Archived: Southlands Rest Home

Southlands Rest Home 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. Southlands Rest Home is a home that provides accommodation and personal care for up to 19 people. The majority of people at the home were living with dementia or other mental health conditions. At the time of our inspection there were 16 people living at the home.

The home is owned by Mr and Mrs Sohun. Mrs Sohun is also the 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.

At our inspection in July 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, staffing and good governance. As a result of our concerns Southlands Rest Home was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements. We undertook a further inspection in March 2017 to check the provider had taken action to meet the regulations. We found the provider had made improvements in the quality of care people received and the service was removed from special measures. At this inspection we found these improvements had not been sustained and identified concerns regarding the way in which the home was managed.

There was a lack of managerial oversight within the service. The provider who was also the registered manager had not identified shortfalls with the care people received or poor practices in staff performance. Safeguarding incidents had not been identified and reported to the local authority safeguarding team or to the CQC. There was a lack of understanding with regard to the responsibilities as registered persons to report significant events to the CQC.

Systems implemented to monitor the quality of the care provided had not been sustained and were therefore not effective in ensuring people received the care they required. The provider and registered manager had not ensured that people were at the centre of the service. The culture and values of the home described by staff and the registered manager were not embedded in to practice which meant people’s choices were not always respected. Although people were asked to give feedback on the home, action was not always taken as a result of their comments.

Risks to people’s safety and well-being were not always identified and acted upon. Accident and incident forms were not completed in detail and were not reviewed to minimise the risk of events happening again. Risk management plans were not always followed by staff and did not always fully address the risks identified. There was a smoking room on the ground floor which did not meet with current legislation regarding smoking in care homes. The smell of smoke permeated throughout the ground floor and no risk assessment was in place regarding this. Medicines were not always managed safely. The key to the medicines cabinet was left unattended and we found gaps in the recording of people’s medicines. People and staff told us they felt there were sufficient staff deployed to meet their needs. However, we identified times when people were left without staff support in communal areas which left them at risk.

Safe infection control practices were not followed and areas of the home were dirty with strong malodours. Not all bathrooms and communal toilets had hot water, soap or paper towels. There was no cleaning schedule in place to guide staff. A number of areas in the home required refurbishment although no plans were in place to address this. The provider had not developed a contingency plan to ensure that people would continue to receive safe care in the event of an emergency. Although individual personal emergency evacuation plans were in place the overall fire risk assessment for the premises was out of date. However, fire equipment was regularly serviced.

Staff did not receive comprehensive training or supervision to support them in their roles. Whilst staff were able to describe the training they had received they did not always demonstrate these skills in practice. People did not always receive support from staff who had been recruited safely. We found two staff members did not have any references to guide the provider on their suitability for their role. Staff told us they felt supported by the registered manager.

People’s legal rights were not protected as the principles of the Mental Capacity Act 2005 were not followed. Capacity assessments were not decision specific and best interest decisions were not recorded. Not all restrictions to people’s liberties had been identified when completing DoLS applications.

People were not routinely provided with choices regarding drinks or food. We observed everyone was provided with the same drink and no choices were offered. People’s comments regarding food had not been taken into account and no menu was available. Meal times were task focussed and staff did not take the time to ensure people were comfortable and had the support they required. We received mixed reviews from people regarding the quality of the food provided. People’s dignity was not always protected. People did not always receive personal care in line with their needs and many people looked unkempt. Staff did not always knock on people’s doors before entering.

People did not always have access to activities in line with their needs and preferences. Although some activities were organised there were significant amounts of time when there was no stimulation apart from the television. People had access to health care professionals although this was not always provided in a timely manner. Staff were not aware of people’s past lives and were unable to fully describe people’s care needs and personalities. Care plans did not give up to date guidance to staff regarding the support people required and people’s end of life care wishes were not recorded. Although some people were supported to maintain their independence, others were not provided with the equipment they required in order for them to eat independently.

