Southfields

We found the following examples of good practice.

Visits to the service were by appointment only and checks are completed on all visitors to the home to ensure they have a negative Covid-19 test result and where required have been vaccinated against Covid-19. Temperatures were also taken, and visitors were asked to sanitise their hands and to wear face masks. Arrangements were in place for visitors to meet people in dedicated places within the service, to minimise the risk of infection transmission.

Staff planned how many people could stay safely at the service by the layout of rooms. The layout of the building has been designed to support people to socially distance while continuing to spend time with each other and staff. Staff had put in a one-way system in the home to reduce direct contact between people, minimising risk of transmission. Staff supported and encouraged people to socially distance as much as possible. There were flats with separate entrances to use to minimise the spread of infection if required.

Staff worked closely with people, their relatives and health and social care professionals to ensure people were admitted to the service safely. Prior to people arriving, staff spent time getting to know people and discussing their expectations in regard to the home and infection control measures as they recognised anxiety has increased. We saw that the service used a range of materials and communication guides to support people in understanding the pandemic and the procedures in place.

The service had good supplies of personal protective equipment (PPE) such as face masks and hand sanitiser, these were readily available at stations throughout the service. Some people staying at Southfields could not wear masks, so staff provided clear pop-up screens which kept people safe but also made them feel more comfortable.

People and staff were following government guidance and the the current Covid-19 testing programme to quickly identify any infections. Staff completed infection control training and a nurse delivered training on how to wear PPE safely. Each member of staff also completed 'test and trace' Covid-19 training. During the pandemic lockdowns, a team of staff stayed at the service to support people. Staff were divided into bubbles to support each service user and minimise crossover of staff.

Enhanced cleaning practices were in place and the building looked clean and well ventilated. There were infection preventative and control policies in place which were updated in line with government guidance. Updates were shared with staff daily.

The service had not been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. However, the values that underpin the guidance such as offering choice, promotion of independence and inclusion were evident in the support people received from staff so they can live as ordinary a life as any citizen.

People’s experience of using this service:

• At our last inspection in January 2018, the provider had failed to complete essential maintenance work in a timely manner. People’s care plans contained information about how they liked to be supported, however, there was further scope to increase people’s independence and plan how they wanted this to be achieved. Feedback on ways to enhance the service was not consistently acted upon and, although the provider had identified they wanted to start to complete formal audits, these had not yet started.

• At this inspection improvement was made and the previous breach in regulation was met. The provider had invested in the property and renovation work had been completed. Care plans were detailed, they clearly set out how people wanted to be supported and reflected people’s goals and ambitions. Systems to assess, monitor and improve the service were robust and effective.

• The quality of care people received had significantly improved since the last inspection, records were up to date and reviewed, guidance was in place for staff to consistently support people.

• The management team continuously reviewed medicines practice, including availability and storage to ensure people received their medicines safely.

• The provider had carried out necessary checks to ensure staff were suitable to work with people. Staff levels reflected people’s needs and ensured there were enough staff to support people.

• People were happy, and staff engaged with people in a kind and caring way. People were busy when we visited and engaging in activities and outings.

• Feedback from a relative and our observation of the care provided were positive. Communication from staff was good and we saw the registered manager and staff were approachable. People and relatives commented on the caring attitudes of staff. People and relatives felt able to raise concerns if they had them.

• Staff had the skills and training needed to support people and were supported by the registered manager. People were encouraged to increase their independence. The service supported people to maintain relationships with family and friends.

• People were involved in the running of the service and were consulted on key issues that may affect them.

• The registered manager and staff worked with a clear vision for the service.

Please see more information in Detailed Findings below.

Rating at last inspection:

The service was rated Requires Improvement at the last inspection on 5 and 16 January 2018. Following this inspection, the service is now rated as Good.

Why we inspected:

This inspection was part of our scheduled plan of visiting services based on their previous rating to check the safety and quality of care people received.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

Southfields is registered to provide accommodation and personal care for up to 15 people. It is a respite service, offering overnight stays for people with learning disabilities, who usually live with family members or carers. Some people stayed at the service for longer periods of time, until a more appropriate placement could be found. People in respite services 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. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

Downstairs there was a kitchen, dining room, activities area, lounge, several bedrooms, sensory room and bathrooms. Upstairs there were more bedrooms and bathrooms. Two training flats were available to support people to become more independent. There was a large garden to the rear of the service with seating which people could access freely.

