We carried out a review of the data available to us about Southgarth Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Southgarth Care Home, you can give feedback on this service.
Southgarth Care Home is registered to provide personal care for up to 25 older people, including people who may be living with mild dementia. The home is a converted Victorian building, located 1.5 miles from the town centre of Exmouth. There are 21 bedrooms. Four of them were registered as shared bedrooms however only occupied by one person (maximum capacity therefore reduced to 21. Some bedrooms had ensuite facilities. At the time of the inspection, 20 people were in residence.
People’s experience of using this service and what we found
People were safe. This was because the staff team received safeguarding training and understood their responsibility to keep people safe. There was a process to be followed to report any safeguarding issues to the local authority and the staff team were aware of this. There were good risk managements in place to ensure people’s health and welfare was not compromised. The number of staff on duty for each shift was calculated based upon each person’s care and support needs. Pre-recruitment checks ensured new staff were recruited safely. Checks included written references and a Disclosure and Barring Service check. Medicines were well managed and administered by those staff who had been trained and were competent. People received their medicines as prescribed.
The service was effective. The assessment and care planning arrangements ensured each person’s care and support needs were met. Staff training had improved and was consistent. New staff completed an induction training programme. The registered manager had ensured all other staff completed the programme of mandatory training to keep their knowledge and skills up to date. People were able to access the healthcare support they needed with the staff team making any arrangements as required. People received the food and drink they needed to maintain a healthy, balanced diet. Any preferences they had regarding food and drink were accommodated.
People were encouraged to retain as much choice and control of their daily lives and staff supported them in their best interests. The service was meeting the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards.
The service was caring. People were looked after by staff who were kind and friendly and listened to what they had to say. Since the registered manager took up post there had been a significant turnover in staff. Feedback we received from people and their relatives evidenced this had been positive for people because the staff team were now better. They received person-centred care and made their own decisions about their daily life. The staff team were fully aware of each person’s specific needs. People looked well cared for.
The service was responsive. Each person was involved in drawing up their care plan and having a say in how they wanted to be looked after. The plans were reviewed monthly and amended as and when needed. This meant any changes in care needs were accounted for and people continued to be looked after in the way they wanted. The service endeavoured to continue looking after people who became very ill or had end of life care needs. They achieved this working in conjunction with family and healthcare professionals..
People were able to participate in a range of activities and were continually asked what they would like to do. There were no restrictions on visitors and where possible, people were able go out independently, or with staff support.
The service was well led. The registered manager provided good leadership for the staff team and had a plan of further improvements they planned to make to the service. Quality assurance systems and regular visits by the provider/support manager ensured the provider knew what was happening in the service. People were very much at the centre of all decision making in the home and their views and opinions were listened to and acted upon.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection
The last rating for this service was Good (published 28 July 2017).
Why we inspected
This was a planned inspection based upon the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the last inspection November 2015, we gave the service an overall rating of ‘Good’. However we rated the ‘safe’ domain as requires improvement because we found a breach of regulations. This was because the provider had not ensured the premises were safe for people using the service. At this inspection we checked that they had followed their action plan and to confirm that they now met legal requirements. We found improvements had been made and risks to people were being safely managed. At this inspection we found the service remained good.
Why the service is rated good.
Individual risks to people’s safety had been assessed and care plans written to show how these were being addressed. At the last inspection we had identified people were not protected by an effective system to assess and monitor the health and safety risks at the home. This was in relation to vulnerable people having access to hot taps in sinks which exceeded the Health and Safety Executive (HSE) recommended temperatures. At this inspection all communal baths and wash basins had thermostatic mixing valves (TMVs) in place. An assessment of risk had been undertaken for each person regarding hot water outlets in their rooms. Where a risk had been identified a TMV had been fitted. This meant people were kept safe from the risk of scalds from hot water outlets
Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs and gave staff clear guidance about how to support them safely. Care plans were person centred and where able people and their families had been involved in their development and ongoing reviews. Staff were very good at ensuring people where able were involved in making decisions and planning their own care on a day to day basis. People were referred promptly to health care services when required and received on-going healthcare support.
