Archived: South Africa Lodge Nursing Home

The inspection team was made up of two inspectors a specialist advisor and an expert by experience. We set out to answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led? Below is a Summary of what we found.

Is the service safe?

Care plans had been developed for people based on an assessment of needs, however these did not always reflect the person's current needs and there was not always evidence of forward planning for people to ensure their individual needs were met.

Records held for people at the time of our visit did not always reflect the action staff had taken to meet people's needs and ensure they were planning effectively to address changing needs. The provider had recognised this as an area of development for the home and had implemented a plan to address this.

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to care planning and delivery and records.

The provider had a clear policy in place that guided staff about how to report abuse. Staff were knowledgeable of the process and what to look for. We saw recorded evidence that the home worked in partnership with the local authority to ensure people were safe. Our records showed we were notified of incidents of a safeguarding nature. Discussions with the manager showed where allegations of abuse were made the provider took them seriously and investigated, where appropriate.

The provider had an effective system in place to ensure people were protected against the risks associated with the management of medicines.

Is the service effective?

At our inspection in February 2014 we found where people did not have the mental capacity to consent to their care, the provider had systems in place to ensure that they acted in accordance with legal requirements. However, we found that these systems were not always effective as best interest decisions could not be evidenced and outcomes of mental capacity assessments did not reflect the decision to be made. At this inspection we found that the home had made improvements and could evidence that best interests and the application of the mental capacity act 2005. Whilst we saw that before people received any care or treatment they or a relative was asked to provide consent, this was not always sought from a person who held the appropriate legal authority. We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to consent to care and treatment.

Is the service caring?

The staff we spoke with knew people well and were able to describe how they respected people's dignity and promoted independence during personal care. Staff also spoke about 'Explaining' things to people, and said they would 'Chat to people, make sure they are okay.' We asked how they knew the preferences of people who were not able to communicate with them verbally, one said 'We would look through their care plan' another said 'Family members give us ideas, we make them welcome so we can give the best care we can.' Most of our observations demonstrated that staff were kind in their approaches when supporting people, however most of our observations of staff interaction were task focused.

Is the service responsive?

Throughout the day of our visit our observations were a mixture of positive, personalised care and support and task led activity. Care, support and engagement by staff appeared to be dependent upon the staff member at the time. Some staff were seen to be standing or sitting, and not attempting to engage with people. One staff member told us 'They always call out' when we asked about a person who had been calling out for a long period of time. However other observations of staff were positive. We saw some staff engaging in activities such as jigsaws, chats about peoples preferred items, providing discreet reassurance when this was needed. We did not see any structured or planned activities for people for the majority of the day of our visit.

Is the service well led?

The service had a number of systems in place to monitor and assess the quality of service. They were able to demonstrate how they involved others in this process. The provider had recognised the need for positive change to take place within the home and had taking some action to address this. The systems used for auditing or care plans and analysing information from incident or accidents was not always effective in ensuring actions were dealt with to improve the service provided to people. Staff told us that the home was well led. One said '[the manager] is brilliant, and the deputy.' They also said '[manager] knows all the staff's names, and the residents. You can talk to [manager].'

We have asked the provider to tell us what action they will be taking to ensure they meet the requirements set by law in relation to the monitoring and assessing of the quality of the service they provide.

At the time of our visit there were 77 people living at the service. The service is separated into six lodges across two floors, with each lodge being allocated dedicated staff. We reviewed the records for six people, spoke to eight staff, three relatives and three people who used the service. We also spoke to the registered manager, deputy manager and Chief Executive officer.

Where people did not have capacity to consent the provider had systems in place to ensure that they acted in accordance with legal requirements. However, we found that these systems were not always effective as best interest decisions could not be evidenced and outcomes of capacity assessments did not reflect the decision to be made. Staff we spoke to were able to tell us how they supported people to make day to day decisions and relatives told us they were involved in discussions about their relative’s care.

We found that people's needs were assessed and saw that staff treated people in a kind and gentle manner respecting their dignity at all times. There were enough suitably qualified, skilled and experienced staff working who had an in depth knowledge of people’s needs. Where people required additional support this was provided.

We found that the service had made improvements to the records they held for people. We found these were clear, consistent and reflective of people’s support needs.

The provider sent us an action plan detailing how they would work to improve this. They told us they would achieve compliance by the end of July 2013. At this inspection we reviewed the progress the provider had made in taking action to ensure compliance in the area of concern.

At the time of our visit there were 86 people using the service. We spoke with staff and reviewed the records for eight people. We found that the provider had not taken appropriate measures to achieve compliance. We found that records relating to people were not accurate and did not provide clear and up to date information. Therefore people were not protected against the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not always maintained.

Our observations demonstrated that staff understood people's needs well. People we spoke with told us that they liked the staff and staff were 'helpful'.

Systems and procedures were in place to monitor the quality of the care. We saw that people had opportunities to raise concerns and we saw that when this happened the home responded positively.

We reviewed care records of five people using the service and found that these were not always accurate and up to date.

Our observations told us that people's people's privacy was promoted and how dignity was supported.

People and their relatives told us that they were happy with the care that they received and that staff were friendly and kind. We saw that staff were responsive to requests for help. A relative told us they were 'on the whole happy' but raised a concern that they found some staff hard to understand where English was not their first language.

Relatives told that they would have no problem to speak to a member of staff if they felt concerned. Staff were knowledgeable on safeguarding matters.Records confirmed that a training programme was in place for staff that included safeguarding.

Care was delivered by staff that understood and were trained to care for people with a variety of nursing and care needs including dementia. Staff told us that they 'enjoyed the training.' Staff were supported through regular supervision.

Systems and procedures were in place to monitor the quality of the care. People told us that they would be happy to raise concerns. A relatives committee was seen to be having a positive influence on the quality of care.