Archived: South Africa Lodge Nursing Home

Updated 21 May 2015

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 is 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 4 and 5 February 2015 and was unannounced. The inspection team consisted of two inspectors, a specialist nurse advisor, a pharmacy inspector and an expert by experience. The expert had experience in caring for people who have difficulties in communicating and may display behaviours that place people and others at risk. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before the inspection, the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We also reviewed information we held about the service including notifications. A notification is information about important events which the service is required to send us by law.

It was not always possible to establish people’s views due to the nature of their conditions. To help us understand the experience of people who could not talk with us we spent time observing interactions between staff and people who lived in the home. We spoke with three people using the service and four family members. We spoke with the provider’s nominated individual and chief operating officer. We also spoke with 19 staff including nursing and care staff, domestic staff, kitchen staff, activity co-ordinators and occupational therapy staff. We spoke with the deputy manager and clinical support lead. We also spoke with three external health and social care professionals.

We looked at the care records for 16 people and medication administration records for 34. We reviewed staff duty records, five recently recruited staff recruitment records, seven staff supervision records and all staff training records. We looked at records relating to the quality monitoring of the service including complaints, accidents and incidents, audits, case reviews and policies and procedures. We observed care and support being delivered in communal areas.

Updated 21 May 2015

This unannounced inspection took place on 4 and 5 February 2015.

South Africa Lodge provides accommodation and nursing care for up to 97 older people. At the time of our inspection there were 72 people living at the home. People living at the home have high complex support needs in relation to their diagnosis of dementia, mental health conditions, learning disabilities and physical disabilities. The home is separated into six lodges who have dedicated staff teams. Each unit is linked with a door. Bedrooms are single occupancy with en-suite facilities and each lodge has communal areas. The lower ground floor of South Africa Lodge is used as an activities hub, with a cinema room, fully equipped hairdressing and nail salon and general area. There is a free area on this floor that the provider is considering as a fully equipped sensory room. In addition to the nursing and care staff the provider has also recruited occupational therapy input.

The home had a registered manager. 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 registered manager was absent from the home during our inspection and this had been notified to us. To ensure continuity of management support the homes chief operating officer was working in the home full time and undertaking the role of the manager.

At the last inspection in July 2014 we asked the provider to take action to make improvements to the obtaining of consent and the application of the mental capacity act 2005, the care and welfare of people who use the service, assessing and monitoring the quality of service provision and records. The provider sent us an action plan stating the action they would take to meet the requirements of the regulations. The provider had made improvements and were meeting the requirements of these regulations, however we identified areas which required improvement, including some care records and auditing systems.

People were supported to take their medicines as directed by their GP. Medicines were not always safely stored. Whilst administration records were complete, supporting information was variable.

Medicines were kept within their recommended temperature range, and administered as prescribed. Some non-prescribed homely remedies were out of date.

People and their relatives were satisfied with the care being provided. They told us staff were kind, caring and respectful. Staff were knowledgeable of people’s needs and supported them to make choices about their day to day lives. Care records had improved. Information was available to guide staff about the management of risks for people and staff understood these. Some care records required further personalisation. People’s privacy, dignity and independence were respected. Staff demonstrated a caring approach to people and understood their needs well. Activities were in place and people were supported to access these as they chose.

Staffing levels were sufficient to meet people’s needs and all appropriate recruitments checks were undertaken before staff commenced work to ensure they were safe to work with people

There were policies and procedures regarding the safeguarding of adults and staff knew what action to take if they thought anyone was at risk of harm. The provider used this information to reflect on practice and share learning with all staff.

Staff were supported to develop their skills by receiving regular training. The provider supported staff to obtain recognised vocational qualifications in Health and Social Care. People and staff said they were well supported. People’s dietary and other health care needs were met and the provider however the monitoring of people’s fluid and diet intake needed improvement, We have made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the service had submitted applications for DoLS to the local authority. Staff demonstrated an understanding of the Mental Capacity Act 2005 and showed how this was applied to peoples care and support.

Service delivery was open and transparent. Staff understood the values of the service and worked to these. Communication in the home was positive and effective. The provider was undertaking regular checks of the service however these were not always effective in identifying concerns. We have made a recommendation about the effective auditing of service provision.

We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which correspond to Regulations 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.