Medicines were safely managed and procedures were in place to ensure people received their medicines as prescribed.
People were supported by staff who had the required recruitment checks in place. Staff received an induction and were knowledgeable about the signs of abuse and how to report concerns. Staff had received training and developed skills and knowledge to meet people’s needs.
There were adequate staffing levels to meet people’s needs. The registered manager and deputy manager undertook a lot of shifts and stepped in to fill staffing gaps. They were working with the provider’s area manager to actively recruit where they had vacancies.
People received person centred care. Staff knew people well, understood their needs and cared for them as individuals. People were relaxed and comfortable with staff that supported them. Staff were discreet when supporting people with personal care, respected people’s choices and acted in accordance with the person’s wishes.
Staff relationships with people were caring and supportive. They delivered care that was kind and compassionate. People said staff treated them with dignity and respect at all times in a caring and compassionate way.
People’s views and suggestions were taken into account to improve the service. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them. They fed back to us that the service escalated concerns appropriately and in a timely manner.
Staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments were completed and best interest decisions made in line with the MCA.
The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provide legal protection for those vulnerable people who are, or may become, deprived of their liberty. They had made appropriate applications for people they had assessed that required to be deprived of their liberty to the local authority DoLS team.
People were supported to follow their interests and take part in social activities. A program of activities was available for people to attend as they chose. The provider was looking at ways of improving activity provision further at the service.
People were supported to eat and drink enough and maintain a balanced diet. People and relatives were very positive about the food at the service. People were seen to be enjoying the food they received during the inspection.
The provider had a range of quality monitoring systems in place which were used to continually review and improve the service. There had been one complaints received at the service since our last inspection. This had been responded to in line with the provider’s policy. The registered manager undertook regular duties and dealt with niggles or concerns as they occurred.
The premises were well managed to keep people safe. The home was clean and homely with a welcoming atmosphere. Systems were used to ensure the environment was kept clean and safe with audits being completed on all aspects of the building and equipment. There were emergency plans in place to protect people in the event of a fire or emergency.
Further information is in the detailed findings below.
We carried out an unannounced comprehensive inspection on 19 and 20 November 2015. We last visited the service in August 2014 and found the service was compliant with the standards inspected and no breaches of regulations were found.
Southgarth Care Home offers accommodation with care and support for up to 25 older people. There were 19 people using the service when we arrived on the first day of our inspection and two people moved into the home during the time of the inspection.
There was a 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.
People said they were happy to approach the registered manager if they had a concern and were confident that actions would be taken if required.
People were not protected by an effective system to assess and monitor the health and safety risks at the home. The provider had identified through their assessment process temperatures of hot taps in sinks in all rooms exceeded the Health and Safety Executive (HSE) recommended temperatures. However no action had been taken to ensure these didn’t pose any risk to vulnerable people at the service.
There were sufficient and suitable staff to keep people safe and meet their needs. The staff and registered manager undertook additional shifts when necessary to ensure staffing levels were maintained. However this meant the registered manager had undertaken a lot of additional shifts which meant they were rushed and having to prioritise their managerial duties.
Risk assessments were undertaken for people to ensure their health needs were identified. Care plans reflected people’s needs, they were personalised and people had been involved in their development. Care plans were regularly reviewed with the person to ensure they remained current and effective. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.
People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place. People’s needs and risks were assessed before admission to the home and these were reviewed on a regular basis.
People could choose from a menu which was regularly reviewed and updated and took into account people’s choices and preferences. People were very positive about the food provided at the home. Staff were polite when supporting people who used the service. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted.
The registered manager and staff demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed and best interest decisions made in line with the MCA.
People had access to a rolling programme of activities at the service. People were encouraged and supported to develop and maintain relationships with other people at the service and avoid social isolation.
