Southview Lodge Residential Care Home

Southview Lodge is a residential care home providing personal care and accommodation., At the time of the inspection 27 people were living at the home. The service can support up to 30 people . All bedrooms and communal areas are accessible on the ground floor. There is a large secure garden with an outdoor seating area and ample car parking.

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

People and their relatives felt the home was safe. Staff had received safeguarding training and were able to identify types of abuse and they knew how to raise concerns. However, we found environmental risk assessments were not robust enough to monitor areas of potential risk. The registered manager had not carried out regular health and safety audits. People’s care plans and risk assessment had been considered, however they had not always been updated when needs had changed, such as following a hospital discharge. Accidents and incidents had been recorded and people had received medical attention where required. However, there was no accident and incident audit to identify themes and trends to assist in lessons learnt.

Medicines were not always managed safely, this included inconsistences to medicines administration records (MARs). Some of the records we reviewed had not been signed to show whether people had received their medicines. We found some concerns around the safe storage of medicines . There were no protocols for ‘as required ’ medicines and there were no risk assessments in place for people who were self-administering creams.

The provider did not have effective recruitment procedures to ensure suitable staff were employed in the home. Employment references had not always been obtained and staff had started work before the Disclosure and Barring Service clearance. The Disclosure and Barring Service helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

The registered manager was open and transparent during the inspection process and the home had visions and values displayed. Staff said the registered manager was very supportive. However, the governance system at the home was not robust. The system did not proactively monitor areas where the care delivered was not safe or meeting standards. The registered manager was not always aware of shortfalls in the home, due to a lack of robust audits and quality assurance systems. Regular audits had not been undertaken in several areas including medicines, health and safety, care records, accident and incidents. The policies and procedures were not up to date with current legislation and best practice guidance.

Records related to consent for care were completed for people with capacity and people told us they were always offered choice and control over the care they received. The provider had systems and procedures for seeking DoLS authorisations. However, these were not consistently followed.

Staff had received an induction and ongoing training, supervision and appraisals. People were supported to eat nutritionally balanced diets and their choices and preferences were considered. The registered manager and the provider had maintained the premises to a high standard and there was adequate space inside and outside the home. People had prompt access to professionals when required.

People told us they were treated kindly and with respect. We saw caring interactions between staff and people. Staff were aware of peoples’ needs. Privacy and dignity were observed during personal interactions.

People were supported with meaningful activities. People were aware of how they could raise a concern or complaint if they needed to. While the complaints policy was not readily available on display a suggestion box was provided for people to raise concerns. No complaints had been received.

No one was receiving end of life care. Improvements were required to the systems for supporting people to plan for end of life care. End of life care records were not robust. Following the inspection, the registered manager and provider gave us assurance that they would introduce robust systems for monitoring the home and to improve their policy and procedures.

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 3 February 2017).

Why we inspected

This was a planned inspection based on the previous rating. We have found evidence that the provider needs to make improvements. Please see the relevant key questions sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We have identified breaches in relation to seeking consent, safe care and treatment, good governance and fit and proper persons employed at this inspection. Please see the actions we have told the provider to take at the end of the report.

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 work alongside the provider and 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.

Southview Lodge Residential Care Home is a large detached residence, situated in a semi-rural location close to Hesketh Village. The home provides 24 hour personal care and accommodation for up to 30 older people. All bedrooms and communal areas are accessible on the ground floor. There is a large garden to the front and rear of the property, with outdoor seating areas and ample car parking. At the time of our visit, 27 people lived at the home.

The service had 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.

At the last inspection on 25 February 2015, we found the provider was not meeting the requirements of the regulations in respect of person-centred care, safe care and treatment, premises and equipment, need for consent, staffing, good governance and the notification of incidents.

During this inspection, we found the provider had made improvements in all these areas and was meeting the requirements of the regulations.

We looked at the recruitment of four staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We found the registered manager had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager completed individual risk assessments for people who lived at the home. This helped to ensure risks were identified and measures put in place to reduce risks to people’s safety and wellbeing. Written plans of care provided a good level of guidance for staff with regard to supporting people safely.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. The provider had undertaken work to refurbish communal areas, as well as toilets and bathrooms. The ‘secret garden’ to the rear of the home had been landscaped and provided a pleasant outdoor area for people to make use of in good weather.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. The provider had increased staffing levels in the evening in response to feedback from people who lived at the home and staff.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups. The provider had made links with local community groups and schools for them to be involved in activities and events at the home, which people told us they enjoyed.

The service had a complaints procedure which was made available to people on their admission to the home. People we spoke with told us they were happy and had no complaints.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

We found people had access to healthcare professionals and their healthcare needs were met.

We observed staff supporting people with their care during the inspection visit. We saw they were kind, caring, patient and attentive.

The registered manager used a variety of methods to assess and monitor the quality of the service. These included satisfaction surveys and care reviews. We found people were satisfied with the service they received.

"They [staff] always treat me with respect."

"I'm asked about what I like and what I like doing."

"I'm well looked after...I go to the social club often."

"I'm very happy here...There's always something going on."

Relatives said:

"We are kept up to date on how [relative] is doing...We got all the information we needed before they came here."

"[My relative] is well looked after, I don't need to worry about them...Since they've been here their health and wellbeing has improved...No complaints...It's calm, quiet and lovely here...It feels like a great big family."

We found that people and their families were involved in the care planning process, with their needs and preferences taken into account in the way care and support was delivered. People were treated with dignity and respect.

The provider undertook comprehensive assessments of people's needs. These translated into person centred plans of care and support which met people's needs. People's independence was promoted as far as possible and people were involved in local community activities.

We found the home had implemented appropriate policies and procedures with regard to cleanliness and infection control. We found the level of cleanliness in the home to be of a good standard.

The provider had robust systems in place to audit, monitor and assess the standard of the service that was provided for people. Feedback was sought from people and their relatives on a regular basis.

During this visit we found that a comprehensive risk assessment was in place and had been completed for one of the bedrails in use. We found that this assessment was not consistent in practice as there were two other bedrails fixed to people's beds that the use of had not been assessed.

People we spoke to told us the food was good. One relative we spoke with told us, ' the food served is good, I have seen in the kitchen.There is fresh food delivered nearly every day'.

During our visit we observed people were content and relaxed. One person we spoke with said, "Staff are very kind, I really like it here".

We saw from the actions set out in the last inspection for the provider that the majority of actions had been met and improvements generally made. One relative that we spoke with told us, 'Overall, I think they are brilliant and provide excellent care to my mother'.

People told us they had no complaints about the service but would be happy to raise their concerns with the staff or managers. One person told us, "I'm happy living here and I would tell the manager if something was wrong".