Archived: Southwinds

At our last comprehensive inspection on 1 December 2016, the provider was placed into special measures by CQC following an inadequate rating. The overall rating for the service remains ‘Inadequate’ and therefore remains in ‘special ‘measures.’ This inspection found that there were not enough improvements to take the provider out of special measures. CQC is now considering the appropriate regulatory response.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. 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 our last comprehensive inspection, the provider was in breach of seven regulations. Fire safety procedures were not followed; people were living in an environment that had unpleasant odours; people’s health care needs were not responded to in a timely manner; their dignity was not promoted; care was not individual to people; the management was ineffective and they had not notified us about incidents when needed. We took enforcement action against the provider and they sent us an action plan on 4 January 2017 telling us how they would make improvements in these areas.

At this inspection, we found that the provider had completed some of these actions, but others were still outstanding. For example, few improvements had been made in relation to the individual and person centred nature of the support people received. In addition, whilst the audit system in place had been effective in relation to fire safety and the environment, and policies had been updated, the provider did not know what some of the policies were, and was not analysing the information gathered.

At our previous inspection, we also found that improvements were needed in various other aspects of the service. We were not confident that there were enough staff available for people during the night; staff did not have personal protective equipment readily available to them; the provider had not responded to safeguarding concerns as they should have done; risks to individuals were not managed. In addition, the provider did not understand or follow guidance when people were not able to make decisions for themselves; people did not have easy access to drinks and they were not supported to make choices about their meals. We also found that people were not actively involved in making decisions about their care; they had limited involvement with the planning of their support; opportunities to participate in meaningful activities were limited; care records did not contain the information staff needed and these were not accessible when staff needed to look at them.

At this inspection, we found that some improvements had been made, however further were required.

Risks to people were still not effectively assessed, monitored and reviewed. Staff were aware of how to safeguard people, but the provider still had not acted on concerns raised. Some staff were not aware of people’s specific health conditions. The provider had still not followed guidance when people were not able to make decisions for themselves. Risks to people when eating were not managed, and people’s choices and preferences were not considered.

People’s independence was not promoted and they were not enabled to make decisions about their care. People did not receive care that was individual to them or person centred. People’s care plans were being updated, but it was not clear how they had been involved with this. Care plans did not contain all the information that was important to people. When care plans were clear about the support people should receive, this was not always followed by staff.

The provider did not manage the service effectively to ensure that people received high quality care. They did not have effective systems in place to drive continuous improvements. They were unaware of the policies they had introduced. The overall culture of the service did not empower the people living there and the provider had failed to meet their legal obligations when things had gone wrong in the service.

The provider had made improvements to the environment, and fire safety procedures were followed. The provider had considered access to staff during the night, and medicines were administered safely. People received support from healthcare professionals, and their privacy was respected. People were able to maintain family relationships and said they would speak to staff if they had any problems.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. 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.

Our last comprehensive inspection took place on 21 March 2016 and we found that actions were required to improve the care that people received. We told the provider to make improvements to ensure that they were acting lawfully when providing care and support to people who were not able to consent to this themselves. The provider should have sent us a report explaining the actions they would take to improve. However, they did not do this. At this inspection, we found insufficient improvements had been made. The provider had considered how they made decisions for people that were in their best interests, but they had not followed the guidance available.

People were not safe. The provider had not ensured that fire safety procedures were followed. We were not confident that there were enough staff to meet people’s needs and keep them safe at all times. Risks to people were not managed effectively and some people were at risk of not having their medicines as prescribed. People were living in an environment that was not free from unpleasant odours and staff did not have easy access to protective equipment such as gloves when needed. Even though staff were aware of how to protect people from harm, we did not have assurance that the provider acted upon concerns that were raised.

Referrals to healthcare professionals were not always made in a timely manner and the provider did not consistently respond to people’s changing healthcare needs. The provider did not support people to make choices about their meals, and drinks were not readily available to people when they wanted them.

People were not treated with dignity and respect, and they were not actively involved in making decisions about their day to day care. People had little choice or control in their lives and their care was not individual to them. They had limited involvement with the planning and review of their support, and people’s opportunities to participate in activities were limited. Care records included some information that was personal to people, but important information was omitted. Records were not always available for staff to refer to when needed.

The provider did not manage the service to ensure that people received high quality care. The audits that were in place were ineffective and the overall culture was not empowering to the people who lived there. Some staff did not feel supported by the management team, and they were not encouraged to contribute to the development of the service. A positive open culture was not seen to be promoted and we were not assured that the provider understood their responsibilities as a registered person. The provider was not up to date with current practices, and some support given was not in line with their registration. We had not been informed of significant events when required.

