Archived: Southbank

The service provides accommodation and personal care to up to thirteen people with learning disabilities. One of the three bungalows that make up the service provides respite care for up to five people. There were 7 people living at the service on the day of the inspection. There was a registered manager in place. 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.

People were kept safe and free from potential harm as staff knew how to keep them safe. Staff knew what they would do to protect a person from the risk of harm and how to report any concerns. People got the assistance from staff who ensured they were available to help them when needed. Staff had time to support people when required and ensured that people’s needs were met in a timely way. People’s medicines were looked after by staff who recorded when they had received them.

People’s care was provided by staff that had been trained to understand their needs and who were supported in their role. People’s decisions about their care and treatment had been recorded and staff showed they listened and responded to people’s choice.

People got to choose their meals and enjoyed the food. Support was provided where needed and alternative diets had been prepared to meet people’s nutritional needs. People were supported to access health and social care professionals with regular appointments when needed and were supported by staff to attend these appointments.

People were comfortable around the staff that supported them were happy to spend time with them. People’s individual care needs were known and respected by staff and their dignity and had been supported and maintained.

People got to enjoy the things they liked to do and chose how they spent their days in their home or time out and about on trips or activities. People were supported by staff who would raise comments or concerns and these were addressed. There were processes in place for handling and resolving complaints and guidance was available in alternative formats.

The registered manager was available, approachable and known by people and relatives. Staff also felt confident to raise any concerns of behalf of people. The provider ensured regular checks were completed to monitor the quality of the care delivered. The management team had kept their knowledge current and they led by example.

We found that people's medication was managed safely. The service had responded to a medication error by improving arrangements.

The guidance in people's care plans about risk areas was detailed but not always accurate. Senior staff were not fully informed about the care arrangements for the people, such as there being no facility to weigh people who were at risk of weight loss. This meant there was a risk that people would not have their care provided safely and correctly.

Some staff had not had the expected refresher training provided on time for safety related subjects such as moving and handling. The majority of staff had not taken part in a fire drill in the last year to ensure they could respond quickly in the event of a fire. The registered manager felt that good progress had been made to address the matter.

The service had worked with the local authority when safeguarding concerns had been raised about the service. CQC monitors the operation of the Mental Capacity Act and the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. While no DoLS application had needed to be submitted relevant staff had been trained to understand when an application should be made and how to submit one.

We found that there was enough staff to meet people's personal care needs within the home. There was not always enough staff to provide people with stimulating and meaningful activities away from the home. Some people's relatives did not think enough outings were provided. One relative said, 'They don't seem to go out and X (person's name) can't entertain themselves'.

Is the service effective?

We found that there were limited systems in place to evaluate the care being provided and the outcomes for the people using the service. The information known and recorded by care staff was not always reviewed by senior staff. Care plans had not been reviewed regularly to ensure they were accurate. This meant there was a risk that people's changing needs would not be recognised and the care adjusted in response.

People and their representatives were not always involved in evaluating and reviewing the service. This meant that the care provided was not being evaluated effectively.

Feedback from two health professionals included concerns that earlier during 2014 the service had not always requested their input quickly enough to ensure people were kept safe by having the equipment they needed. They had however found senior staff more proactive during their recent involvement.

Staff training and supervision arrangements had not been effective at ensuring staff were well trained and supported in their role. The improvements the register manager was working to implement had not been shared with staff in a way that had helped lift team morale.

Is the service caring?

Family members we spoke to told us they usually found the staff friendly and helpful. They told us the staff were caring and informed them if their family member was unwell. One said, 'Lovely staff, you can't fault them'. Another said, 'On the whole we are very satisfied', and 'Some of the carers are devoted'. Another said, 'It has been great for X (person's name) they have a pint at the pub and go out for lunch. It's fantastic'.

Families told us that they were not routinely contacted at the end of a respite stay. This meant they did not know what their family member had been doing and so could not talk to them about their stay.

We met one person when they arrived for their respite care stay. We saw they seemed pleased to arrive and be greeted by staff they knew. In the residential service we saw that people were clean and comfortably dressed. Staff spoke nicely to people as they assisted them. They communicated in clear and kind voices and we saw people respond positively to them. Staff offered people regular drinks and encouraged people to be independent where possible. This showed that the staff were caring and were considering what people may want and need.

Is the service responsive?

We found that changes had been made in response to some situations such as a medication error.

We found examples of when the service had been responsive. They had admitted a person in December 2013 into the respite bungalow in response to them no longer being safe in their own home. They had worked to help rebuild one person's confidence when they no longer wanting to use the respite care service because of compatibility issues. The service had worked openly with the local authority when safeguarding concerns had been raised about the service.

The majority of families we spoke to had concerns about communication systems in the service and had difficulty accessing the manager. Concerns and other feedback was not always effectively captured and responded to. This had led to people's relatives feeling like they were not listened to. One family felt that the service had not taken action quickly enough with compatibility problems to stop them having a negative outcomes for their family member.

Staff had raised concerns that the staffing levels severely limited how often people could leave the home and go on outings into the community. The provider had not responded quickly to this feedback. Changes were being made but people using the service were not yet benefitting from these.

Is the service well led?

The service had recently changed the way they provide care and treatment to people. People we spoke with told us that this change in service provision could have been managed better. They told us they were not given information about the service, what to expect. The registered manager told us that managing the two services through a time of change had been very difficult, however, they felt progress was now being made.

Feedback on the quality of the service was not sought from people using the service and their representatives. A survey was being developed.

There were a number of quality assurance systems in place. These had not always been effective at making sure essential standards of quality and safety were provided for people using the service. Changes were being made to these systems.

The service had appropriately submitted notification to use about significant events in the home in line with their legal responsibility to do so.