Southernwood House

Southernwood House is a residential care home providing personal care to up to 28 people. It is in an adapted building. The service provides support to adults of all ages, some of whom may be living with a physical disability or dementia. At the time of our inspection there were 19 people using the service.

Southernwood House also provides care to people in their own home. We did not review this part of the care provided as only two people were using the service at the time of the inspection and their care was in the process of being transferred to a new service provider.

People’s experience of using this service and what we found

Medicines were not always safely managed and audits in place to monitor the safety of medicines were not effective in keeping people safe.

Other audits in the home identified areas for improvement and the manager took action to make changes and enhance the quality of care provided. The manager gathered the views of people using the service and staff to identify areas for improvement.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff in place to meet people’s needs and staff had received the training needed to provide safe care. Staff had been safely recruited to ensure they were safe to work with people living at the home.

Risks to people receiving care had been identified and care was planned to keep people safe. The home was clean, and staff wore PPE correctly to reduce the risk of infection.

Where concerns were raised the manager worked with the local authority and healthcare professionals to ensure people were safe and well.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 13 August 2022).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found the provider remained in breach of regulations.

We made a recommendation at the last inspection regarding audits. We found medicines audits were still ineffective at supporting the safe management of medicines.

The last rating for this service was requires improvement (published 13 August 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

We received concerns in relation to risk management, medicines management and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Southernwood House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to the safe management of medicines and the auditing of medicines which had not picked up ongoing and recurrent issues at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Southernwood House is a residential care home providing personal care to 24 people aged 65 and over at the time of the inspection. The service can support up to 28 people and is in an adapted building.

The service also provides personal care to people living in their own home. Seven people were using this service at the time of inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

People’s experience of using this service and what we found

There had been improvements in the management of risks, medicines and infection control since our last inspection. However, there were still concerns that people were not fully protected from risk as care plans for people who received care in their own home did not fully identify risk. Some areas of the home needed attention to prevent the spread of infection. Recording of medicines did not fully support the safe management of medicines in the care home .

Management audits had improved and were identifying the majority or areas in the home which needed improvement.

We have recommended the provider ensures that audits reflect best practice guidance.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

There were enough staff to meet people’s needs and staff had the skills needed to support people safely. They had received training in how to keep people safe from harm and were confident to raise concerns.

People were supported to receive visitors in line with government guidance. People were supported to give feedback about the quality of care provided.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement published 07 October 2021.

At this inspection we found improvements had been made However, the provider remained in breach of one regulation. The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We inspected safe and well-led as those were the areas where we found concerns. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found evidence the provider needs to make improvements. Please see the safe section this report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified a breach in relation to the safe management of medicines and infection control processes in the home at this inspection.

We have made a recommendation about the audits in the home.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Southernwood House is a residential care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 28 people and is in an adapted building.

The service also provides personal care to people living in their own home. Seven people were using this service at the time of inspection. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided.

People’s experience of using this service and what we found

People were not supported to have maximum choice and control of their lives and whilst staff supported people in the least restrictive way possible and in their best interests; the policies and systems had not been followed.

Systems to monitor the quality and safety of the service were ineffective and had not picked up areas where improvements were needed.

Staff had not always identified where people were at risk of abuse and had not raised concerns with external agencies to get support and advice.

Risks to people were not reassessed when people’s needs changed and had not been reviewed on a regular basis. This put people at increased risk of falls and malnutrition.

Medicines were not safely managed, and people could not be assured of receiving their medicines as planned. Medicines audits did not drive improvements in the quality of medicines recording.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 31 December 2019).

Why we inspected

We received concerns in relation to the management of medicines, infection control, staffing levels and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Southernwood House on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding people from harm, safe management of medicines, keeping people safe from risk and the management of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ There was clear information throughout the service for visitors regarding following safe infection control practices. There was personal protective equipment (PPE) and hand sanitiser available for all visitors.

¿ People were supported to keep in touch with their relatives via telephone calls and video links.

¿ Throughout the outbreak staff worked to support people to remain engaged, tailoring activities to stimulate people. This included music, talking books and activity packs.

¿ Arrangements were in place to manage new admissions during the COVID-19 pandemic. These followed the latest government guidance.

¿ People who had a positive COVID-19 test or displayed COVID 19 symptoms were being isolated. Staff supporting them had their own changing room and a separate area had been made available for staff to have their breaks.

¿ Staff were clear about how to manage the risks of the spread of infection. They were able to demonstrate they wore personal protective equipment(PPE) in line with Public Health England (PHE) guidance. There were PPE stations throughout the service with hand washing and hand sanitizer facilities available. Staff had received extra training in donning and doffing PPE and the registered manager had set up systems so staff could be updated on a regular basis.

¿ The registered manager had carried out risk assessments/profiles on all staff so that they could be supported by the provider to work safely. Where staff had been isolating due to a positive COVID-19 test, they were supported by the registered manager with regular telephone calls.

¿ The recent outbreak of COVID-19 at the service had been managed well and the plans in place to support people had been utilised safely. There was evidence to show how staff who tested positive or had displayed symptoms of COVID-19 had shielded in line with the government guidance and were symptom free before returning to work.

¿There was an enhanced cleaning programme in place at the service and the service was visibly clean. Regular deep cleans had been carried out to prevent the risk of cross contamination.

¿ The registered manager had arrangements in place to keep people and their relatives up to date with events at the service. They wrote to relatives regularly to inform them of changes and spoke with them on the telephone.

Further information is in the detailed findings below.

Southernwood House is a residential care home providing personal and nursing care to 27 people aged some of whom may be living with dementia or a physical disability at the time of the inspection. The service can support up to 28 people in the care home.