Staff did receive an induction and training, and had some opportunities to discuss their work and roles. Some people’s independence was promoted and their privacy was respected. Staff knew people well and we were told that the staff were kind. People were able to maintain family relationships that were important to them. There were some opportunities for people to share their views and they knew how to raise concerns.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

At our last comprehensive inspection on 4 May 2017, the provider continued to be in special measures following a second inadequate rating. The overall rating for this service remains inadequate, and therefore remains in special measures. This inspection found that there were not enough improvements to take the provider out of special measures. CQC is pursuing the appropriate regulatory response.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timescale.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was a registered manager in post. 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 our last comprehensive inspection in May 2017, the provider was in breach of eight Regulations. Risks to people had not been assessed, monitored or reviewed; incidents were not reported as potential safeguarding concerns; the provider had not followed guidance when people were unable to make decisions for themselves; people’s independence was not promoted; and people still did not receive care that was individual to them. In addition, the provider still did not have effective systems in place to ensure they met the standards required in the home. The provider had not met the requirements needed when things had gone wrong, and did not display their rating on the web site that was in place at the time.

We took enforcement action against the provider. On 7 August 2017, the provider informed the local authority that an action plan had been completed and submitted to the CQC. We had not received this. We asked the provider to send this to us, which they did on 11 August 2017. We saw that this action plan did not address two of the breaches in Regulations. We had also found that improvements were needed to ensure that people’s choices were listened to and that they were actively involved in making decisions about their care. At this inspection, we found that the actions had not been completed, and the provider had not made the improvements they were told to.

Risks to people were still not effectively managed, and the provider had not taken the action they told us they would. Staff did not follow guidance when available to ensure that risks to people were minimised. The provider was still not reporting potential safeguarding issues to the necessary people. They had not reviewed staffing levels when people’s needs had changed. There were not enough staff available to ensure people received the support they needed to keep them safe and meet their needs.

The provider was still not following the guidance available when people were unable to make certain decisions for themselves. Some people were at risk of not having their nutritional needs met, and the provider had not acted upon concerns. Some people were trying to be more independent, but the provider did not ensure they had the support they needed to do this safely and in the right way. People were not supported to make choices about their care, and their dignity and privacy was not respected.

People were not in control of their lives, and they did not receive care that was individual to them. When people had identified things they would like to achieve, they had not been supported to do this. People’s care records did not reflect their needs and did not give staff important information to help them support people in the right way.

The provider did not assess, monitor and drive improvement in the quality and safety of the service. They did not respond as needed when things had gone wrong, and was still not meeting the requirements regarding displaying their latest rating. They were not able to show that they understood their responsibilities of their registration with us.

Concerns about people’s changing healthcare needs were not shared with all the necessary external professionals. Staff received training, but were not always able to show how they put this learning into practice.

People received their medicines as prescribed. They were able to maintain relationships with people they knew that were important to them. Staff spoke with people in a kind manner and relatives had the opportunity to attend meetings with the provider.

We found ten breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

There was a registered manager in post. 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 our last inspection on 31 December 2015, a warning notice was issued in relation to the need for consent. The provider sent us a report on 6 March 2016 explaining the actions they would take to improve. At this inspection, we found the issues resulting in the warning notice were no longer applicable. However, further improvements were required.

Even though people had capacity assessments in place, they were not decision specific and did not show how decisions made were in people’s best interests. We saw some people might have had restrictions placed upon them as they were not able to go out on their own and may not have had the capacity to make decisions about their safety. Applications to ensure these restrictions were lawful had not been made.

People received a varied and nutritious diet, however the changes we had previously been told about which would increase people’s choices had not yet happened. People did not have easy access to drinks. This meant that people were potentially at risk of not having enough to drink during the day.

We found that improvements were required to ensure the audits that were in place were effective in identifying any shortfalls and driving continuous improvement. Improvements were also needed to ensure all the records relating to people’s care reflected each individual and were reviewed regularly. The provider needed to improve the recruitment process so this was safe. We found the overall culture at Southwinds did not empower the people who used the service.

People were able to maintain relationships that were important to them. They had the opportunity to take part in various activities that interested them and knew how to make complaints or raise concerns. Work was in progress to enable people to contribute to the planning of their and staff treated people kindly and their privacy was respected.

People told us they felt safe and staff knew how to protect people from harm. Risks were assessed and staff knew how to manage these safely. Medicines were managed accordance with good practice and people’s health was maintained.

We found there were enough staff to meet people’s needs and staff told us they had received training to develop their knowledge and skills.

You can see what action we told the provider to take at the back of the full version of the report.

Is the service safe?

The provider had a system in place to monitor the quality of the service and ensure that people were safe. There was a current profile of risk in place for each person providing staff with the necessary information to keep people safe.

We found that annual reviews for each person had been completed by social workers and six monthly reviews of care and support had been carried out by the service. Where people's needs changed reviews had been held or information updated to provide a current record of people's support needs.

