Archived: Southfields House

Southfields House is a residential care home providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. The service can support up to 45 people.

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

Staff completed body maps where injuries and bruises on people had been identified and these were regularly reviewed. However, not all unexplained injuries and bruises had been investigated to identify the possible cause. Staff received training on safeguarding and understood how to recognise and report abuse.

People had individual risk's assessed with strategies in place to mitigate risks. However, staff did not always follow the strategies.

Staff demonstrated a knowledge of people’s care needs and how to keep them safe.

Checks were in place to ensure the environment was safe.

Medicines were administered and stored safely.

People were protected against infection. Staff wore appropriate personal protective equipment [PPE] and the home appeared clean.

Auditing and oversight of some care records required improvement.

People and relatives spoke positively about the care provided and people were supported to stay in contact with their loved ones.

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 23 September 2020) and there were breaches of regulation identified. 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 improvements had been made and the provider was no longer in breach of regulations.

The service remains rated requires improvement. This service has been rated requires improvement for four consecutive inspections.

Why we inspected

We carried out an unannounced focused inspection of this service on 11 August 2020. Breaches of Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. This included risks in relation to eating and drinking, pressure area care, hot water and fire. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

We also checked whether the Warning Notice we previously served in relation to Regulation 17 (1) of the Health and Social Care Act (Regulated Activities) Regulations 2014 Good governance had been met.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

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.

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.

Southfields House is a care home providing care and support for older people and people with dementia. The service is separated into six units, three units provide short term care and rehabilitation and three units provide long term residential care. The service is registered to provide personal care to up to 45 people. At the time of inspection there were 23 people living in the home.

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

The provider had quality control systems in place, however they were not effective, as required improvements had not been made in a timely way.

Quality improvement measures and oversight of medicines had been ineffective at driving enough improvement in this area. ‘As required’ medicine guidance for staff required further development to ensure people received their medicines as prescribed. Medicines records required improvement.

The provider did not always learn lessons when things went wrong; where audits had identified errors, action plans had not resulted in enough improvement.

Risks to people had not been effectively assessed and recorded, the provider had not maintained effective oversight of risks to people’s health and well being. This included risks in relation to eating and drinking, pressure area care, hot water and fire. Records did not reflect that staff were supporting people in line with their care plans.

Food hygiene measures were not sufficient. People were at risk from food that had not been stored safely. Infection control procedures had not been fully implemented.

Recruitment procedures were not robust and did not ensure safe recruitment practices.

There were enough staff deployed to provide people with safe care. People’s relatives and staff provided positive feedback about staffing levels.

People’s relatives and staff told us that they felt supported by the management team and the registered manager was making improvements to the service.

Care records were person-centred and contained sufficient information about people’s preferences, specific routines, their life history and interests. People and their representatives were involved in the planning of their care and given opportunities to feedback on the service they received. People’s views were acted upon.

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.

Rating at last inspection

The last rating for this service was requires improvement (published 12 December 2019), the provider was in breach of regulation 17.

Why we inspected

The inspection was prompted in part due to concerns received about the management of medicines and pressure area care. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has not changed following this focused inspection and remains Requires Improvement.

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.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Southfields House is a residential care home providing personal care to 33 people with a physical disability, sensory impairment, dementia and mental health needs at the time of the inspection.

The service can support up to 45 people across six separate units, each of which have separate adapted facilities. 19 people lived at the home permanently and 14 people were temporarily staying at the home to receive reablement support at the time of inspection.

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

The service had a registered manager. However, they had been absent since July 2018. The provider had appointed an acting manager who was responsible for monitoring the quality of the service and ensuring the regulatory requirements were met. Quality assurance systems and processes identified where improvements were needed. However, we found action was not always taken quickly enough to resolve issues found.

Decision specific mental capacity assessments and best interest decisions had not been undertaken for all people that lacked capacity to make decisions about their care. However, we found 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.

