Archived: Southfield Care Home

Updated 14 July 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Health and Social Care Act 2008.

This was a targeted inspection to check whether the provider had made improvements since our last inspection.

Inspection team

The inspection was carried out by two inspectors and a pharmacy specialist.

Service and service type

Southfield Care Home is a ‘care home’. People in care homes receive accommodation and nursing and/or personal care as a single package under one contractual agreement dependent on their registration with us. Southfield Care Home is a care home without nursing care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided. At the time of our inspection there was not a registered manager in post. However, the manager completed their registration with CQC on 17 June 2022.

Notice of inspection

This inspection was unannounced.

What we did before the inspection

We reviewed information we held about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. The provider was not asked to complete a Provider Information Return (PIR) prior to the inspection. This is information providers are required to send us annually with key information about the service, what it does well and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We looked around the building and observed people being offered care and support in communal areas. We spoke with six members of staff including the nominated individual, manager, team leaders, care staff and the cook. The nominated individual is responsible for supervising the management of the service. We reviewed a range of records. This included six people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and a variety of records relating to the management of the service, including audits and policies.

Updated 14 July 2022

About the service

Southfield Care Home is a residential care home providing accommodation and personal care for up to 54 people aged 65 and over. At the time of the inspection there were 24 people living at the home. Southfield Care Home accommodates people in one adapted building over two floors. At the time of the inspection people were all living on the ground floor.

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

Despite highlighting shortfalls at the last three inspections, the provider had failed to take enough action and people continued to be at risk of harm and poor care.

The provider was unable to demonstrate robust governance arrangements and learning had not taken place. Systems and processes designed to identify shortfalls and drive improvement were not effective and had not identified the concerns we found. Significant shortfalls identified at the last inspection had not been addressed. The provider did not demonstrate they understood their legal responsibilities.

The provider had not complied with their lawful duties to display their current inspection rating at the service and on their website.

People did not always receive their medicines in a safe way. Specific issues we had raised at the last inspection concerning the management of medicines had not been addressed. The systems in place and management oversight had failed to identify the repeated shortfalls.

The provider had not assessed and mitigated the risks to people, and people did not have an accurate and complete care record. This included hazards in the home’s living environment as well as risks associated with people’s health, safety and wellbeing. Procedures failed to safeguard people from the risk of abuse.

Safe recruitment practises were not followed as the required background checks had not been undertaken before staff started work at the home.

Most people and relatives told us they felt safe and there were enough staff to meet people’s needs. Staff were kind, respectful and caring and we observed warm and friendly interactions between people.

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 Inadequate (published 14 January 2022). 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 made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Southfield Care Home on our website at www.cqc.org.uk

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led 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 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 safeguarding, safe care and treatment, medicines, staff recruitment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 return sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.