Archived: South Quay Care Home

South Quay is a care home which provides accommodation and care for up to 58 people across two separate wings. One wing provided nursing and personal care for older people. The other wing provided nursing and personal care for those with a neurological condition. During our inspection there were 12 people on the neurological unit and 39 people on the older person's unit.

People’s experience of using this service and what we found

Staff deployment and organisation differed between shifts on the older people’s wing. Some people told us that more staff would be appreciated. We have made a recommendation about staff deployment.

Medicines were generally managed safely. We identified shortfalls with certain aspects of medicines management including the recording of topical medicines. The registered manager told us that this would be addressed.

People told us they felt safe. There were no ongoing safeguarding allegations. Safe recruitment procedures were followed.

Staff supervision and appraisals had not been carried out as planned. The registered manager had a plan in place to address this issue. Staff however, told us that they felt supported and the registered manager’s door was always open to discuss any concerns. There were gaps in certain training. Ongoing training was being carried out.

We received mixed comments from people and staff about the quality of meals. The registered manager was aware of this issue and had already held meetings with kitchen staff to address this matter.

Records did not always demonstrate people were supported with their nutritional and hydration needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People were positive about the caring nature of staff. We observed positive interactions between staff and people.

Care plans did not always reflect people’s needs and staff did not fully record the care they had given, such as support with personal care. This meant it was difficult to check whether care and support had been provided as planned. People’s social needs were not always met.

There was a complaints procedure in place. Formal complaints were recorded and responded to. However, it was not clear how informal concerns and complaints were managed and monitored.

During the inspection we identified shortfalls with various aspects of the home, especially relating to the maintenance of records. There was a new registered manager in post. She was supported by two ‘unit managers.’ Both unit managers had a small number of supernumerary hours each week to carry out management duties. It was not clear whether there were sufficient management hours/oversight to ensure improvements were made in these areas.

The registered manager was open and honest about the improvements which were needed. She said that changes were being introduced gradually. This was to ensure that improvements were more likely to be maintained in the long term.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 16 July 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found certain improvements had been made; however, further action was required, and the provider was still in breach of regulations.

This is the second consecutive time this home has been rated requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We identified breaches in relation to person-centred care and good governance. Please see the action we have told the provider to take at the end of this report. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Notification of other incidents and issued a fixed penalty notice which the provider has paid. Full information about CQC's regulatory response found during the inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously inspected South Quay Care Home in April 2016, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

South Quay 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.

South Quay accommodates a maximum of 58 people across two separate units. One of the units is for older people. One of the units specialises in providing care for people with a neurological condition. During our inspection there were nine people on the neurological unit and 33 people on the older person’s unit. Some people who used the service received nursing care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Required improvements to fire doors, bathrooms and the outdoor space had not been completed by the provider.

Premises had been visited by the provider’s Resident Experience Care Specialist but, as yet, no improvements had been made.

People who required input from physiotherapy had not always received this, whilst some people who required one-to-one support from staff had not always had this planned effectively. Care staff worked extremely hard to ensure detrimental impacts on people were limited due to these provider failings.

There were sufficient staff in order to keep people safe although the provider used a dependency tool more suited to establishing staff levels for older person’s care, whereas one of the units specifically supported people with complex physical needs. We have made a recommendation about this.

Premises were generally clean with infection control practices followed and sufficient domestic staff in place.

Staff had received safeguarding training, were clear on their responsibilities and could give examples of when they had acted effectively to keep people safe.

People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.

Risk assessments were in place and were reviewed regularly, with involvement and advice from external specialists where appropriate.

Medicines administration practices were in line with good practice and the nurse we spoke with demonstrated a sound understanding of people’s medicinal requirements.

Pre-employment checks of staff remained in place, including Disclosure and Barring Service checks, references and identity checks, as well as Nursing and Midwifery Council (NMC) register checks of nurses.

Aside from the concerns regarding physiotherapy, people had accessed external healthcare professionals such as GPs and dietitians to get the support they needed. Staff liaised well with these professionals.

Staff received a range of mandatory training and training specific to people’s needs.

People were encouraged to have healthy diets, enjoyed a range of mealtime choices and were protected from the risk of malnutrition.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Relatives and external professionals confirmed staff had formed good relationships with people.

People were encouraged to remain independent and access their local community, whilst activities co-ordinators encouraged community groups to visit the service. This reduced the risk of social isolation.

The atmosphere at the home was calm and relaxed. Person-centred care plans were in place and reviewed regularly.

