dates, amounts received/withdrawn, running balance, receipt numbers and 2 signatures had  been obtained for each transaction.

Fire Safety/Health and Safety 

A Fire Risk Assessment was completed in January 2020 by the previous RI of the service and a Fire Emergency Plan had been compiled in 2021. The manager confirmed that some works had been required this year to ensure the Home is compliant in terms of fire safety.

Staff had undertaken regular checks in terms of fire alarm testing, emergency lighting etc. to ensure all were in working order.

Personal Emergency Evacuation Plans (PEEP’s) were in place for all individuals within the Home and had been reviewed regularly.

Fire drills had been held frequently, with the last one having been held in August 2023.  These also included the names of the people present, how long the drill lasted for and where it was held.

The manager undertakes regular weekly and monthly environmental/health and safety checks.


People are supported with their medication needs and two MAR (Medication Administration Records) were viewed which indicated that medication was being administered and via a chart produced from local pharmacies.

The Home Environment 

Springfield care home is beautiful spacious home and all areas viewed during the visit were clean and tidy. Some improvements have been made to the property this year in terms of re-decoration, steps to the front of the Home have been re-cemented, and other areas re-painted.  People also benefit from large grounds which are well maintained and the contract monitoring officer was aware that there are plans to have a sensory area in the garden.

There is an internal lift that is used for people who may require the use of this to move within the floors of the Home.

There is no CCTV in operation, however there is a security alarm that is located outside the building in order to alert to any unexpected visitors.

Staff have created a ‘sensory room’ in one of the upstairs rooms which is very colourful and a suitable area for residents to have their own space and stimulation.


The main lounge was decorated for Halloween and residents and staff enjoyed talking about this.  There was a lovely ‘up beat’ atmosphere with staff talking to the residents, there was laughter heard during the visit and a support worker was reading a book to one of the gents.

Another gent was very animated and enjoyed talking with the contract monitoring officer and staff.  He was very keen to explain what he had packed ready to take with him for his trip out that day with staff.  

Corrective / Developmental Actions


Mandatory Policies/Procedures to be reviewed where they are overdue and for amendments to be made/updates to ensure they reflect the service being delivered.  Timescale:  Within 6 months.  RISCA Regulation 38


Springfield residential home continues to provide a welcoming environment for individuals to reside in, and for staff and visitors also.  There was a lovely atmosphere with lots of conversation and laughter being heard.

Staff are supported to access a wide range of training and it is positive to learn that there are plans to hold more training sessions on a face to face basis.  There continues to be a stable staff team providing consistency to the residents.

Documentation continues to be comprehensively written and there are very good internal quality assurance processes in place, lead by the management of the service.

The contract monitoring officer would like to thank the manager and her team for their time and hospitality during the monitoring visit.

  • Author: Andrea Crahart,
  • Designation: Contract Monitoring Officer
  • Date: October, 2023