• Care Home
  • Care home

Archived: Southernhay Residential Home

Overall: Requires improvement read more about inspection ratings

Second Drive, Landscore Road, Teignmouth, Devon, TQ14 9JS (01626) 773578

Provided and run by:
Mrs Mary Crook

All Inspections

17 May 2016

During a routine inspection

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

22 October 2015

During an inspection looking at part of the service

Southernhay Residential Home is registered to provide accommodation and care for up to 20 people living with dementia. At the time of the inspection, there were 18 people living at the home.

The home is managed by the registered provider. Therefore, it does not need to have a registered manager. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered provider was available during our inspection visit.

We carried out an unannounced comprehensive inspection of this service on 17 and 22 June 2015. Breaches of legal requirements were found. CQC took enforcement action because the provider was not meeting the regulation relating to safe care and treatment. We served a warning notice telling the provider they must take action by 24 September 2015.

We undertook this unannounced focused inspection on 22 October 2015 to check that the service had met the legal requirements in relation to the warning notice. This report only covers our findings in relation to the warning notice. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southernhay Residential Home on our website at www.cqc.org.uk.

The purpose of this current inspection was to check people were receiving safe care. We found that action had been taken to improve safety.

At the previous inspection we found that people were not always protected against the risks of receiving unsafe care. This was because risks to people’s welfare and safety were not always identified and managed. It was not possible to check whether people had received their medicines as prescribed. There were no personal emergency evacuation plans that told staff how to safely assist people in the event of a fire. The premises were not always maintained appropriately.

At this inspection we found risks had been assessed. For example where one person had been assessed as being at risk of falls there was a plan in place which set out the equipment and number of staff required to minimise the risk.

Personal emergency evacuation plans had been written for each person and staff were able to describe how they would assist people in the event of a fire.

People received their medicines as prescribed by their doctor to promote good health. The medicine administration record (MAR) sheets were fully completed. One person had been prescribed medicine to control their pain with a variable dose. Staff had not recorded how many tablets they had administered each time. We discussed this with the registered provider who told us they would ensure staff knew to do this in future.

We spoke with a visiting relative who told us they felt their relation was safe and had complete trust in the registered provider.

Actions had been taken to address the shortcomings identified at our last inspection. The rating for the safe question has improved from ‘inadequate’ to ‘requires improvement’. We are unable to judge the key question as ‘good’ because the actions taken to ensure people receive safe care have not been in place long enough to ensure they are applied consistently and over time.

A further comprehensive inspection will take place to inspect all five questions relating to this service. These questions ask if a service is safe, effective, caring, responsive and well-led.

17 and 22 June 2015

During a routine inspection

Southernhay Residential Home is registered to provide accommodation and personal care for up to 20 people living with dementia. Nursing care is provided by the local community nursing team.

The home is managed by the registered provider. Therefore, it does 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. The registered provider was available throughout our inspection visit.

At the last inspection carried out on 2 December 2013, we found the provider was not meeting the regulations in relation to records and quality assurance. Following the inspection the provider sent us an action plan telling us about the improvements they were going to make. They told us they would make these improvements by the middle of March 2014. During this inspection in June 2015 we found that the provider had not taken sufficient action in relation to the concerns previously identified.

The service was not well-led. There was no quality assurance system in place. As a result the provider had not found a number of concerns identified during this inspection. We found concerns in relation to mental capacity assessments, Deprivation of Liberty Safeguards, care plans, medicine management, risk management, and staff recruitment and training.

People who lived in the home were not always safe. People’s medicines were not always well managed. Although staff had signed to confirm they had administered medicines, it was not possible to check whether medicines had been given because of poor accounting and record keeping. Safe staff recruitment practices were not always followed to ensure staff were suitable to work with people who lived in the home.

Risks to people were not always assessed, identified, and managed. For example, one upstairs bedroom window opened wide over a roof which may have placed people at risk of falling from a height. Disposable razors, denture cleansing tablets, and an anti-bacterial spray were observed in bathrooms which may have placed people at risk of injury or harm. After the inspection, the provider confirmed that the window had been restricted. There was no personal emergency evacuation plan in place for each person that told staff how to safely assist them in the event of a fire. The premises were not maintained appropriately to ensure people were kept safe.

