Archived: Southfields House

Updated 7 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 September 2017 and was unannounced. The inspection team consisted of three inspectors, an expert by experience and a specialist advisor. Our advisor was a pharmacist. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Prior to our inspection we reviewed the information we held about the service, including statutory notifications that the provider had sent us. A statutory notification is information about important events which the provider is required to send us by law.

Over the course of the inspection, we spoke with eight people who used the service, two relatives, the registered manager, the area manager, two team leaders, a shift leader and four care staff. We viewed eight records about people’s care and treatment which included their daily care records, risk assessments and medicines records. We did this to ensure that they were accurate, clear and up-to-date. We made observations of the care being delivered to people and looked at people's care from planning through to delivery.

We looked at the systems the provider had in place to monitor the quality of service to ensure people received care that met their needs.

Updated 7 November 2017

This inspection took place on 18 September 2017 and was unannounced. The service provides accommodation for up to 46 older people who require support with their personal care. At the time of our inspection there were 40 people living at the service. We carried out this comprehensive inspection due to concerns we had received about the service in the two months prior to this inspection.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission 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.

At this inspection we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches we identified were in relation to medicines management, risk assessing, nutritional monitoring and support, safeguarding people against abuse and in relation to how the service was being run. At our last inspection the service was rated as 'Requires Improvement.' You can see the action we have asked the provider to take at the end of this report.

People's risk assessments and care plans did not always reflect their current needs. Risks to people had not always been accurately calculated and this put people at risk of receiving unsafe care and support.

Medicines were not being safely managed, stored or administered at the service and although an action plan was in place to improve medicines and how they were being managed, some of the issues we identified had not been identified by the registered manager. There had been eight substantiated safeguarding investigations into people who had not received their medicines as required over the period of two months.

People were not being adequately supported with their nutritional needs and there was confusion within the service about how people's meals were fortified. This was not always happening as required. People had not always been referred to the dietitian where this may have been required. There was not an adequate number of staff to support people as they needed at mealtimes.

Staff felt supported and were trained to deliver safe care to people. This training was monitored and refreshed when needed. However, there was a training gap in relation to managing behaviour which may have been challenging for staff.

Although there were mental capacity assessments carried out at the service, there were no best interest meetings held or documented to consider decisions made in relation to how people were cared for. There was not adequate monitoring and oversight of Deprivation of Liberty Safeguards at the service.

Incidents and complaints had not always been appropriately recorded or responded to and some safeguarding incidents had not been recognised as such by the registered manager. We have made a recommendation about the management of complaints. Some of the safeguarding concerns we looked at had not been responded to as they should have been in order to protect people from the risk of abuse.

There was a lack of management oversight across the service which meant that people's risks were not being monitored and improvements were not made as needed. Quality assurance systems were not effective as information was not being monitored by the registered manager.

People were cared for by kind and compassionate staff who knew people well. People's privacy was respected and their dignity maintained and care records detailed people's personal histories and their preferences in relation to their care.

People were encouraged to remain independent wherever possible and there were activities within the service that people could choose to get involved with.

Most staff felt supported by the registered manager and there were regular meetings held to obtain both the views of staff and the views of people who used the service.