Some improvements had been made in managing medicines. There had been staff training in the safe handling of medicines and protocols established for some medicines that were given 'as required'. Cumulative totals of medicines in stock were not in place. It was therefore not possible to check that all medicines in stock were correct. Progress needs to continue. We identified other shortfalls in the way medicines were recorded and handled. We have asked the provider to tell us how they will make improvements.

Where people did not have capacity to make certain decisions, relatives, advocates and other professionals involved in the person's care had been involved in discussions to ensure decisions were made in the person's best interests. The provider had followed the principles of the Mental Capacity Act 2005.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. Training was being arranged for all staff in relation to the Mental Capacity Act 2005 and DoLS.. Key staff had information and knew how to make applications under this legislation. At the time of this inspection no one using the service was subject to DoLS.

Is the service effective?

We observed positive engagement between staff and people who used the service. Some people were unable to communicate verbally but had their own communication style using signs, sounds, body language and facial expressions. One person used Makaton, a language programme using signs and symbols to help people communicate.

People's health care needs were monitored closely. We saw that referrals had been made to a range of health professionals when concerns were identified in relation to people's health. We saw that each person had a six monthly or annual health check according to their GP's recommendation.

Some care and support records had been reviewed and updated. Some records had many additions and needed to be re-written for clarity and ease of use. We saw that some records relating to activities were not up to date and needed revision. Most information was in place although clarity was needed in some records.

Is the service caring?

We spoke with two relatives who visited the home regularly. They expressed high levels of satisfaction with the care and support provided by the home. One relative said, "I like the attention to detail and some strict routines. For instance X lost a lot of weight but has now regained weight because mealtimes and intake were monitored closely by staff. I am happy with the way staff deal with X. I know that X is safe and well-cared for." Another relative told us, "Staff are wonderful, nothing is too much trouble."

People we spoke with who used the service made the following comments: "It's good here everyone is nice". "I am happy here I like going out and doing the things I like". "It's good here, I watch sport and we play games together. We are all friends". "Staff are good to us and take us out."

Staff were able to tell us in detail about people's needs and how they supported them. We asked staff to engage with people who could not tell us their views of the service. People were asked for their views and responded positively with smiles and gestures indicating they were happy in their home. People were comfortable and relaxed in the company of staff.

Is the service responsive?

We saw from reviews of people's care needs that plans of care had been adapted when there had been a change in a person's needs or wishes.

Staff had responded to a suggestion from a social worker to consider a referral to an independent advocate for a person. The advocate had been involved in making a decision in the person's best interests.

When people's health needs had changed, external health professionals had been contacted in a timely way. Their advice had been sought, recorded and actioned.

Is the service well-led?

The provider is also the registered manager and has worked daily in the home since it was established many years ago.

People's views about the service are sought in reviews, questionnaires to relatives and people using the service, meetings of people using the service, staff meetings, staff supervision and appraisals.

Checks were completed to ensure the home provided a safe place to live. Risk assessments reviewed and reduced the risks to people. Incidents and accidents were monitored to ensure people's safety and wellbeing.

We spoke with the manager and deputy manager and looked at records.

We found that although some improvements had been made in the management of medication, the service still required some improvement.

We found that the correct recruitment procedures were being followed.

We saw records and the manager told us that there was sufficient staffing during the night.

People we spoke with said they were happy living at the home. One person told us: "I'm happy here. I can go to my bedroom when I want. I do lots of drawing and writing".

Plans of care identified the support people needed. They gave information about the way people expressed their wishes and the help people needed to make decisions about their care.

People were supported to have their health and personal care needs met. People had regular health check-ups and were supported to receive specialist health care support.

Arrangements were in place to make sure that people had their nutritional needs met. Some people could be more involved in planning and preparing their meals.

Improvements were needed in the way the home managed people's medication. There was no system in place to check that people were having their medication as prescribed.

The home needed to ensure that all employment checks were made on staff that provided support to the people that lived at the home.

Surveys were in place to gain the views of people that lived at the home. These could be provided in a more suitable format. The home was monitoring the quality of care it provided to people.

Some people who used the service were unable to communicate with us due to their complex needs. Other people told us they liked living at Southwinds and had lived there along time. Some people had attended day services so we were unable to talk with them.

We observed that staff treated people with dignity and respect and offered appropriate and timely support when necessary.

Staff told us they were happy at Southwinds and felt they had sufficient training to ensure they completed their care roles effectively. They told us they felt supported by the manager and could go to them at anytime.

The service followed Staffordshire and Stoke- on -Trent's safeguarding policy and staff we spoke with were aware of the procedure and what constitutes abuse.

Quality assurance systems were in place to ensure the quality of the service being delivered was constantly monitored.