Staff knew how to recognise, and report suspected abuse. They had been safely recruited and had access to the training they needed to meet people’s individual care needs. Staff had a good knowledge of infection control requirements and had access to personal protective equipment. Staff felt well supported by the management team.

There had been an increase in medicines errors and there were no protocols in place to instruct staff to administer medicines people were prescribed ‘as required’. Following our inspection, the service implemented protocols for ‘as required’ medicines and met with the GP surgery and pharmacy to develop a new system for ordering and stock control of medicines. People told us they received their medicines on time.

People told us they were happy with the food available and were able to choose what they wanted to eat and drink. Staff contacted health professionals as needed and had received specific training to meet people’s individual needs.

People were supported by staff that were kind and caring. Staff respected people’s privacy and dignity and involved them in decisions about their care. Staff knew people’s hobbies, interests, preferences and wishes and we observed staff talking with people about these. Activities such as crosswords, newspapers and jigsaw puzzles were available for people to use.

Complaints were managed in line with the providers complaints policy. People and relatives told us, they felt confident action would be taken should they complain.

The service understood their requirements in relation to duty of candour and were open and honest with us during our inspection. They worked with partner agencies such as commissioners and healthcare professionals to meet the needs of the people living at the service.

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 29 December 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 enough, improvement had not been sustained and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to the governance of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Southfields House is located in Northampton and is registered to provide accommodation and personal care to older people. It provides care for older people and people with a physical disability and accommodates 45 people across six separate units, each of which have separate adapted facilities.

The provider had recently started to provide reablement support to people for up to six weeks following discharge from hospital. When we visited there were 23 people living at the home permanently and nine people temporarily living at the home receiving reablement support.

The reablement support was being provided in two areas, separately to people that lived at the home permanently to minimise any disruption. However, the provider told us that they were planning to increase the number of reablement beds available and extend this to a third unit. The provider was in the process of consulting with people and their relatives regarding this change.

This is Southfield House’s first comprehensive inspection under the current provider. The inspection took place on the 12 November 2018 and was unannounced.

The provider notified us that the registered manager was absent from work. 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 provider had appointed an acting manager as an interim arrangement.

People were at risk of not receiving a nutritionally balanced meal or adequate nutrition as a menu was not being followed and there were inconsistencies in the kitchen staff. This impacted on the quality and the variety of food available to people.

We found the poor cleanliness of the kitchen and unsafe food storage had not been adequately addressed by the management team, despite this being identified in meeting minutes and audits two months prior to the inspection.

Risk assessments were in place but did not always include enough information to assist staff in identifying a deterioration in people’s health condition.

Some people at the home were prescribed medicines on a when required basis. We found there was no guidance in place to advise staff when and how to give these medicines.

People were at risk of accidents or incidents re-occurring as reports were not immediately reviewed to identify learning. This meant changes were not promptly made to reduce the risk of the incident occurring again.

The quality assurance systems in place identified areas that needed improving. The acting manager had developed an improvement plan to enable the service to prioritise areas for action. Whilst we found the acting manager had implemented improvements that impacted positively on people, further improvements were required and we could not be assured these would be sustained or were embedded in practice.

People were treated with warmth and kindness by the staff and management team, and supported by staff that had taken time to get to know them and enjoyed spending time with them. People's privacy and dignity was protected and promoted always.

People were assisted to maintain relationships with their families, visitors were welcome at any time and were made to feel at home.

People told us they felt safe and staff understood their roles and responsibilities to safeguard people from the risk of harm. There were sufficient staff available to meet people's needs and staff had been safely recruited.

People using the service and their relatives knew how to raise a concern or make a complaint and felt confident these would be addressed.

People were supported to access relevant health and social care professionals and there were systems in place to manage medicines safely. People received their medicines as prescribed.

People were supported by staff that had the skills and knowledge to meet their needs. Staff received effective and regular supervisions and appraisals to enable them to carry out their roles effectively.

At this inspection, we found the service to be in breach of one regulation of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Further information is in the detailed findings below.