The recruitment process at the home was robust and required recruitment checks were carried out. New staff received a thorough induction that gave them the skills and confidence to carry out their role and responsibilities effectively. Staff received regular training and updates when required and several staff were undertaking higher level qualification in health and social care. Staff had a good knowledge of how to safeguard people from abuse.
We found one breach of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.
Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.
If you want to see the evidence that supports our summary please read the full report.
This is a summary of what we found:
Is the service safe?
People had been cared for in an environment that was safe. Medication was securely stored and administered by competent staff.
The care home took all reasonable precautions to check that they only employed staff who were safe to work with vulnerable adults.
CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place. The registered manager was planning to take advice regarding the recent Cheshire Judgement and how it might apply to Southgarth.
Is the service effective?
People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care needs and that they knew them well. One person told us "They've changed my life being here. They run the home well."
Is the service caring?
People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. We observed staff encouraging and supporting one person to transfer from a chair to a wheelchair. One relative we spoke with told us that Southgarth was "homely" and that "(My relative) has said I am happy here, I like it here." A person who lived at the home told us "They look after you well here. I think I am happy with it, it is nice to have somebody look after you if you have a fall or something."
Is the service responsive?
People's needs had been assessed before they moved into the home. Following a recent incident the assessment process had been improved which will make the service safer for individuals in the future. People had individual care and support plans that were designed to ensure that their needs were met.
Is the service well-led?
There were extensive quality assurance processes in place. We saw questionnaires were used to find out what people, and their families, thought about the services they received. These were backed up with meetings for people living in the home and their families. We were told, by relatives and a visiting health care professional, that when the registered manager's attention was drawn to issues they responded and things were changed as a result.
The home carried out regular internal audits and monitored how they progressed towards implementing improvements. They also sort the opinion of professional advisors, for example, they used a pharmacy to carry out annual audits of the medication management systems.
People who lived in the home were positive about the care and support they received. Comments included 'you couldn't find a better place' and 'staff meet my needs, everything is done to my liking'.
Care workers knew how to report concerns to ensure people were protected from the risk of harm. People who lived in the home told us they felt safe.
We found that there were enough care workers on duty to meet people's needs. Care workers were experienced and knew the people well. They had received appropriate training and professional development which enabled them to carry out their job role effectively.
The home had a comprehensive quality assurance system to assess and monitor the quality of the service. People told us that their comments were listened to and acted upon.
We found that some items in the first aid box had passed their expiry date. The provider took action to remedy this.
Since our last visit the registered manager had left the home. A new manager had been appointed and started just three weeks prior to our visit. They told us that they were still learning about the people living there and were undertaking an induction and training programme. They told us that they felt they would have enough time to be able to manage the home effectively once they had settled in.
We spoke with 5 people living at the home, six staff and one relative (on the telephone). We also spoke with six people who were sitting in the small lounge. Because of the complexities of their illnesses, some people were unable to tell us about their experience of living at the home. Therefore both direct and indirect observation was used to assess the wellbeing and happiness of people in the home, as well as speaking with them. People living at the home that we spoke with were happy with the care they received and we did not see any practice that gave us cause for concern.
People we spoke with said they felt well treated and their privacy and dignity were respected. We saw signs of well being and many examples where people were being treated with respect by staff. People moved freely around the inside of the home looking relaxed and comfortable. People who spent their time in bed were warm and looked clean and free from pain. Information about visits from and to health care professionals had been recorded in individual care plans, showing clear evidence that people are supported to maintain access to specialist medical services.
We toured the communal areas of the home and looked in some bedrooms. The home was generally clean and tidy throughout. However, the provider may wish to note that there was one corridor and one bedroom where there was a strong unpleasant smell.