People did not always benefit from support from staff who had up-to-date training. Although staff had not completed training we saw most staff had skills to meet peoples needs.

People were not always treated with dignity and respect. Staff were not always aware of their responsibilities. For example, one person was at risk of choking. The care plan had not been updated to give staff information on how to support this person. Some staff were not aware they needed to stay with the person whilst they were eating, and were unsure what to do if the person did choke. Staff had not been given information about people’s personal histories. This meant staff did not have important information which could help them to understand and respond to each person’s dementia care needs in a caring and compassionate way. Most staff were kind and caring, showing patience when supporting people. Some staff showed skill when encouraging people and distracting them to relieve distress. For example, when one person showed signs of distress, a member of staff reassured them. The person responded by saying “You’re lovely”.

The provider had not followed the principles of the Mental Capacity Act 2005 for those people who did not have the capacity to make their own decisions. There were no mental capacity assessments in people’s care plans. It was not clear how people’s care and treatment was carried out in their best interests where they lacked capacity to make decisions about their care themselves. The Care Quality Commission (CQC) monitors the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Most people’s freedom to leave the premises or move around the home was restricted without the protection of a legal authorisation to do so under the Deprivation of Liberty Safeguards. The provider had not made application for authorisations for people to be deprived of their liberty.

People who lived in the home had some degree of dementia. The environment was not suitably adapted for people living with dementia. People did not benefit from individual activity plans to ensure they had meaningful activities to promote their wellbeing. During our Short Observational Framework for Inspection (SOFI), several people showed signs of boredom and frustration.

People were at risk of receiving inconsistent care. Care plans were confusing with information in different places. People’s care plans did not accurately reflect their care needs. As a result, staff did not have the information available to help them to deliver consistent and appropriate person centred care based on the person’s needs and preferences.

The registered provider was visible in the service but was not aware of their legal responsibilities, such as the requirement to let the CQC know about the events that took place in the home. For example, one person had been seriously injured. The provider did not have a copy of the new Regulations which came into force on 1 April 2015. They downloaded these from the internet during our inspection.

The provider had recently arranged for a senior member of staff to take on extra responsibilities so they would be able to make the required improvements. The staff member had enrolled on the Level 5 Diploma in Leadership and Management. During our inspection, a new quality assurance system was delivered to the home.

Since the inspection, the provider has spoken with the local authority quality monitoring team. The team are visiting the home to support the provider to make improvements to quality and safety for people.

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 this report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'.

The service 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."

2 December 2013

During a routine inspection

There were 19 people who used the service on the day of our visit. We spoke with three people and saw three support plans. We also spoke with three members of staff. People we spoke with said 'I wouldn't want to be anywhere else', 'everything's alright here' and 'we have a laugh and a joke'. Staff we spoke with said 'I so enjoy caring'.

People we spoke with said it was a 'friendly, homely place' and they 'felt okay here'.

We saw that one person was referred to by their preferred name rather than their given name; this was made clear in their support plan. Staff felt that they knew people's needs 'quite well'. When we asked staff to describe what they knew about a person, they said they did not know the person's history but felt they 'knew the basics' and that information was available if they needed it.

There was no evidence that the views of people who used the service were obtained; the manager confirmed that the last survey was conducted in 2008. We saw that the support plans were not accurate records in respect of each person who used the service as there were sections which had not been completed. There was no evidence that staff training was up to date although staff told us what training they had completed.

24 July 2012

During a themed inspection looking at Dignity and Nutrition

We carried out an unannounced inspection on 24 July 2012. On the day of our visit there were 19 people living at Southernhay Residential Home. We spoke with six people living at the home, three relatives, four staff members and looked at four people's care files.

People told us what it was like to live at the home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an 'expert by experience'; people who have experience of using services and who can provide that perspective.

Most of the people who used the service at Southernhay Residential Home had a dementia and therefore some were not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allowed us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they got and whether they had positive experiences.