On the whole staff interacted with people in a kind manner. People’s religious needs were respected as people had access to local church services. Relatives told us they felt welcome when visiting the home and no restrictions were in place on visiting hours. The provider had developed a complaints process which was shared with people and relatives.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

During our inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The home is owned by Mr and Mrs Sohun and Mrs Sohun is also the registered manager. Accommodation is arranged over two floors and there is a communal lounge and dining room available on the ground floor. The home is located on the outskirts of Redlill town centre providing people with easy access to local amenities. There were 12 people living in the home on the day of the inspection.

The registered manager/provider was present for the duration of our inspection. 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 and associated Regulations about how the service is run.

At our last inspection in July 2016 risks to people were not being managed well. At this inspection improvement had been made. However some people who were at risk did not have appropriate management guidance in place for staff to follow in order to manage these risks safely.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required.

There were sufficient numbers of staff on duty to meet people’s care needs. Staff recruitment procedures were safe. Employment files contained all the relevant checks to help ensure only appropriate staff were employed in the home.

Staff met with their line manager on a one to one basis to discuss their work. Staff said they felt supported and told us the registered manager worked with them and was supportive.

Staff were aware of their responsibilities to safeguard people from abuse and were able to tell us what they would do in such an event and they had access to a whistleblowing policy should they need to use it.

People were encouraged and supported to be involved in their care as much as possible. People had individual care plans. These were informative and updated regularly. They also contained information for staff to enable them to be able to respond to people’s needs effectively. However some care plans contained conflicting information that would not provide staff with the most up to date information. We have made a recommendation.

People and staff interaction varied. It was evident that permanent staff knew and understood people’s needs and aspirations better than some agency staff. Staff were caring to people and respected their privacy and dignity.

People were provided with a range of nutritious foods to maintain a healthy diet. People told us the cook was new and had begun to provide good home cooked. We saw people had access to drinks and snacks throughout the day and staff provided support for people to eat and drink when required.

Staff had followed legal requirements to make sure that any decisions made or restrictions to people were done in the person’s best interests. Staff understood the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards (DoLS).

People’s health care needs were being met. However people who were at risk of losing weight required more support.

Staff received a good range of training specific to people’s needs. This allowed them to carry out their role in an effective and competent way.

The registered manager worked in a hands on capacity operated an open door policy and we saw several examples of this throughout the day when staff, relatives and people who used the service sought their support and advice.

If an emergency occurred people’s care would not be interrupted as there were procedures in place to manage this.

Systems were in place to audit and monitor service provision and best practice, in order to improve outcomes for people who used the service. However improvement was required regarding the monitoring of risk management auditing in order to identify shortfalls and act on these.

A complaints procedure was available for any concerns. This was displayed in the home. People and relatives had been provided with a copy of this when they were admitted to the home.

People and their relatives were encouraged to feedback their views and ideas into the running of the home.

At the last inspection in July 2016 this provider was placed into special measures by CQC. We issued three warning notices in relation to breaches of regulations 12, 17 and 18. This inspection found that there was sufficient improvement to take the service out of special measures.

The Home is located in Redhill and is close to local amenities. On the day of our inspection there were 17 people living at the service. The home is owned by Mr and Mrs Sohun. Mrs Sohun is also the 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 and associated Regulations about how the service is run. The registered manager present during the inspection.

Risks were not well managed. When risks to people were identified assessments were not always put in place to minimise the risk of harm to people. These were not supported with guidance for staff to follow to help keep people safe.

There were not sufficient numbers of staff employed to meet the needs of the people who lived at the home which meant people were left unsupported and at risk of harm. Staff recruitment procedures were robust to ensure that staff had appropriate checks undertaken before they commenced employment.

People were not protected from the risk of abuse. Staff had received training in safeguarding adults. They told us they would report anything they were concerned about to the registered manager. We noted an incident in the home the previous week had not been managed well by the registered manager and had not been referred to the local authority in line with safeguarding procedures.

People told us they had their medicines when they needed them. All medicines were administered and disposed of in a safe way.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. When people’s liberty was restricted to keep them safe the provider had applied for an authorisation to the local authority. However they had not followed the principles of the Mental Capacity Act and had not undertaken a mental capacity assessment or held a best interest meeting prior to making the application or to ensure that people could consent to care and treatment.

