Archived: Southernhay Residential Home

Updated 29 July 2016

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 17 May 2016 and was unannounced. Two social care inspectors carried out the inspection.

Before the inspection we gathered and reviewed information we held about the registered provider. This included information from previous inspections and notifications (about events and incidents in the home) sent to us by the provider. The provider completed a Provider Information Return (PIR) before the inspection. The PIR is a form that asks the provider to give some information about the service, what the service does well and improvements they plan to make.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We met, spoke with or spent time with the 14 people using the service, two relatives, two health care professionals, the provider, deputy manager, and four staff. We looked at three care plans, records relating to medicines, quality assurance, and staffing. We looked around the premises including bedrooms, bathrooms, and communal areas.

Updated 29 July 2016

Southernhay Residential Home is registered to provide accommodation and care for up to 20 people living with dementia. At the time of this inspection, 14 people were living in the home.

The home was managed by the registered provider. Therefore, it did not need to have a registered manager. 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.

This inspection took place on 17 May 2016 and was unannounced. The last comprehensive inspection was carried out on 17 and 22 June 2015. At that time, the service was rated ‘inadequate’ and placed in ‘special measures’. We found the service was not meeting the regulations in relation to person centred care, dignity and respect, consent, safeguarding, notifications, staffing, quality assurance and safe care. We served warning notices in relation to quality assurance and safe care. After our inspection, the provider invited the local authority quality monitoring team to support them to bring about improvements. We met with the provider and told them they needed to make improvements. We carried out a focused inspection on 22 October 2015 to check whether the warning notice relating to safe care had been met. Improvements had been made and the Safe key question was rated ‘requires improvement’. The provider sent us an action plan telling us what they were going to do to ensure people received a good service. They told us all of the improvements were to be completed by 4 December 2015.

The provider information return told us the service now had a quality assurance system in place which was followed by staff, monitored and audited. On this visit in May 2016 we checked and found some improvements had been made, however people were still not receiving a safe, effective, responsive or well led service. The quality assurance system was not robust and had not picked up the shortfalls we identified. The provider was developing their quality system, which was not yet in place. The deputy manager had designed a quality assurance planner which was to be introduced. Medicine audits had been carried out regularly. Staff recruitment files were checked to ensure all the required information was in place.

Risk assessments had been carried out for each person. Although most risks were being managed to ensure people were kept safe, people’s choking risks were not being fully managed. Two people had been identified as needing supervision when eating due to the risk of choking. However, we observed people were left a number of times with food on their own. People were protected from other risks as appropriate arrangements were in place. This included risks relating to harm to themselves and other people, medicines, and pressure sores.

People’s nutritional needs were not always well managed. One person did not eat their lunch. It was taken away and no other food was given to them until they were offered a snack later in the afternoon. Another person was enjoying their food and looked for more food in the bottom of the bowl. Staff came and took away their bowl and did not offer them any more food. People who did not require support with eating had to wait to have their meals until the people who required support were finished. This meant people in the living room watched as other people ate for about twenty minutes before they were offered their meal. However, we also saw occasions where staff took their time when supporting people to eat and came down to their eye level. People clearly enjoyed their meals and these had been freshly prepared. We observed staff show one person, who had problems with communication, different cups in order to identify whether they wanted a hot drink or a cold drink. They were then able to point to the cup they wanted and staff brought this choice. People’s weights were recorded regularly. One person had lost weight in the last few months. Staff had referred them to the GP in relation to their reduced appetite. Staff were able to tell us why this had occurred and what they were doing to try to increase the person’s weight.

At our last inspection we found the provider had not followed the principles of the Mental Capacity Act (MCA) 2005 for those people who did not have the capacity to make their own decisions. Although there was evidence that people’s relatives and representatives were now involved in their care planning and decision making, the provider displayed a lack of knowledge of the MCA. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. Although the provider had made applications to the local authority in relation to this, they lacked understanding of the Deprivation of Liberty Safeguards (DoLS).

At our last inspection, care plans did not give clear information to ensure people’s needs were met. At this visit, we found improvements had been made but further work was needed. Staff knew people well. When we spoke with them about individual people they were clear about what they needed to do to meet their needs. Care plans contained more detailed information and were reviewed monthly. However, information about one person’s moving and handling was not clear. This posed a risk of inappropriate care. Information about people’s personal histories and interests had been added to the care plans. We observed that staff used this information when chatting with people, who enjoyed these interactions.

Although we observed a number of caring interactions, there were also occasions when staff were not respectful and did not acknowledge people. Staff spoke about people with compassion and concern. They gave us examples of how they tried to make people’s lives better. This included a staff member bringing in adult colouring books for people. Another staff member got a person a newspaper and chocolate while they were in hospital so they knew they were thinking about them. The provider went to visit this person in hospital after they had finished work in the evenings. Relatives told us they were always made welcome. One relative said “If you ring up, they put your mind at ease. We’re very lucky to have [person] here”.

Relatives told us they felt people were safe. We observed people were comfortable with staff and smiled in response to them. Staff understood the signs of abuse, and how to report concerns within the service and to other agencies. Safe staff recruitment procedures were in place. This helped reduce the risk of the provider employing a person who may be a risk to vulnerable people.

There were sufficient staff to meet people’s needs. Staff responded to people’s needs and requests in good time. Staff did not seem rushed and remained calm and attentive to people’s needs. People were given one to one time with staff who sat and spoke with them. One person told us “They sit and have a chat with me”. Staff said “We can do a lot more one to one” and “it’s become more person centred. We used to do a lot of group activity but now we can do one to one more. People like that one to one time”. During the morning staff spent time with one person doing a jigsaw and then painting their nails. As a result the person’s mood improved and they were laughing. However, we saw that during this time, there was very little interaction with the other three people who were sitting in the lounge. During the afternoon a musical entertainer visited the home. Staff got up and danced with people and made it enjoyable for them.

At our previous inspection, staff had not received training to ensure they had the knowledge and skills to meet people’s needs effectively. At this inspection, we checked and found improvements had been made. Staff said “I have done lots of training” and “All my training is up to date”. There were still some gaps in staff training but there was a plan in place to ensure staff completed these. Staff told us they felt well supported and had regular opportunities to discuss their work.

The premises and equipment were maintained to ensure people were kept safe. For example, checks had been carried out in relation to fire, hoists, and gas safety. There were arrangements in place to deal with foreseeable emergencies. The provider had sought guidance for supporting people with dementia in an enabling environment. They showed us information relating to bedrooms, corridors, and bathrooms. Work had not commenced. They said they planned to start this work after they had finished improving the garden. Additional seating areas had been built in the garden which meant it was easier for people to go outside.

The provider worked within the home alongside the staff team. They had a very good knowledge of the people who lived there. Staff told us they found the provider approachable. A staff member said “(name) is approachable and listens to my ideas”.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We are taking further action in relation to this provider and will report on this when it is completed. The overall rating for this service is ‘Requires improvement’ and the service remains 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