The service also provided personal care to people living in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service was provided for seven people when we inspected.

People’s experience of using this service and what we found

There were enough staff both in the care home and providing support to people in their own homes to meet people’s needs. They had received training and support to ensure that they had the skills to care for people safely. Staff had a good understanding of how to keep people safe from abuse and were confident to raise concerns.

Staff were kind and caring. They respected people’s privacy and dignity and supported people to be as independent as possible. People living in their own home were visited by a small number of care staff so that they could build relationships and trust with them. People were able to access daily activities as well as planned events to help them mark different times of the year.

Medicines were well managed and the registered manager took immediate action to strengthen medicines audits when we identified issues. The home was clean and tidy, and staff worked to reduce the risk of infection. Accidents and incidents were recorded and people’s care was reviewed to keep them safe from similar events.

People received an assessment before they moved into the home or started using the care at home service. Care plans accurately reflected people’s needs. Risks to people were identified using best practice tools and guidance, and care was planned to keep people safe. Care plans were reviewed at set intervals or when a person’s needs changed to ensure they reflected the latest care people needed. People’s wishes at the end of their lives were respected and staff worked with healthcare professionals to ensure people were pain free and comfortable.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. People’s ability to access information was assessed to ensure they had access to information relating to their care.

People and staff told us that the registered manager was supportive and would listen to their concerns and take action to improve the quality of care people received. Effective systems were in place to monitor the quality of care provided. The registered manager was proactive in taking action to support people’s safety when we raised concerns with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Requires Improvement (published 10 October 2018).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Southernwood House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Southernwood House accommodates up to 28 people in one adapted building. It provides care for older people some of who may be living with dementia. It also provides care for younger people who need support and people who may have a physical disability. The service is also registered to provide personal care to the same groups of people living in their own houses and flats in the community. However, at the time of the inspection the provider was not proving this service to anyone.

There had been no registered manager at the home for over six months. 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. The previous manager had deregistered on 1 November 2017. The deputy manager was running the home with support from the area manager.

This is the first inspection where the service has been rated Requires Improvement.

The provider’s recruitment processes ensured that staff were safe to work with vulnerable people and for most of the time there were enough staff to meet people’s needs. However, at busy times people had to wait for care. Staff received training and support which enabled them to provide safe care for people. However, at times systems in the home did not fully support safe care. For example, there were no protocols in place to support staff to administer medicines prescribed to be taken as required in a consistent manner. In addition, records of people’s nutritional intake did not record their food and fluid intake in a way which would support clinicians to assess people’s dietary needs.

The home had been pleasantly decorated and there were signs to support people to find their way around the home. However, more could be done to support people living with dementia to be independent and we recommend that the provider takes account of best practice in providing a dementia friendly environment. Furthermore, we found some of the furniture was old and worn and in need of replacement.

The provider had purchased a computer system to record the care that people needed. However, staff were still learning how to use the systems and we found that the care plans did not fully support people’s needs. In addition, the deputy manager and area manager had not utilised audits in the system. The deputy manager was aware of these concerns and further training on the system was planned.

Despite the lack of information in the care plans staff knew people’s needs well and people were happy with the level of care they received. Risks to people while receiving care were accurately recorded and care was planned to keep people safe. When people neared the end of their lives care was planned to help them have a dignified death and they and their relatives were offered comfort and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were asked for consent before any care was provided and were offered choices around food, clothing and where people liked to spend time. Staff respected people’s privacy and dignity. People were supported to engage in a variety of activities to enhance their wellbeing.

The provider had systems in place to monitor the quality of care needed and action was taken to resolve concerns. The area manager had reviewed the care and environment and had an action plan in place to drive improvements. Complaints and incidents were reviewed and action taken to keep people safe and to reduce the risk of similar situations occurring in the future. People living at the home and their relatives had their views of the care provided considered and They were kept informed of planned changes in the home.

If you want to see the evidence supporting our summary please read the full report.

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe. Safeguarding procedures were in place. Staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Recruitment practice was safe and thorough. All the required checks had been carried out before staff commenced their employment.

The registered manager set the staff rotas. We found that they took people's care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were met.

Is the service effective?

People's health and care needs were assessed. People and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people's records and saw that care plans set out people's individual care needs. Care plans had been reviewed on a regular basis and adjustments made when a person's care needs changed.

During our inspection we observed members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person told us: 'I have just moved in. It's been fine so far. It's nice to have some company.'

People who used the service, their relatives and friends completed a satisfaction survey every three months. Where concerns or comments were raised these had been addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home. This included GPs, district nurses, palliative care nurses and a chiropodist.

Is the service responsive?

The provider had a complaints policy in place and information was displayed in the home. There was written information in people's bedrooms, should people or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction. They were able to tell us how they would escalate any concerns raised.

People completed a range of activities in and outside the home on a regular basis. The home had its own minibus, which helped to keep people involved with their local community. There were good links with the local secondary school and pupils were involved in volunteering.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

Staff we spoke with were positive about the management skills of the registered manger. One member of staff told us they felt supported: " They really care about the people that live here and makes sure we have what we need to look after people."

Another person told us, "It is my home, the staff look after me well. We get on well." Someone else said, "The food is really good, you get a good choice and it's nice and fresh and home cooked."

One person told us they had been unwell at Christmas, they told us, "They really looked after me and helped me to get better."

We saw people received dignified and sensitive care by a well trained team of staff. People were offered a range of activities to participate in. A trip to a local church was planned which people told us they were looking forward to.

We didn't manage to speak with any visitors or relatives during our visit, however we saw some compliments were left in the comments book. One person said, "I'm so glad Nana has a great place to live with lovely staff." Another person had said, "X had a wonderful stay with you all and came home full of life and fun."