Archived: Southlands Rest Home

Updated 8 July 2021

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the registered manager is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection was prompted by concerns raised regarding the care people were receiving at Southlands. During the inspection we identified that safeguarding concerns were not being reported to the local authority safeguarding team and that accidents and incidents were not routinely recorded and actioned. Following the inspection we alerted the local authority to our concerns and shared information regarding the specific incidents we had identified. The local authority safeguarding team are currently working with the service in order to minimise the risks to people’s safety and care.

This inspection took place on 21 November 2017 and was unannounced. The inspection team consisted of two inspectors.

Before the inspection we gathered information about the service. We reviewed records held by CQC which included notifications, complaints and any safeguarding concerns. A notification is information about important events which the service is required to send us by law. This enabled us to ensure we were addressing potential areas of concern at the inspection.

We did not ask the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. This was because we were following up on concerns we had received.

As part of our inspection we spoke with five people, three relatives, the registered manager, deputy manager and four staff. We observed interactions between people and staff. We reviewed the care plans for six people, medicines records and the records of accidents and incidents. We looked at mental capacity assessments and applications made to deprive people of their liberty.

We looked at three staff recruitment files and records of staff training and supervision. We saw records of quality assurance audits. We looked at a selection of policies and procedures and health and safety audits. We also looked at minutes of meetings of staff, people and relatives.

Updated 8 July 2021

We carried out an unannounced inspection to Southlands Rest Home on 21 November 2017. This inspection was carried out to follow up on some concerns we had received regarding the level of care and the quality of the service people received at the home.

Southlands Rest Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Southlands Rest Home is a home that provides accommodation and personal care for up to 19 people. The majority of people at the home were living with dementia or other mental health conditions. At the time of our inspection there were 16 people living at the home.

The home is owned by Mr and Mrs Sohun. Mrs Sohun is also the 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 our inspection in July 2016, breaches of legal requirements were found and we took enforcement action against the provider. We issued warning notices in relation to safe care and treatment, staffing and good governance. As a result of our concerns Southlands Rest Home was placed into special measures. The provider wrote to us to say what they would do to meet legal requirements. We undertook a further inspection in March 2017 to check the provider had taken action to meet the regulations. We found the provider had made improvements in the quality of care people received and the service was removed from special measures. At this inspection we found these improvements had not been sustained and identified concerns regarding the way in which the home was managed.

There was a lack of managerial oversight within the service. The provider who was also the registered manager had not identified shortfalls with the care people received or poor practices in staff performance. Safeguarding incidents had not been identified and reported to the local authority safeguarding team or to the CQC. There was a lack of understanding with regard to the responsibilities as registered persons to report significant events to the CQC.

Systems implemented to monitor the quality of the care provided had not been sustained and were therefore not effective in ensuring people received the care they required. The provider and registered manager had not ensured that people were at the centre of the service. The culture and values of the home described by staff and the registered manager were not embedded in to practice which meant people’s choices were not always respected. Although people were asked to give feedback on the home, action was not always taken as a result of their comments.

Risks to people’s safety and well-being were not always identified and acted upon. Accident and incident forms were not completed in detail and were not reviewed to minimise the risk of events happening again. Risk management plans were not always followed by staff and did not always fully address the risks identified. There was a smoking room on the ground floor which did not meet with current legislation regarding smoking in care homes. The smell of smoke permeated throughout the ground floor and no risk assessment was in place regarding this. Medicines were not always managed safely. The key to the medicines cabinet was left unattended and we found gaps in the recording of people’s medicines. People and staff told us they felt there were sufficient staff deployed to meet their needs. However, we identified times when people were left without staff support in communal areas which left them at risk.

Safe infection control practices were not followed and areas of the home were dirty with strong malodours. Not all bathrooms and communal toilets had hot water, soap or paper towels. There was no cleaning schedule in place to guide staff. A number of areas in the home required refurbishment although no plans were in place to address this. The provider had not developed a contingency plan to ensure that people would continue to receive safe care in the event of an emergency. Although individual personal emergency evacuation plans were in place the overall fire risk assessment for the premises was out of date. However, fire equipment was regularly serviced.

Staff did not receive comprehensive training or supervision to support them in their roles. Whilst staff were able to describe the training they had received they did not always demonstrate these skills in practice. People did not always receive support from staff who had been recruited safely. We found two staff members did not have any references to guide the provider on their suitability for their role. Staff told us they felt supported by the registered manager.

People’s legal rights were not protected as the principles of the Mental Capacity Act 2005 were not followed. Capacity assessments were not decision specific and best interest decisions were not recorded. Not all restrictions to people’s liberties had been identified when completing DoLS applications.

People were not routinely provided with choices regarding drinks or food. We observed everyone was provided with the same drink and no choices were offered. People’s comments regarding food had not been taken into account and no menu was available. Meal times were task focussed and staff did not take the time to ensure people were comfortable and had the support they required. We received mixed reviews from people regarding the quality of the food provided. People’s dignity was not always protected. People did not always receive personal care in line with their needs and many people looked unkempt. Staff did not always knock on people’s doors before entering.

People did not always have access to activities in line with their needs and preferences. Although some activities were organised there were significant amounts of time when there was no stimulation apart from the television. People had access to health care professionals although this was not always provided in a timely manner. Staff were not aware of people’s past lives and were unable to fully describe people’s care needs and personalities. Care plans did not give up to date guidance to staff regarding the support people required and people’s end of life care wishes were not recorded. Although some people were supported to maintain their independence, others were not provided with the equipment they required in order for them to eat independently.

On the whole staff interacted with people in a kind manner. People’s religious needs were respected as people had access to local church services. Relatives told us they felt welcome when visiting the home and no restrictions were in place on visiting hours. The provider had developed a complaints process which was shared with people and relatives.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.

During our inspection we found eight breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.