South Collingham Hall

South Collingham Hall is a care home providing personal care and accommodation for up to 33 people. There were 24 people using the service at the time of our inspection.

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

The manager had developed a comprehensive auditing process to check the quality of service being provided. These audits enabled them to monitor all areas of the service being provided and make any necessary changes to the benefit of the people living there.

People were provided with a safe place to live. Shortfalls identified at our last inspection regarding the environment had been addressed. People felt safe living at South Collingham Hall and risks to people had been identified, assessed and managed. Staff were aware of how to keep people safe from avoidable harm and any concerns were appropriately reported. People received their medicines as prescribed and staff had received the training they needed in order to provide people with their medicines in a safe way. The service was clean and odour free and staff followed the provider's infection control policy. Appropriate recruitment processes were followed to make sure suitable numbers of staff were available to meet people’s needs. The manager made sure lessons were learned when things went wrong to continually improve the service provided.

People’s needs had been assessed prior to them moving into the service and plans of care had been developed for staff to follow. The staff team had been provided with the training they needed to enable them to meet people’s individual and diverse needs. People were supported with their nutritional needs and supported to eat and drink well. Staff made sure people were supported to access the relevant healthcare professionals when they required it.

Improvements had been made to the environment, providing people with a comfortable place to live. We saw curtains were missing in the main lounge area, plans were in place to address this. People’s rooms were personalised and there were places available for people to meet with others or to be alone.

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 were kind and caring, and treated people with respect. People were involved in making decisions about their care and their consent to care was always obtained. The staff team treated people in a dignified way.

Comprehensive plans of care had been developed and these had been monitored regularly. Staff knew people’s care and support needs well and had the opportunity to be involved in the care planning process. People knew how to make a complaint and were confident their concerns would be listened to and addressed. People’s wishes at the end of their life had been explored and followed.

The staff team felt supported by the manager and their thoughts on the service were sought. People and their relatives were asked for their opinion of the service through day to day conversations, meetings and the use of surveys. The manager worked in partnership with others to provide people with the care and support they needed.

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 29 April 2019) and there were three breaches of regulation.

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.

This service has been in Special Measures since 29 March 2019. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating and carried out to follow up on action we told the provider to take at the last inspection.

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.

People’s experience of using this service:

Although the risks to people’s safety had been identified, measures to mitigate these were not always in place. The assessments of people’s needs were not always current and the treatment they received was not always in line with their assessments. Some areas of the environment posed a risk to people’s safety, this included the risk of infection. People did not always feel there were adequate numbers of staff available to support them. There was a lack of processes in place to learn from incidents and accidents at the service.

Staff had not always received the appropriate training for their roles. People were not always supported with their nutritional needs; some people did not receive diets appropriate to their needs.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

People had built some positive relationships with staff; however, people were not always supported to receive individualised and personalised care in a timely way. Furthermore, people’s privacy and dignity was not always well supported. There was a lack of social stimulation for people at the service. The registered manager had not kept a record of complaints made to the service, although people told us their complaints were addressed.

There was a lack of leadership and over sight at the service and the quality monitoring systems did not highlight when there were concerns or issues about people’s care or the environment they lived in.

Rating at last inspection: Requires Improvement.

Why we inspected: This was a planned inspection based on the rating at the last inspection. sufficient improvements had not been made since our last inspection and the rating has worsened to a rating of Inadequate. This is the fifth consecutive time this service has not received a rating of Good.

Enforcement: 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: The service has now been placed in special measures. This means we will work with the provider to improve the service and work with partner agencies to monitor the service.

We will keep the service under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, we will inspect it again within six months.

We expect that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

At our previous inspection on 24 May 2017 the provider was in breach of a number of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The concerns were around the lack of assessment of the risks to people’s safety. The management of safeguarding issues. The lack of sufficiently skilled and experienced staff. The lack of consent and the lack of systems in place to assess, monitor and improve the quality and safety of the service. During this inspection we found the provider had made a number of improvements to the service and whilst further improvements were required, they were no longer in breach of any regulations of the health and social care act.

A registered manager was in post and they were available during the 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People at the service were protected from possible abuse as staff at the service had the knowledge and understanding of the types of abuse people could be exposed to and how they should report issues of concern. Staff felt confident the management team would address any issues raised. The registered manager fulfilled their responsibilities in dealing with safeguarding issues by reporting, investigating and acting on concerns raised ensuring that lessons were learnt from incidents.

Some issues we raised in relation to fire safety risks were addressed by the provider following our visit. The risks to people’s personal needs were regularly assessed to ensure they received safe care appropriate to their needs.

Staffing levels met the needs of people. The cleanliness of the service was maintained and monitored and staff were knowledgeable on how to protect people from the risks of infection.

Whilst medicines were managed safely majority of the time, we found an area of practice which could impact on people and lead to unsafe administration of medicines. This was addressed following out visit.

Nationally recognised and established assessment tools were used to assess people’s needs and staff received appropriate training for their roles. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However the policies and systems in the service did not support this practice. The provider sent us information to show they had addressed this following our inspection.

People lived in a service which met their needs in relation to the premises and adaptions were made where needed. People had access to information in a format which met their needs.

People’s health and nutritional needs were well managed and staff acted on advice given to them by health professionals to manage people’s health and nutritional needs.

People were cared for by staff who knew their needs and preferences, and were caring and kind towards them and their relatives. They were supported with respect by staff who maintained their privacy and dignity whilst encouraging and supporting their independence.