Health care needs were being met. People had access to a GP, chiropodist, optician and a community psychiatric nurse. Specialist input was also in place on referral from the GP. Staff had received training and supervision. However the registered manager was not able to provide us with a training record or supervision plan as this was not available on the day of our inspection.

People were not involved in their care planning and care plans were not reviewed regularly. People’s bedrooms had mainly been decorated to a good standard and were personalised with their own possessions. People were generally satisfied with the food however nutritional plans were not updated when dietary needs changed which did not provide staff with up to date information.

People were treated with dignity and respect. Staff were polite and addressed people by their preferred name. Personal care was undertaken in private however staff did not time to spend with people or undertake activities with them.

People told us they sometimes felt unsupported by the registered manager. They felt they were not being listened to and their concerns not acted upon. People and relatives were aware of the complaint procedures and told us they would know how to make a complaint. However people had complained about the activities and not being able to watch television and said no action had been taken to address this.

The registered manager had not ensured that accurate records relating to the care and treatment of people and the overall management of the home were maintained. For example risk assessments were either not in place or not up to date, accidents and incidents were not being managed appropriately, care plans were not being reviewed and quality auditing processes were not being undertaken. There were not robust audits taking place that should have identified the concerns found at this inspection.

The overall rating for this service is ‘inadequate’ and had been placed in special measures. Services in special measures will be kept under review and if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this time. If not enough improvement is made within the time frame so that there is still a rating of inadequate for any key questions or overall we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed could be escalated to urgent enforcement action. Where necessary another inspection will be conducted within a further six months, and if there is not improvement so there is still a rating of inadequate for any key question or overall we will take action to prevent the provider from operating the service. This will lead to cancelling their registration or varying the terms of registration. For adult social care services the maximum time for being in special measures will usually be no longer than 12 months. If the service has demonstrated improvements when we inspect it and it is on longer inadequate for any of the five key questions will no longer be in special measures.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014.

Below is a summary of what we found. The summary is based on our observations during our visit, discussions with people who used the service, their relatives, the staff supporting them and looking at records.

Is the service safe?

People told us they felt safe living in the home. They said they could talk to the manager and the staff if they felt upset or unsure about anything. Safeguarding procedures were in place and staff understood their role and responsibility in safeguarding the people they cared for. We saw safe manual handling procedures being undertaken and saw no negative practices during our visit.

The service was clean and safe and provided people with safe access to all areas of the home.

Is the service effective?

People's health care needs were assessed with them whenever possible and written in a care pan. Arrangements were in place for people to visit their GP or to have a home visit when appropriate to monitor their individual health care needs. People also had effective mental health support and had regular contact with a Community Psychiatric Nurse (CPN) or clinician when required.

Is the service caring?

People who used the service told us the staff were very caring and always treated them well. We saw the staff on duty were kind and caring and spoke with people who used the service in a polite and respectful manner. We were told by one person the staff supported them to go out in a taxi to meet friends in the local town. We saw people were supported to eat their meals in a sensitive and caring way and staff took the time to enable people to be as independent as possible. A person who used the service told us that staff always found them something they liked to eat.

Is the service responsive?

The service was responsive to the needs of people who used the service. For example when a risk had been identified the provider responded with an action plan to minimise the risk but allow the individual to be as independent as possible. This included the management of a smoking policy and people using community facilities independently.

Is the service well led?

The home is well managed by the provider who is also the registered manager. They have the support if a deputy manager and well established staff team who have a good understanding of the needs of the people who used the service.

There was a good auditing system in place for the monitoring of service provision and to recognise improvement when required. There were regular health and safety audits undertaken to ensure the health and welfare of people who used the service and to promote a safe working environment. Complaints and accidents were monitored and lessons learnt from the outcome of these.

One person said "the staff are lovely and always help me to go out." Another person told us that "I can come and go as I please and the staff support me to do this"

We saw that people's needs were assessed and that care and treatment was planned and delivered in line with their individual care plan.

We observed that people looked comfortable and relaxed sitting in the lounge and looked well groomed.

We found the premises and grounds were well maintained and clean.

We saw that people had their medication administered safely and in accordance with the home's medication procedures.

Staff told us that they felt supported by the provider and had the training and supervision necessary to undertake their roles.