People that we spoke with praised all the staff who work at the home. One person told us that 'there are some very clever staff here, you couldn't get better no matter where you went or what you paid'. Another told us that staff were caring but did not often have time to sit and talk they said that "they are always on the go, they flop down in that chair when they do stop to chat. They are just so busy'. We were also told that "staff are very good, but always seem to be short staffed, they are tired by the end of their shift after working 8-8". People also told us that staff always 'spoke nicely', 'treat me well' , 'always ask what I want' and that they 'can talk to anyone' if they were unhappy.
We were able to talk to staff and observe them while they provided care and support to people who use the service. We heard staff speaking with people in a kind and respectful manner and they responded promptly, discreetly and sensitively to people when they asked questions or needed help.
On the day of our visit there were 17 people living at the home. On duty during the morning were three carers, the chef, a cleaner and the new manager. During the afternoon there were two carers and the manager on duty. Care staff have to prepare evening meals ' during our visit afternoon care staff were in the kitchen making sandwiches. The new manager told us that there was also a maintenance man on duty and that each night there were two care staff awake.
Staff were able to tell us about different types of abuse and what they would do if they suspected abuse was occurring. However, they told us that the training they received was limited and that it was more just a 'refresher than proper training'.
At our last visit we found that there were systems to monitor and audit the quality of services. However due to limited management time these audits were not always robust and did not always raise issues that may affect risks to people who lived in the home. The systems for involving people living in the home and obtaining their opinion of the service were erratic. At this visit we found that there had been no overall improvement.
We spoke with three relatives and two friends of people living in the home, all said they found the home welcoming and the staff to be very caring and friendly. Relatives said they were kept informed of any changes to their relative's care and said they were involved in decisions about care when appropriate.
We observed staff speaking with people in a kind, patient and respectful manner. Staff were cheerful but very busy. We spoke with some people who spent most of their time in their bedrooms. They told us the preferred spending time in their rooms and were not keen to join in any activities. Some said they would have enjoyed some company at times but understood that staff were busy.
We asked people if they were involved in decisions about their care and if reviews of their care were discussed with them, only one person said yes. We noted that monthly reviews of people's care plans are recorded but they do not involve the person who is receiving the care. We were told by staff this would take too long. The manager told us that yearly reviews take place where the person in the home, the funding authority and relatives are involved. The manager also told us she attempts to have house meetings but staff time pressures do not always enable this to happen.
People told us the food was 'wonderful'. People said they had plenty of drinks and biscuits throughout the day. We observed people had jugs of drinks in their room. People said they were given a choice of meal each day but could not remember being involved in decisions about what food went on the menus. At lunchtime, before people had come into the dining room, we observed staff pouring drinks of blackcurrant squash into glasses and placing them on the tables. We did not observe staff asking people if they were happy with these drinks or being given a choice. This was confirmed by people when we asked if they are given a choice of drinks, they said no. The manager told us they had found that people preferred blackcurrant to orange squash, however other flavours or types of drinks had not been considered. In one person's care plan it stated they preferred lemon squash to drink.
We observed meals being served sporadically. People on each table were not served their meals at the same time. We observed one person had their food but did not want to start eating until the others at the table had been served. The remaining people at the table were last to be served. This meant the person's food who had already been served on that table was at risk of going cold. The manager told us this does not normally happen, usually the cook plates up meals by table. We observed staff bringing meals to people, they did not explain or remind people what the meal was, or ensure they were still happy to have it.
People living in the home told us they liked the staff and found them caring and helpful but often busy. Many people felt they did not like to disturb the staff because they were too busy. One person told us they found one member of staff rude. This was raised with the manager at the time of our visit. The manager told us she would investigate further.
People told us that staff have very little time to sit and chat with them, apart from when they are carrying out personal care. We were told that house meetings with people living in the home are irregular.
During our visit, we observed people in their bedrooms and in the two lounges of the home. We noted throughout the visit there was very little engagement between staff and people, other than passing comments. Although staff were cheerful and friendly they did not appear to have time to spend talking to people or engaging in activities. At lunchtime, staff served people their meal but the conversation between people and staff was limited.