People received individualised care from staff who had the information they required to provide that care. People were supported to take part in a range of social activities and maintain relationships that were important to them. People were comfortable when raising concerns or complaints and felt issues raised were addressed to their satisfaction. People’s wishes in relation to their end of life care were supported with care and empathy.

The service undertook auditing processes to maintain the quality of the service. However further work was required to analyse particular areas of care at the service. Following our inspection, the manager sent information to show how they had addressed this.

We carried out an unannounced comprehensive inspection of this service in October 2016 and a focused inspection in December 2016. Breaches of legal requirements were found and we took action to ensure the necessary improvements were been made to make sure people received safe care and support. The provider sent us six action plans following the October 2016 inspection but did not provide us with one following the December 2016 inspection.

The service had a registered manager in place 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.

People may be left at risk of harm or abuse because the procedures designed to protect them were not followed. Some risks to people’s health and safety were not being clearly identified.

People may not be provided with their care and support when this was needed because there were not always enough staff on duty. People may not receive their medicines safely because the training staff had for this was out of date and they had not been assessed to be competent in following safe medicines practices. Some risks of infection were not being identified and controlled.

People were being cared for and supported by staff who had not been trained to do so. People’s right to make decisions for themselves may be overlooked as the Metal Capacity Act (2005) was not always followed.

People were not provided with a positive mealtime experience which could affect their nutritional and fluid intake. Staff understood people’s healthcare needs and their role in supporting them with these.

People were cared for and supported by staff who respected them. Staff usually respected their privacy and dignity. Where possible people were involved in planning their own care.

People received their care and support in a task oriented manner rather than in a person centred and proactive way. People’s care plans were not always kept up to date and staff rarely referred to these. There was a system in place for people to raise any complaints, but this had not been used.

The views and experiences of people who used the service, relatives and staff were not captured to improve the service. The systems to monitor the quality of the service and identify where improvements were needed were not effective.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full report.

The service had a registered manager. 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.

At our inspection in October 2016 we asked the provider to take action to make improvements in respect of the systems used to monitor the quality of the service and to obtain and act on people’s feedback. In addition, we asked the provider to make improvements to the records that were kept about people’s care. During this inspection we found that some improvements had not been made but further work was required to achieve compliance.

The quality assurance systems in place had begun to identify areas for improvement and we saw that some improvements had been made. However, follow up audits and action plans had not been put into place to ensure continuous monitoring of the service.

Records relating to the care staff provided to people were not accurate and had not been kept up to date. There was an open and transparent culture at the home although formal staff meetings were not held routinely. The provider had begun to allocate more resources to the home and several areas of the home had been refurbished and redecorated. In addition, a new role of activities co-ordinator had been created which was having a positive impact on people’s quality of life and helped to ease pressure on the care staff.

The service had a registered manager. 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.

At our inspection in January 2016 we asked the provider to take action to make improvements in respect of the cleanliness of the building and maintaining a safe environment. During this inspection we found that only limited improvements had been made. A legionella risk assessment of the water supply at South Collingham Hall had been carried out. However, not all of the recommendations that had been made had been implemented in a timely way. Steps had not been taken to ensure a clean environment was maintained in order to reduce the risk of infection.

People were left exposed to avoidable risks because steps had not been taken to assess and mitigate risks to people’s health and safety. The building and equipment used was not always fit for purpose. There were not sufficient numbers of staff employed or deployed to meet people’s needs in a timely way.

Staff understood their responsibility to protect people from the risk of abuse, although not all staff had received safeguarding training. People received their medicines when they needed them and medicines were stored and recorded appropriately.

Staff had not been provided with all of training required to care for people effectively. Staff told us they received supervision and felt supported. People’s rights under the Mental Capacity Act (2005) were not always upheld. Relevant applications to deprive people of their liberty had not always been made.

People had access to sufficient quantities of food and drink and told us they enjoyed the food. However, support to eat and drink was not provided in a timely way. People had access to a range of healthcare professionals, but guidance provided was not always followed in practice.

People, or their representatives, were not routinely involved in planning and reviewing their care. Staff endeavoured to respect the day to day decisions people made but were not always able to accommodate their wishes. Staff supported people in a caring manner and had developed positive relationships with people. People were treated with dignity and respect by staff.

Person-centred care was not always provided and people’s care plans were often out of date or contained incorrect information. Staff were aware of people’s care needs and tried to provide activities and stimulation. However, no activities were provided on the day of our inspection. People told us they would feel comfortable making a complaint and knew how to do so.

At our inspection in January 2016 we asked the provider to take action to make improvements in respect of the systems used to monitor the quality of the service and to obtain and act on people’s feedback. During this inspection we found that sufficient improvements had not been made.

The quality assurance systems in place were not sufficiently robust in detecting issues of concern and bringing about improvements. There were limited opportunities available for people to provide their feedback about the quality of the service. There was an open and transparent culture at the home although formal staff meetings were not held routinely. Adequate resources had not been provided towards the upkeep of the building and to ensure good quality care could be provided.

There were several breaches of regulations and you can see what action we told the provider to take at the back of the full version of the report.

People who used the service told us the care and support provided at the home was good and they got on well with staff. One person said 'The staff look after me and are always kind'.

We observed effective communication and good relationships between staff and the people living in the home. People's needs and risks were assessed and care and support was planned and delivered in line with their individual care plans.

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

There were sufficient experienced staff to meet people's needs. Staff had regular supervision and training. This meant that staff had the right knowledge to meet people's individual needs.

The provider had an effective system to regularly assess and monitor the quality of service that people receive.