People who used the service, relatives and professionals we spoke with gave positive feedback about the staff team but acknowledged the service needed to improve, specifically with regard to the premises. Staff felt they were not always listened to by senior management but worked well as a team and with their immediate line managers.

The culture remained one focussed on caring for people in a dignified, personalised way, but this was largely down to the passion of the care team and not the provider, who needed to make a range of improvements to service provision.

We found the service was in breach of regulation 9 (Person-centred care) and regulation 15 (Premises and Equipment).

You can see what action we told the provider to take at the back of the full version of the report.

We undertook a follow up inspection on 28 July 2015 to look at these two areas. We found that action had been taken to address the previous breaches and no further breaches were noted. We did not change the rating at this inspection because we wanted to be sure that the improvements noted at the home would be maintained. We undertook a further inspection of the home on the 19 April 2016. This was a comprehensive inspection of the home to check that the improvement previously noted had been sustained.

South Quay Care Home is registered to provide accommodation for up to 58 people and is divided into two distinct units; one unit supporting older persons, some of whom were living with dementia, which can accommodate up to 45 people, and a smaller unit offering care and respite facilities to a maximum of 13 younger people with a neurological condition. At the time of the inspection there were 32 people living on the older person’s unit and 12 people using the neurological conditions service. The neurological unit had previously been subject to a separate management and reporting system. This had changed in January 2016 and all elements of the home were the managed by the registered manager for the location.

The home had a registered manager who had been registered since September 2014. 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 told us they felt safe living at the home and felt the staff treated them appropriately. There were systems in place to help protect people from harm or abuse and staff had a good understanding of safeguarding issues. They told us they would report any concerns of potential abuse to the registered manager or the regional manager. Staff were also aware of the registered provider’s whistle blowing policy and knew how they could raise concerns about care.

The premises were effectively maintained and safety checks undertaken on a regular basis. Remedial work on some building and safety issues was being undertaken at the time of the inspection. Some people and staff highlighted that staff could be busy, although people said they were supported with their care in a timely manner and we did not witness long waits when call bells rang. Proper recruitment procedures and checks were in place to ensure staff had the correct skills and experience to support people at the home. Staff told us they had access to a range of learning. They told us, and records showed that regular supervision took place and people had an annual appraisal.

People’s wellbeing was monitored and they had access to general practitioners and other health professionals. Where necessary specialist advice was sought. Medicines were managed safely and effectively.

People told us they had sufficient food and drink. We observed meals served at the home to be hot and appetising. Alternatives to the planned menu were also available to people. People who required special diets or assistance with their dietary intake were effectively supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw that, where appropriate applications had been made to the local authority to restrict people’s freedom in line with the MCA. We saw evidence that assessments and best interests meetings had taken place in relation to people’s care and health needs.

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff had a good understanding of people’s individual needs. People said they were treated with dignity and respect and staff were able to demonstrate how people’s dignity was maintained during the provision of personal care.

People had care plans that reflected their individual needs and these were reviewed to reflect changes in people’s care requirements. There were a range of activities offered for people to participate in. A series of events were taking place to celebrate the Queen’s 90th birthday. People told us they knew how they could raise a complaint, if they needed to. Complaints and concerns were dealt with by the registered manager, using a full and proper process.

The registered manager carried out regular checks on people’s care and the environment of the home. A recently developed electronic feedback system was in place. Comments recorded on the system by people using the service or their relatives were overwhelmingly positive. The registered manager held regular meetings with staff groups. The manager had notified the CQC of accidents and incidents at the home, as they are legally required to do so. Records maintained at the home were up to date and stored securely.

We looked at the care records of six people who used the service. We saw that there were care plans in place related to people's assessed individual needs and that these had been reviewed on a monthly basis.

We spent time observing the care delivered by staff and found that it reflected the information contained within people's care plans. We found that food and fluid charts, positional change records and bedrail monitoring records were up to date and contained no gaps. Daily records were up to date and contained good detail. We examined the medication administration records (MARs) for the unit and found these were up to date and contained no gaps in signatures.

People's needs were assessed and care was planned and delivered in line with their assessed needs. One person told us, 'I love it here. You are treated like one of the family. The staff are great; I have full praise.' Another person said, "The treatment in here could not be better.'

On the day of our inspection there were adequate numbers of staff on both units to meet the needs of people who lived at the home. One relative told us, 'I feel there is always enough staff about. I am here every day and there always seems to be someone around.'

The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

We examined in detail the records of five people who used the service and an additional four sets of records to check particular issues relating to consent and records keeping. We found in some cases records maintained within people's rooms were incomplete.