Background to this inspection
Updated
7 December 2019
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 Care Act 2014.
Inspection team
The inspection was carried out by two inspectors, an assistant inspector and an Expert by Experience. An Expert by Experience is a person who has personal experience of using or caring for someone who uses this type of care service.
Service and service type
South Quay 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.
The service had a manager registered with the Care Quality Commission. 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.
Notice of inspection
This inspection was unannounced.
What we did before the inspection
Before the inspection we looked at information received from the service, including incidents or any allegations made. We contacted the local authority commissioning and safeguarding teams, the local fire authority, the infection control lead for care homes in the area, dietitian teams and Healthwatch. Healthwatch is an independent consumer champion that gathers and represents the views of the public about health and social care services in England. Any comments received supported the planning and judgements of this inspection.
We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with 14 people who used the service and 10 relatives about their experience of the care provided. We also spoke with a community matron for nursing homes and a local fire officer. We spoke with members of staff including, the registered manager, regional manager, resident experience support manager, two unit managers, a trainee care home assistant practitioner, a senior care worker, four care staff, two members of housekeeping staff two activities coordinators and the chef. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
We reviewed a range of records. This included eight people’s care records and multiple medication records. We looked at two staff files in relation to recruitment. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.
Updated
7 December 2019
About the service
South Quay is a care home which provides accommodation and care for up to 58 people across two separate wings. One wing provided nursing and personal care for older people. The other wing provided nursing and personal care for those with a neurological condition. During our inspection there were 12 people on the neurological unit and 39 people on the older person's unit.
People’s experience of using this service and what we found
Staff deployment and organisation differed between shifts on the older people’s wing. Some people told us that more staff would be appreciated. We have made a recommendation about staff deployment.
Medicines were generally managed safely. We identified shortfalls with certain aspects of medicines management including the recording of topical medicines. The registered manager told us that this would be addressed.
People told us they felt safe. There were no ongoing safeguarding allegations. Safe recruitment procedures were followed.
Staff supervision and appraisals had not been carried out as planned. The registered manager had a plan in place to address this issue. Staff however, told us that they felt supported and the registered manager’s door was always open to discuss any concerns. There were gaps in certain training. Ongoing training was being carried out.
We received mixed comments from people and staff about the quality of meals. The registered manager was aware of this issue and had already held meetings with kitchen staff to address this matter.
Records did not always demonstrate people were supported with their nutritional and hydration needs.
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.
People were positive about the caring nature of staff. We observed positive interactions between staff and people.
Care plans did not always reflect people’s needs and staff did not fully record the care they had given, such as support with personal care. This meant it was difficult to check whether care and support had been provided as planned. People’s social needs were not always met.
There was a complaints procedure in place. Formal complaints were recorded and responded to. However, it was not clear how informal concerns and complaints were managed and monitored.
During the inspection we identified shortfalls with various aspects of the home, especially relating to the maintenance of records. There was a new registered manager in post. She was supported by two ‘unit managers.’ Both unit managers had a small number of supernumerary hours each week to carry out management duties. It was not clear whether there were sufficient management hours/oversight to ensure improvements were made in these areas.
The registered manager was open and honest about the improvements which were needed. She said that changes were being introduced gradually. This was to ensure that improvements were more likely to be maintained in the long term.
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 16 July 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 we found certain improvements had been made; however, further action was required, and the provider was still in breach of regulations.
This is the second consecutive time this home has been rated requires improvement.
Why we inspected
This was a planned inspection based on the previous rating.
Enforcement
We identified breaches in relation to person-centred care and good governance. Please see the action we have told the provider to take at the end of this report. We also identified a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Notification of other incidents and issued a fixed penalty notice which the provider has paid. Full information about CQC's regulatory response found during the inspections is added to reports after any representations and appeals have been concluded.
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 meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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.