The service had a registered manager in post. A registered manager is a person who is 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.

We last inspected Southfields in October 2016 when three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified. We issued requirement notices relating to safe care and treatment, person centred care and good governance.

At our inspection in October 2016, the service was rated 'Requires Improvement'. We asked the provider to take action and they sent us an action plan. The provider wrote to us to say what they would do to meet legal requirements in relation to the breach. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Some improvements had been made, and the previous breaches found at our last inspection had been met. However, we found one new breach of the regulations. This is therefore the second consecutive time the service has been rated Requires Improvement.

At our previous inspection we found that the service was ‘dated’ and required modernisation. At this inspection we found that essential maintenance works, such as fixing the front door and replacing the flooring in the dining room had been delayed. Although the registered manager had continuously chased the provider’s maintenance department there had still been a delay, and this had impacted on people. We were told people were confused and their regular routines were disrupted by not being able to use the front door. The service was clean and people were protected from the spread of infection. Improvements had been made regarding fire safety within the building.

Previously, we had found that people’s care plans did not contain the necessary level of detail to give staff the guidance they needed to assist people safely and in line with their preferences. Since our last inspection staff had re-written each person’s care plan, involving people and those important to them. There was now clear guidance in place regarding how to assist people with potentially unstable healthcare conditions, such as diabetes and epilepsy. Before people started using the service they were given the opportunity to visit, and attend tea visits and a full care plan was written to ensure staff had the necessary guidance they needed.

Although people’s care plans had been re-written they did not contain formalised goals which people were working towards. Throughout the inspection we observed staff doing things for people, such as getting them drinks and providing food. People received the care they needed but were not given the opportunity to complete these tasks themselves. A representative of the provider told us they were in the process of changing people’s care plans to ensure there was a greater focus on encouraging their independence. They agreed this was an area for improvement, and is something we will follow up at our next inspection.

At our last inspection staff and the registered manager had not always acted on feedback from people. People now completed monthly questionnaires regarding their stay at the service and the results were published on a notice board. Staff told us this prompted them to follow up on any issues that were raised. Although this situation had improved, we found in team meeting minutes senior staff had dismissed concerns regarding activities raised by an external professional and no action had been taken to address them. We discussed this with both the registered manager and a representative of the provider and they had been unaware of the concerns raised. We made a recommendation about ensuring feedback is fully responded and listened to. Complaints were documented and responded to in line with the provider’s policy.

Staff, people and their relatives all told us that the registered manager was approachable and they felt the service was well-led. A representative of the provider and the registered manager both told us their vision for the service was an integrated approach between children’s and adult respite services, and to ensure an easy transition between the two. They told us they wanted to increase people’s opportunities to do more for themselves. This would ensure the service was working in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen. Staff were kind and caring and treated people with respect and dignity.

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. Staff had an understanding of The Mental Capacity Act (2005) and when people lacked the capacity to consent to staying at the service, the registered manager had applied for Deprivation of Liberty Safeguards (DoLS.) People were involved in making decisions about their care and staff knew how to communicate with them.

The registered manager and senior staff completed a range of checks and audits on the service. A representative of the provider told us they were planning to introduce formal checks, including spot checking files and observations on staff. This had been documented on an action plan, but had not yet been put into place. As such, this was an area for improvement. The registered manager was fully aware of their regulatory responsibilities and had notified us of any important events that had happened in the service. The rating was displayed clearly and legibly on a notice board in the hallway. Staff were recruited safely.

Health and social care professionals fed back that they had good working relationships with the registered manager and staff, and they had worked well together to support people with complex needs. The registered manager had reported any potential safeguarding concerns to the local authority safeguarding team and staff told us they knew how to recognise and respond to abuse. People were protected from the risk of discrimination. Any incidents that occurred were clearly documented and the registered manager looked for ways to prevent them from happening again.

People were supported to eat and drink safely. When people had specific dietary needs, such as for cultural or religious reasons these were catered for. People were supported to lead healthy lives and see health care professionals when necessary. Medicines were managed safely.

There were enough staff to keep people safe. Staffing levels changed depending on the needs of the people using the service. Staff received the necessary training and met regularly to reflect on their practice. On the second day of our inspection the service was not providing support to people for a week, as staff were receiving training.

The service was not currently supporting anyone at the end of their life.

