2 and 7 July 2015
During a routine inspection
This inspection took place on 2 and 7 July 2015. The first day of the inspection was unannounced and the second day was announced.
Southfields Care Home is a large property providing accommodation over two floors. The provider delivers a service for three adults with learning disabilities, mental health needs and/or physical health needs.
The service did not have a registered manager. The previous registered manager had recently resigned and an acting manager had been in place at the service since May 2015. 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 home is one of two homes that the provider has in the local area. The home had five support workers and a senior support worker. There had been changes to the senior management team with the registered manager for both homes and the locality manager leaving recently which meant the home did not have a qualified manager to ensure the service was meeting the fundamental standards. We carried out this inspection to assess whether people were receiving safe, effective, caring, responsive and well led care. We found breaches in the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014.
Not all risks to people had been recognised and assessed. Action had not always been taken to keep people safe. We found risk assessments had not been reviewed and changed to make sure they were up to date and accurate. Staff knew how to recognise some of the different types of abuse and said they would report any concerns to the manager, they were unsure of how to report abuse to other agencies outside of the service. Staff did not have the knowledge to meet people’s needs and deliver care in the way they needed them to.
Care plans and behaviour plans were not up to date and information was held in different places making it difficult to find. Despite the care plans being recently reviewed, information was not always accurate and did not reflect changes in people’s needs. Staff were using conflicting and out of date information.
Medication practices were not always safe. People received their medication on time however medicines were kept in an unsafe manner. Arrangements for taking medication away from the home needed improvement. Medication stock control systems were not robust enough to prevent the possibility of medication being mis-managed.
Health action plans were not in place for two of the people who used the service. Health action plans hold information about the person’s health needs, the professionals who support those needs and various appointments. Because health action plans were not in place for everyone who used the service, this meant their overall health needs potentially were not identified or addressed.
The service was not well led and the staff lacked the direction and support they needed to meet people’s needs and provide care safely. The Care Quality Commission has a statutory duty to monitor the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005 (MCA). The aim is to make sure that people in care homes, hospitals and supported living who lack the capacity to make decisions for themselves are looked after in a way that does not inappropriately restrict their choices.
The provider did not follow the principles of the Mental Capacity Act 2005 to make sure that any decisions that were made for people lacking capacity were made in the person’s best interests. Some DoLS applications were needed and had not been made. We were concerned that the process and paperwork had not been followed rather than any deprivation of liberty in operational practice. We have asked the provider to send us the statutory notifications regarding Deprivation of Liberty safeguards (DoLs) for people who use the service.
We saw that people's nutritional and hydration needs were met but were not always monitored effectively.
People were not always involved in assessments of their needs and the planning of their care. Care plans did not include information on what people could do well or what their personal goals were.
We saw that people were supported to make complaints. The complaints process was in a format people could understand and the service encouraged people to give feedback.
Relevant recruitment checks were made to make sure staff were suitable to work at the home.
We found a number of breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulation 2014 in relation to requirements relating to registered managers, person centred care, need for consent, safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.