Sotwell Hill House

Sotwell Hill House is a residential care home providing accommodation and personal care to up to 36 older people. At the time of our inspection there were 26 people using the service.

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

Systems and processes to maintain effective oversight required improvement. Audits had not previously identified concerns found on inspection. Therefore, improvements had not been made.

Risks to people had not always been assessed or appropriate mitigating strategies implemented. Injuries to people were not always investigated as required and records of injuries did not always have the necessary information documented.

The provider had made improvements and the previous recommendation made by CQC regarding legionella risks had been mitigated.

People were supported by staff who were described as kind and caring. Staff had been safely recruited.

People received their medicines as prescribed. Staff received training and staff recorded when medicines were administered.

Information was shared with people, relatives and staff. Relatives were kept up to date with changes or incidents that occurred with their loved one. Feedback was sought from people, relatives and staff annually.

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.

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 30 March 2022) and there was a breach of regulation. 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.

At our last inspection we recommended that the provider consider current guidance on managing legionella and take action to update their practice accordingly. At this inspection we found they had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service. 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.

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.

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

Enforcement and Recommendations

We have identified breaches in relation to effective management oversight at this inspection.

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

Sotwell Hill House is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 36 people in one adapted building.

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

Whilst some risks were managed well, we found the management of falls could be improved. Where people had had falls, their risk assessments were not always reviewed, and the falls care plans lacked detail about how staff should minimise the risk of falls.

We found the provider’s processes around legionella risk assessments and management could be improved. The provider had a part system to manage legionella. However, they did not have a risk assessment or management plan to measure against this risk. Therefore, they had no way to measure how far the system they had reduced or managed legionella risk. We have made a recommendation about management of legionella.

People’s care plans contained conflicting information which could put them at further risk.

Incidents and accidents were recorded; however, trends and patterns were not always identified which meant there was no learning that followed to minimise any further risks.

We found staff deployment could be improved to ensure safe evacuation at night. The staffing levels did not take into account the layout of the building in addition to people’s needs. The registered manager and deputy manager often worked on the floor to cover for unplanned absences.

The provider’s quality assurance processes were not always effective. We found the audits completed had not identified any of the concerns we found. There was a lack of effective monitoring and systems in place to monitor the safety and quality of care

People living at Sotwell Hill House told us they felt safe receiving care from compassionate staff who new them well. Recruitment checks were robust to ensure staff were suitable to work with vulnerable adults and staffing arrangements met people's needs.

Medicines were managed safely, and people received their medicines as prescribed. Staff had the necessary skills to carry out their roles. Staff had regular training and opportunities for regular supervision and observations of their work performance.

Sotwell Hill House was a family run home which was well-led by a long-standing registered manager and provider who had support from an established team of staff. The service had a clear and stable management and staffing structure in place and staff worked well as a team. We received overwhelmingly positive feedback from relatives regarding the way the home was run and how they had adapted during the Covid 19 pandemic to maintain a caring environment.

Rating at last inspection

The last rating for this service was good (Published 1 August 2019)

Why we inspected

The inspection was prompted in part by a notification of a significant incident, following which a person using the service died. This incident is subject to an investigation. As a result, this inspection did not examine the circumstances of the incident.

The information shared with CQC about the incident indicated potential concerns about the management of risks in relation to accidents and incidents. This inspection examined those risks and reported on the findings in the safe and well led domains.

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

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.

Enforcement

We have identified one breach in relation to lack of good governance. 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.

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

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 changed from good to requires improvement based on the findings of this inspection.

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

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.

Sotwell Hill House is a residential care home providing personal and nursing care to 30 people aged 65 and over at the time of the inspection. The service can support up to 36 people with a range of conditions in one adapted building.

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

Medicines were managed safely. Risks were assessed and there was guidance to ensure risks were managed. There were effective systems in place to ensure good infection control. The manager used a dependency assessment tool to assess the staffing needs of the service. However, some people and staff did not always feel there were enough staff to meet peoples' needs.

There were systems in place to monitor the quality of the service. The registered manager continually looked for ways to improve the service. There were links with the local community and there were plans in place to improve those links. There were systems in place to engage people, relatives and staff. Staff told us they felt listened to, however they did not always feel action was taken to address issues.

People enjoyed the food and dietary needs were met. People were supported to access health and social care professionals when needed. Staff completed training to ensure they had the skills and knowledge to meet peoples’ needs. We have made a recommendation about new staff induction.

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.

