Cranswick Lodge

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

The provider had systems in place for oversight and monitoring the safety and quality of the service which under the new manager had resulted in improvements. However, these improvements were on-going and further work was required regarding the deployment of staff and activities for people. The provider was actively recruiting to support this.

Risks to people's health and safety were identified and records had been updated to reflect these. This ensured staff had up to date information about people they required. Fire safety processes had been improved and regular checks were consistently completed to ensure staff knew the correct action to take to support people in the event of a fire. People's medicines were managed safely and lessons learnt were acted upon, shared with staff and put in to practice.

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 supported by kind and caring staff. Staff felt more supported by the new manager and were receiving regular training to support them in their roles. People’s dining experiences and improved and staff were aware of people’s specific dietary needs. Relatives felt people’s wellbeing had improved due to the improvements made at the service.

Improvements already made, required time to be embedded across the service. The new manager was aware of further improvements that were needed and they were committed to making positive changes.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 01 November 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 we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 01 November 2022. 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 inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

We will request an action plan and 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Southlands is a residential care home providing accommodation and personal care for up to 48 older people who may be living with dementia or a physical disability. At the time of the inspection, 38 people were using the service.

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

Risks to people’s health and safety were not always identified and managed as records were not up to date and staff did not always have access to required information. Fire safety processes were not appropriately followed. Staff were not effectively trained and supported in their roles and the provider had not ensured there were sufficient staff on shift to meet safely people’s needs. We have made a recommendation about staff recruitment processes.

People’s medicines were not managed safely. Not all areas of the service were clean and personal protective equipment (PPE) was not stored and used appropriately by all staff. People’s nutritional and skin care needs were not always met and referrals to healthcare professionals were not made in a timely manner. There was a lack of activities and social stimulation for people.

Systems to ensure people’s rights were upheld were ineffective as legal authority to deprive people of their liberty had expired and conditions were not always met. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Governance systems were ineffective at identifying and addressing shortfalls and where shortfalls were identified, prompt action was not taken. There was a lack of meaningful oversight by the provider.

People’s relatives told us staff were caring. However, opportunities to engage with people were missed as staff were busy. Staff supported people to maintain their independence and dignity.

There was a poor culture at the service and staff did not always feel supported. The provider had increased support to the service and staff due to the significant shortfalls in the service.

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

Rating at last inspection

The last rating for this service was good (published 19 May 2021).

Why we inspected

We received concerns in relation to the management of medicines, staffing, poor care and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. We inspected and found there was a concern with medicines, staff training and deployment, fire safety, managing risks and meeting people’s needs, so we widened the scope of the inspection to become a comprehensive inspection which included all the key questions.

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.

Enforcement and Recommendations

We have identified breaches in relation to medicines, risk management, infection control processes, meeting people’s care and nutritional needs, staff numbers and training, maintaining people’s rights and maintaining the quality and safety of the service at this inspection.

Please see the action we have told the provider to take at the end of this report.

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 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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 take action 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.

Southlands is a residential care home providing personal care to 39 people aged 65 and over at the time of the inspection. The service can support up to 48 people.

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

People felt safe and well looked after. All areas were clean, tidy and there was sufficient cleaning taking place to keep people safe from the risk of infection. Relatives said they were confident that staff provided good care in a safe way.

Care plans and risk assessments were in place for people's support needs. These were reviewed regularly and covered people's health conditions. Families confirmed that they were able to contribute their views on their relative’s care and support.

The assessment, monitoring and mitigation of risk towards people had improved. The registered manager carried out regular checks and analysis of falls and incidents to ensure learning from events was undertaken. This meant risks to people's health and safety were reduced.

People received their medicines on time and when they needed them.

Staffing levels were consistent, and staff were confident they could meet people’s needs. Improvements had been made to how staff were deployed, with staff based in and around communal areas throughout the day. We observed staff being patient, kind and respectful towards people. Care was person-centred and staff had time to chat with people during the day.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

There was a registered manager who had come into post since the last inspection. They were making positive changes to the service; people, staff and relatives spoke highly of them. There was evidence of good leadership, oversight and management within the service.

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 requires improvement (published 12 April 2019).

Why we inspected

The inspection was prompted due to concerns received about two people falling in the service and receiving a serious injury. A decision was made for us to inspect and examine those risks.

We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 coronavirus and other infection outbreaks effectively.

We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the safe and well-led sections of this full report.

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

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.

We found the following examples of good practice.

¿ Systems were in place to isolate people with COVID-19 to minimise transmission. This included personalised infection control care plans, to ensure individuals were appropriately supported.

¿ People who were isolating at the service had their own dedicated staff to meet their support needs. Staff maintained social distancing where possible and encouraged people to remain socially distanced.

