Archived: Southfields House

There was a registered manager in post at the time 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 2008 and associated Regulations about how the service is run.

At this inspection we found breaches of four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches we identified were in relation to medicines management, risk assessing, nutritional monitoring and support, safeguarding people against abuse and in relation to how the service was being run. At our last inspection the service was rated as 'Requires Improvement.' You can see the action we have asked the provider to take at the end of this report.

People's risk assessments and care plans did not always reflect their current needs. Risks to people had not always been accurately calculated and this put people at risk of receiving unsafe care and support.

Medicines were not being safely managed, stored or administered at the service and although an action plan was in place to improve medicines and how they were being managed, some of the issues we identified had not been identified by the registered manager. There had been eight substantiated safeguarding investigations into people who had not received their medicines as required over the period of two months.

People were not being adequately supported with their nutritional needs and there was confusion within the service about how people's meals were fortified. This was not always happening as required. People had not always been referred to the dietitian where this may have been required. There was not an adequate number of staff to support people as they needed at mealtimes.

Staff felt supported and were trained to deliver safe care to people. This training was monitored and refreshed when needed. However, there was a training gap in relation to managing behaviour which may have been challenging for staff.

Although there were mental capacity assessments carried out at the service, there were no best interest meetings held or documented to consider decisions made in relation to how people were cared for. There was not adequate monitoring and oversight of Deprivation of Liberty Safeguards at the service.

Incidents and complaints had not always been appropriately recorded or responded to and some safeguarding incidents had not been recognised as such by the registered manager. We have made a recommendation about the management of complaints. Some of the safeguarding concerns we looked at had not been responded to as they should have been in order to protect people from the risk of abuse.

There was a lack of management oversight across the service which meant that people's risks were not being monitored and improvements were not made as needed. Quality assurance systems were not effective as information was not being monitored by the registered manager.

People were cared for by kind and compassionate staff who knew people well. People's privacy was respected and their dignity maintained and care records detailed people's personal histories and their preferences in relation to their care.

People were encouraged to remain independent wherever possible and there were activities within the service that people could choose to get involved with.

Most staff felt supported by the registered manager and there were regular meetings held to obtain both the views of staff and the views of people who used the service.

We undertook this focused inspection on 8 August 2017 to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southfields House on our website at www.cqc.org.uk”

Improvements had been made to ensure that people received personalised care. People were more able to get out of bed when they wished and to receive their personal care when they wanted to, and not as a result of staff availability.

People received their medicines from competent and skilled staff. People’s medicines were handled appropriately and people were not rushed to take them. Staff understood the importance of ensuring people could take their medicines when they were ready and improvements had been made to this.

The home had a permanent registered manager and the provider had increased their support at the home. Quality monitoring systems had been increased and they were effective at identifying where improvements were required. Medication audits identified improvements and action was taken to remedy any identified issues. Improvements had been made to enable people, their relatives and staff to provide feedback about the service. The registered manager listened to people’s views and took action as required.

The service was no longer in breach of the regulations and remains rated as Requires Improvement.

Since we carried out the inspection of this service, we received information of concern which we will be reviewing further.

There was a registered manager in post however at the time of the inspection they were on a period of extended leave and an acting manager was supporting the service. 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 did not always receive their medicines from competent and skilled staff. People were rushed to take their medicines and they were not always given them in the correct format, for example dissolved in water. The systems in place to ensure people received their medicines safely required improvement as they were not always given at regular intervals, or with sufficient lengths of time between each medicine. People’s medicines were not always ordered and received in sufficient time, resulting in people not always being able to take their medicines as required.

There was not enough staff to meet people’s needs in a timely and person centred way. People that were unable to get out of bed until they received staff support did not have their preferences respected and spent longer in bed than they would choose. At mealtimes there was insufficient numbers of staff to support people to have their meals without delay, and with a person centred approach.

Improvements were required to ensure that existing staff had the appropriate skills and competencies in all aspects of people’s care. Existing members of staff had significant gaps in their training records and timely action was not taken to rectify this. Care staff had a lack of knowledge about the Mental Capacity Act and the principles around providing safe care to people, however the management team ensured that people’s mental capacity had been assessed and appropriate support systems were in place.

Staff had not always received the guidance and support they required to ensure they were performing to the best of their abilities. We found that these systems were improving and staff were beginning to receive regular supervision.

Staff required support to ensure people received adequate nutrition and fluids to meet their needs. People did not always have access to drinks and people’s nutritional needs were not always sufficiently monitored and assessed. People’s healthcare needs were not always well managed and there were occasions that people’s relatives became involved to ensure they were sufficiently supported.

There were limited opportunities for stimulation and meaningful interaction. People had very little options to vary their day and follow their interests or have new experiences. People and their relatives were not involved in reviewing their care plans following their initial review when they moved into the home. Each person had a care plan in place which helped explain the care each person required.

The home had experienced changes in the management over a short period of time and there had been times when there had not been sufficient leadership in place. Quality monitoring systems were not always effective at identifying where improvements were required and when issues had been identified they had not always been actioned in a timely way. There were a lack of effective systems in place for people, their relatives and the staff to provide feedback about the service.

People praised the caring nature of staff and the friendly approach they had. Staff were knowledgeable about the people they cared for and were reassuring and supportive to people when they were anxious or distressed.

People were encouraged to express their views about day to day matters and staff understood the need to respect people’s confidentiality. Advocacy services were available for people that required additional or independent support and visitors were able to visit people when they wished.

We identified that the provider was in breach of four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3). The actions we have taken are detailed at the end of this report.

There was not a registered manager in post. 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. There was a manager in post and they had submitted their application to the CQC promptly once appointed.

Improvements were required to the staffing levels within the home to ensure people received timely and person centred care at all times. Improvements were also required to ensure that people’s care plans reflected their current needs and levels of support.

People felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. There were sufficient recruitment procedures in place to protect people from receiving unsafe care from care staff unsuited to the job.

People received care from staff that were supported to carry out their roles to meet the assessed needs of people living at the home. Staff received training in areas that enabled them to understand and meet the care needs of each person.

Risk assessments were in place to protect people from identified risks and they helped to keep people safe. People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.

People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

Care plans were written in a person centred manner and focussed on ensuring people had choice and person centred care. They detailed how people wished to be supported and people were fully involved in making decisions about their care. People were able to choose where they spent their time and what they did.

Quality assurance systems were in place to monitor the care and support people received was in line with their requirements. People and staff reacted positively to the manager and the culture within the home focussed upon supporting people to receive the care they required in a nurturing environment. Systems were in place for the home to receive and act on feedback and policies and procedures were available which reflected the care provided at the home.

We looked at care plans and associated risk assessments and health monitoring records for two people using the service. We also spoke with five people using the service.

All the people we spoke with told us they were pleased with the care they received. Comments included, 'the staff are very friendly, helpful and kind'. We observed the staff carried out their duties in a relaxed manner, they spoke respectfully to people and encouraged people to be as independent as their capabilities would allow.

We saw that people's care plans specified the individual preferences of the person. They gave information on the level of support people required to meet their physical, mental, social and emotional needs.

We saw that regular health and safety quality monitoring checks were carried out on the environment, people's care records and staff records. We also saw that people using the service, relatives and staff were asked to provide feedback on the quality of service delivery. This meant that areas needing improvement were identified and appropriate action was taken to improve the service delivery.