Staff showed kindness and compassion. People were treated with dignity and were valued as individuals. People were involved in their care which ensured their choices and decisions were respected. Staff promoted people’s independence by encouraging them to do what they could for themselves.

There was a range of activities for people to enjoy and it was clear these had a positive impact on people’s well-being. Care plans were person-centred and valued people as individuals. Care plans included people’s end of life wishes. There was an effective complaints policy in place and people were confident that any concerns would be addressed in a timely manner.

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 10 December 2016)

Why we inspected:

This was a planned inspection based on the previous rating.

Follow Up:

We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Sotwell Hill House is a care home providing accommodation for people requiring personal care. The service supports older people with a variety of conditions which includes people living with dementia. At the time of our visit there were 29 people living in the service.

We carried out an unannounced comprehensive inspection of this service on 4 and 6 November 2015. Breaches of legal requirements were found relating to the management of risks to people and the safe management of medicines. We also found that care and treatment was not always provided with the consent of the relevant person. The provider sent us an action plan stating the action they would take to improve the service to the required standard. We undertook this comprehensive inspection on 8 November 2016 to check that they had followed their plan and to confirm that they now met the legal requirements. At this inspection we found actions had been completed and improvements made.

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.

We were greeted warmly by the registered manager and staff at the service. The atmosphere was open and friendly.

People told us they felt safe. Staff understood their responsibilities in relation to safeguarding. Staff had received regular training to make sure they understood how to recognise and report safety concerns. The service had systems in place to notify the appropriate authorities where concerns were identified.

People were supported by staff who were knowledgeable about people’s needs and provided support with compassion and kindness. People received high quality care that was personalised and met their needs.

Where risks to people had been identified risk assessments were in place and action had been taken to manage the risks. Staff were aware of people’s needs and followed guidance to keep them safe. People received their medicines as prescribed.

There were sufficient staff to meet people’s needs. Staffing levels were consistently maintained. The service had robust recruitment procedures and conducted background checks to ensure staff were suitable for their role.

Staff understood the Mental Capacity Act 2005 (MCA) and all staff applied its principles in their work. The MCA protects the rights of people who may not be able to make particular decisions themselves. The registered manager was knowledgeable about the MCA and how to ensure the rights of people who lacked capacity were protected, this included Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed the food and had enough to eat and drink. Where people required support with their food and drink they were supported appropriately.

The service had systems to assess the quality of the service provided. Learning needs were identified and action taken to make improvements which promoted people’s safety and quality of life. Systems were in place that ensured people were protected against the risks of unsafe or inappropriate care.

People told they enjoyed activities in the home and the provider provided a range of activities for people to engage with. This included religious services and trips outside of the home.

Staff spoke positively about the support they received from the registered manager. Staff supervisions and meetings were scheduled as were annual appraisals. Staff told us the registered manager was approachable and there was a good level of communication within the service.

People and their relatives told us the service was friendly, responsive and well managed. People knew the registered manager and staff and spoke positively about them. The service sought people’s views and opinions and acted upon them.

We found assessments and care plans detailed people's preferences and choices. One relative told us 'they were wonderful here they discussed everything with us'. One person told us 'I knew all about this place before I came, it is most acceptable the staff are very nice, very pleasing'.

We found improvement in the way staff were supported and trained to enable them to deliver good care. One care worker told us 'we have supervision at least every six months but I can raise any issues when I need to and the management will always listen to any problems we may have'.

We found the service had quality assurance methods in place which involved people, to make sure they maintained and enhanced the quality of the service they were providing.

We saw good arrangements in place in relation to medication procedures. One care worker told us 'we are all trained and medication is all very well checked'.

We found improvements in how the service monitors and improves its' quality. People we spoke with were happy with the service and knew how to complain if they had a concern. One person we spoke with told us 'I would go to the Manager if I had any complaints but I have never had any'.

Care plans detailed a person's support needs in clear sections such as mobility, dressing, personal care, appetite. Risk assessments used a traffic light system, red amber, green to indicate the level of risk and enabled staff to understand the level of support required.

We heard that people were protected from abuse. Staff had done safeguarding training and were aware of how and when to raise an alert. People and their relatives felt they were safe. One person told us 'I feel very safe here. I've never felt worried or uncomfortable about anything."

We found that supervision was not regular. This meant that staff may not have had proper guidance to provide good care to people. Although some staff we spoke with felt they could talk to the manager, a lack of formal supervision meant that these discussions were not recorded and action taken was not evident.

We saw that, although the home had a number of ways in which they gathered views about the quality of the service, there was no evidence that the information had any impact on the care provided. This was because no action was identified following collection of information.