¿ National guidance was followed on the use of personal protective equipment [PPE]. There was clear signage on the correct use of PPE and stations were in place to ensure staff had access to PPE in a safe area. Staff demonstrated a good understanding of the appropriate application and removal of PPE.

¿ The environment had been adapted to promote social distancing and was very clean. Additional cleaning was taking place including frequently touched surfaces.

¿ People who used the service were supported to maintain contact with their families and friends through phone calls, video calls, and window visits. Information was displayed in appropriate places to make all visitors aware of the procedures that they were required to follow upon entering the service. At the time of our visit the home was closed for non-essential visitors.

Further information is in the detailed findings below.

People’s experience of using this service: People and their relatives told us the service was safe but did not feel there was enough staff to meet their needs. People spent long periods of time sat in communal areas with no staff presence or interactions. Care plans contained appropriate assessments of risk and instructed staff how to reduce the likelihood of harm. Appropriate recruitment checks were completed.

The home environment was clean and tidy which reduced the risk of infection and staff knew how to report any concerns if required. People were supported to receive their medicines at the right time.

People were supported by staff who had induction training and on-going training to ensure staff had the skills, knowledge and support they needed to perform their roles. People and relatives spoke positively about staff. People were provided with food and drink they enjoyed and it was presented in a way to meet people's individual needs.

We observed staff were kind and caring and people were observed to be content and happy in staff presence. People told us they were encouraged to be as independent as possible and staff respected their privacy and dignity.

Care plans were person centred and reviewed on a regular basis. A variety of activities were available to people everyday and people were encouraged to take part. A complaints procedure was in place in an accessible format.

There were ongoing quality checking arrangements in place where action plans were developed to support the continuation of improvements for the benefit of people who lived at the home. Staff told us they felt supported by the management team.

Rating at last inspection: Requires Improvement (Report published January 2018).

Why we inspected: This was a planned inspection based on the rating at last inspection.

Follow up: We will to continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At the inspection on 8, 12, 13 July 2017 we had found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in Regulation 9 Person centred Care; Regulation 11 Need for Consent; Regulation 12 Safe Care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 17 Good Governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The rating was Inadequate overall and the service was placed into special measures. Following that inspection we requested an urgent action plan from the provider which they provided immediately. They have provided regular action plans since that inspection.

We then inspected on 24 October 2017 and found that improvements had been made although there was a continued breach of Regulation 11 of the Health and Social Care Act Regulations (Regulated Activities) 2014 because the service was not consistently making decisions in people’s best interests. The service was rated Requires Improvement overall and the service was removed from special measures.

In addition there is a current police investigation relating to historic events. CQC have not reported on these matters at this inspection.

At this inspection we found further improvements at the service with no breaches of regulations.

Southlands 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 accommodates up to 48 older people who may be living with dementia in one building.

There was a manager employed at the service. They were not yet registered with CQC although their application had been accepted and was being processed. 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.

We found that recent changes at the service, in relation to the staffing and management, had positively impacted on the quality of the service. Quality assurance systems, although effective in identifying areas for improvement had not allowed sufficient time for actions to be completed and checked. This was discussed with the manager.

Most staff were recruited safely and appropriate checks were completed prior to people commencing work, to ensure they were suitable to work with vulnerable people. We identified that one person started work with only preliminary checks in place but they were supervised during their induction period until full checks were completed. There were sufficient staff to meet people’s care needs safely. Staff received an induction, appropriate training and supervision. We made a recommendation about staff recruitment.

Staff were knowledgeable about people’s needs and we found that people were receiving the care they required. There was up to date information in care files which meant that staff had all the information they needed to ensure that people received consistent and responsive care in line with their preferences. Some records were not fully completed although the relevant issues had been identified. Food and fluid charts did not have sufficient space allowed for all records of what people had to eat and drink. The provider was aware that improvements were needed to some records and had them under review.

People’s wishes at the end of their life had been identified. Where appropriate anticipatory medicines had been prescribed.

Staff had been trained in safeguarding adults and were aware of what action to take if they saw or suspected abuse. There were policies and procedures in place and the provider followed local area safeguarding procedures in reporting incidents.

People were aware of how to make complaints and there was a policy displayed around the service. Complaints had been managed in line with company policy.

Accidents and incidents had been recorded and analysed in order to identify patterns and trends and take action to repeat further incidents.

People who used the service told us that staff were caring and we found that staff supported people in a way that promoted their dignity and independence. We observed positive, friendly interactions between people and staff.

The environment had been further developed to make it dementia friendly and this work was on going. Improvements had been made and there was now an outside space that was secure and people could access freely. There was a variety of activities available at the home and visitors were welcome at any time. The service was clean and tidy.