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

Downstairs there was a kitchen, dining room, activities area, lounge, several bedrooms, sensory room and bathrooms. Upstairs there were more bedrooms, bathrooms, and a games room which was not in use as it was being redecorated. Two training flats were available to support people to become more independent. There was a large garden to the rear of the service with seating which people could access freely. People using the service had a range of physical and learning disabilities. Some people were living with autism and some required support with behaviours that challenged.

The service had a registered manager in post. A registered manager is a person who is 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. The registered manager had taken up post at Southfields in July 2016 and was also the registered manager of two other services within the providers group.

Some risks relating to health care conditions such as epilepsy and diabetes had not been assessed fully. Other assessments had been completed to support people to remain safe.

Safety checks had not identified the risks of fire doors being propped open. Emergency evacuation plans lacked enough information about how people required support from staff. The provider had not done everything reasonably practical to reduce the risk of harm to people.

The service lacked oversight and improvement was not driven. People’s feedback was obtained with the view of improving the service, but action was not taken or recorded to demonstrate the improvements that had been made.

Care plans lacked enough person specific detail which meant people may be at risk of receiving inappropriate support particularly as the service was utilising a lot of agency staff to cover shifts. People’s behavioural guidelines lacked enough information to guide staff to manage incidents well. Support plans were not individual and were written in a generic format.

It was not possible to see if all staff had received regular supervisions as a general supervision matrix was not available. The registered manager did not have good oversight of this and relied on the team leader’s assurance that supervisions were up to date.

Areas of the service were worn and dated; paint was flaking away from walls in the dining room and lounge. The provider planned to refurbish all areas of the service but a confirmed date had not been agreed.

Staff were aware of their responsibilities in relation to keeping people safe. They knew how to report any concerns to their manager and also to agencies such as the local safeguarding team or the Commission.

There were safe processes for storing, administering and returning medicines; medicines were administered by trained staff.

Accidents and incidents were recorded and audited to identify patterns and the registered manager used this as an opportunity to learn and improve outcomes for people.

Staffing was sufficient, staffing numbers varied according to the placements which were being supported. A dependency tool was used to work out the required number of staff needed depending on people’s individual needs.

New staff underwent an induction which prepared them for their role and did not work unsupervised until assessed as competent to do so. Safe and robust recruitment process were in place to ensure people were supported by appropriately checked staff.

Staff demonstrated caring attitudes towards people and showed concern for people’s welfare. When people required to be supported with their anxieties staff did this in a patient and compassionate manner.

People were supported to make their own decisions and staff gave people information to make an informed choice. When people’s choices posed a potential personal risk this was respected. Staff demonstrated they understood people well.

People's needs were assessed before they started using the service. People's healthcare needs were managed well. If people became unwell when using the service staff supported them to see a doctor.

People had choice around their food and drinks and staff encouraged them to make their own decisions and choices.

Staff felt positive about the future of the service and were positive in the feedback they gave about the registered manager who they found supportive and approachable. The registered manager understood the key challenges of the service and had spent time building relationships with the staff to improve morale in the team.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report.

We saw that people were treated with respect and dignity. People were supported to be independent in line with their individual abilities and to make choices about their daily lives.

People's needs were set out in their individual care records which were kept up to date and regularly reviewed. The information provided staff with guidance about how to meet people's needs in the ways they preferred and about how to promote their health and welfare. People told us they liked the service, one person told us ' It's happy and they help you a lot, I'm very happy here'

The service made sure that they worked in co-operation with other health and social care professionals that supported people.

Staff told us that they were well supported and they received the training they needed for their role. They also had opportunities for further professional development. People told us they liked they staff. One person said 'They are pretty good, I can chat to them when I want to'.

Whilst it had not received any complaints, the home had a complaints policy and procedure in place that was available in an accessible format for people.

People had an assessment of their needs and had their needs met when using the service. They told us they were happy with the care and support they were receiving. One person said 'I am happy with X being here'. Relatives told us 'X thoroughly enjoys it' and 'X really loves it'. Other comments from relatives included 'X asks when the next visit will be' and 'I am happy because X is happy'.

People were involved in decisions about their care and their daily lives. People told us they felt listened to. We saw that people had their privacy respected and staff promoted their dignity. Everyone had their own private space and had access to the facilities they needed in the service.

There were systems in place for checking the safety and suitability of the building. The manager also regularly checked the quality of the service and took action to improve things when needed. People told us they were happy with the staff that supported them. We found that staff had the skills they needed to care for people and meet their needs.