People received appropriate support with their nutritional needs and systems were in place to ensure that people received their medicines safely. People had access to a range of healthcare professionals, to support them in maintaining their health. Health and social care professionals we spoke with told us that improvements had been made at the service.

At this inspection we found that improvements had been made although there was a continued breach of Regulation 11 of the Health and Social Care Act regulations (Regulated Activities) 2014 because the service was not consistently making decision’s in people’s best interests.

Southlands is a care home that provides accommodation and personal care for up to 48 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors. There were 32 people resident at the service when we inspected.

There was no registered manager employed at this service. 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. There was an interim manager in post at the time of our inspection who was in the process of applying for registration.

Risks to people had been identified although the risks relating to specific medical conditions people might have had not always been identified.

Staff recruitment was robust. There were sufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner except for the servicing of one lift.

Most training was completed but the learning from training was not yet embedded and therefore not yet just routine practice for staff.

People were not always supported to have maximum choice and control of their lives and staff had not supported them in the least restrictive way possible; the policies and systems in the service were clear and did not support this practice. Staff had not followed the correct process for making best interest decisions in line with company policy.

People’s nutritional needs were met.

Staff were described by people as being caring and we saw positive interactions between people and staff.

Activities took place but were not always meaningful to people living with dementia. Activities at the service were being developed.

The environment was not dementia friendly, particularly outdoors and did not reflect current good practice guidance.

People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service at the last inspection. This was now being addressed by the provider.

The quality assurance system was effective.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

We moved our planned comprehensive inspection to an earlier date because we had received concerns about some people who had lived or still lived at the service from a member of the public and from East Riding of Yorkshire Council. When we carried out our inspection we identified breaches of Regulation 9 Person Centred Care, Regulation 11 Need for consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good Governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) 2014. CQC requested an urgent action plan which was sent by the provider.

Southlands is a care home that provides accommodation and personal care for up to 48 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors. There were 41 people resident at the service when we inspected.

There was no registered manager employed at this service. 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. There was an interim manager in post at the time of our inspection, who had worked at the service for seven weeks, but they left shortly after the inspection. The regional manager was overseeing the service.

Risks to people had been identified but the written assessments did not reflect the practice of staff. Accidents and incidents had not always been managed in a timely fashion which had resulted in some people waiting for medical assistance, causing them distress.

Staff recruitment had not always been safe but was now more robust. There were insufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner in most cases but one passenger lift was not working. This had been the case for a prolonged period of time and the provider confirmed this lift had been decommissioned.

Most training was completed but the learning from training had not been embedded over time into staff practice. Staff had not always been supported appropriately but since the interim manager had started in post supervisions had been reintroduced.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. However, staff had not followed the correct process for giving covert medicines after implementing the correct procedures in making the best interest decision.

The chef was knowledgeable about people’s dietary needs and the food we saw was nutritious. They were aware of how to fortify diets and provide fortified drinks and finger foods for people living with dementia but these were not always nutritious with people eating a lot of sandwiches and biscuits. Staff were not effectively monitoring people’s food and fluid intake and taking action, as required.

Staff were described by some people as being caring and we saw staff speaking politely to people in a friendly manner. However, other people told us that not all staff were caring and did not promote people's dignity or meet people's basic care needs through the care they provided. Staff practice did not always reflect what was written in in the care plans.

Activities took place but were mainly in groups and they were not meaningful to people living with dementia.

The environment was not dementia friendly and did not reflect current good practice guidance.

People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.

Notifications had not always been made to CQC in a timely manner but they are now been sent when required.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service. This was being addressed by the registered provider but the Commission had some serious concerns.

The quality assurance system was not effective. The issues found at the inspection had not always been identified through auditing and monitoring. The provider had an action plan which the manager was using to demonstrate where improvements were being made.

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.

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.

We found that improvements had been made to medication practices and record keeping within the service. The provider had sent the Care Quality Commission an action plan following our visit in September 2013 and the actions within it had been completed by the time of this inspection.

There were clear processes in place for what should happen when a person moved to another service, such as a hospital, which ensured that the person's rights were protected and that their needs were met.

People told us 'We get our medicine on time and when we need it', but we found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

The provider had an effective quality assurance system in place and people's views and opinions of the service were listened to and acted on where necessary. There was also a complaints system available, which people understood and were confident of using if needed.

Records about people who used the service enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept behind locked doors to keep it safe and confidential.

People who used the service told us that they enjoyed living in the home. People said 'The care we receive is very good. We can talk to the staff about our care and treatment and they listen to our opinions and respect our wishes.'

People told us that they enjoyed the food in the home. Three people said 'There is a good choice of meals with alternatives offered to us if we do not like what is on the menu.'