Southernwood residential home is situated in the residential area of Amersham and provides accommodation for up to six people from the age of 18 to 64 with a learning disability.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.

Medicines were not always managed effectively in accordance with best practice guidelines. Stock levels of medicines were not accurate and did not reflect what medicines had been booked into the service. Prescribed medicines did not always correspond to what medicines were being administered.

We have made a recommendation regarding the management of medicines.

The quality team of the provider completed checks on the service; we saw these had been completed. However, none of these checks had identified the issues relating to stock levels of medicines noted during the inspection.

Recruitment files we saw showed that there were robust recruitment systems in place. Sufficient numbers of staff were available to meet the needs of the people at the service. All of the people living at the home had been assessed as needing one to one care in order to safely meet their needs.We were aware the provider was in consultation with the relevant authorities to request additional funding to meet increased needs.

Risks to people were appropriately assessed and recorded in care records. Each risk encouraged people’s independence and focused on what people could safely do for themselves.

Staff understood the different types of abuse and what signs to look for. Staff told us they would not hesitate to report any concerns they had.

Relatives we spoke with told us they felt their family member was safe living in the home.

Staff were trained in a range of subjects relevant to the needs of people using the service. New staff completed an induction programme and shadowed experienced staff before being assessed as competent. Staff were supported by having regular supervisions and appraisals. Staff told us they felt supported.

Mental Capacity assessments were carried out and recorded. DoLS applications had been submitted in accordance with good practice.

Arrangements were not in place to ensure the service was clean and hygienic to ensure that people were protected from acquired infections. Premises and equipment was not kept clean and cleaning was not completed in line with current legislation and guidance. Staff told us they were expected to carry out cleaning duties of the home. However, due to people’s high level of care needs this was not always possible. A cleaning schedule was not in place to show areas that had been cleaned or were in need of cleaning.

We have made a recommendation in relation to implementing a cleaning schedule to show areas that had been cleaned or were in need of cleaning.

The registered manager told us that open communication with families was encouraged at all levels. They said that they see families on a regular basis when they visit.

Staff had been trained to ensure that people received their food and fluids in a safe manner. One person was unable to have food orally and we saw a Percutaneous Endoscopic Gastrostomy (PEG) tube was in place in order for sufficient nutrients to be given. Staff had been trained in administering food via a PEG tube. People living at the service were not able to demonstrate a preference for a particular meal or drink, but staff told us they knew from experience what people preferred and provided food accordingly.

People’s day to day health needs were met by the service in collaboration with families and healthcare professionals. Staff supported people at healthcare appointments and used information to update care plans.

We observed staff interacting

We observed positive interactions between staff and people who used the service during our visit. People were supported by staff members to access community services on a regular basis. We saw that people’s independence was maintained through effective care planning and respecting people’s wishes around their needs.

We spoke with relatives of people who used the service. One relative told us “I have total confidence in the staff; they have a really good team.” Another relative told us “We feel our relative is well cared for.” We observed that relatives were kept informed and supported by the service in regards to people’s care and welfare.

Staff were knowledgeable around safeguarding issues and were able to explain how they would escalate their concerns. We saw the provider had safeguarding posters, flowcharts and telephone numbers readily available in communal areas for staff, relatives and visitors if they had concerns about people’s wellbeing.

The provider had adequate numbers of skilled and experienced staff to ensure people’s care and social needs were met. Staff received regular training, supervision and appraisals to support them in their roles and to enhance their professional development.

We spoke to staff, viewed policies and processes, reviewed two sets of notes, three staff records, spoke to the families of three people using the service and observed the daily routine to gain further insight of the care provided. Some people had gone to a day centre before we arrived and returned whilst we were there. Everyone we saw was involved in some activity.

There were appropriate processes in place to recruit staff and support their training. Staff showed an excellent knowledge of people living there, they had used innovative techniques to aid communication and there was good rapport between them. Staff told us they liked working there and care was provided in a considerate and caring manner.

We contacted the families of three people who had been living at Southernwood for some time. Everyone praised the staff and manager at the home. One person said they felt “so fortunate as the care was so good”. Another told us “staff know him so well and know just what he likes”. People we observed appeared satisfied with the care they received and were seen to have a good relationship with the carers. We saw that they were able to personalise their own rooms and that the home was clean and comfortable.

We saw evidence of a system in place to audit the quality of care. There was a complaints process in place and families knew how to complain if needed. Team meetings were used to discuss new information and matters important to people using the service.

People using this service were unable to express their views directly to us. We spoke to representatives of some families after our visit to the home.

One relative of a person who had been admitted recently told us that they were very pleased with the service.

They said they had been given enough information to help them in their decision before admission. This, together with visits and meetings, covered all aspects of the admission process and the service provided.

They said that the general atmosphere in the home was friendly and well organised. Their son had settled in well and was very happy living there. The person expressed confidence in the staff. Staff knew how to provide support to each person.

Another person described the service as “Brilliant – especially now that the manager is back”. They too expressed confidence in the service. They said that the staff were “Excellent”, that they knew their relative’s (the person using the service) likes and dislikes. They told us they couldn’t fault the staff.

Southernwood is situated in the residential area of Amersham and provides accommodation for up to six people with physical and learning disabilities. Southernwood also provides outreach support to people who live in the community. At the time of this inspection there were six people living at the home.

Southernwood has a registered manager in place. 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.

This inspection was undertaken over two days which involved speaking with staff, relatives, management and undertaking observations. We were unable to speak with people as they were unable to verbally communicate.

The service was providing ‘good’ care to people. Safe practices were undertaken around people’s risk management. For example, where it was deemed that people may lack capacity to manage their medicines or finances, the provider had taken appropriate action to ensure people were safeguarded against potential abuse. Relatives we spoke with told us they felt their loved ones were safe. Staff within the service were aware of how to report and escalate any safeguarding concerns to the appropriate people. Staff had received training to ensure they could work effectively and safely with people. We found the provider had effective recruitment procedures in place, including the training, supervision and induction of staff members. We found medicines were handled in a safe and effective way.

We looked at how people using the service were supported through the use of the Mental Capacity Act 2005 (MCA,) and the Deprivation of Liberty Safeguards (DoLS). We found staff were knowledgeable around their roles and responsibilities when working with people around consent. We spoke with two staff members who were able to explain what the MCA and DoLS meant, and how this affected the people they worked with. Where required, mental capacity assessments were completed along with evidence of best interest meetings.

People were supported to have sufficient amounts to eat and drink and to promote and maintain a balanced diet. The home involved people as much as they could with menu planning. A ‘likes and dislikes’ approach was adopted to ensure people were provided with what they wanted and when they wanted it. For example, on our first day of inspection, people were provided with a fish and chip lunch at their request. Where people required specialist diets or were at risk of weight loss, the provider ensured peoples’ nutritional and hydration needs were met.

The service demonstrated caring practices. Staff were respectful of people and treated them with dignity. When one person became visibly upset, we saw how staff responded to them to try and make them feel better. Staff were patient with people and made sure people were given the time they needed when completing tasks. The service had received positive feedback from health and social care professionals which they shared with the commission. One staff member had been nominated for a ‘Making a difference award’. This staff member had been nominated and selected from a large number of staff working for the whole provider for their outstanding work. 

We found the service to be well-led by an available and visible registered manager. Staff members, other health and social care professionals and relatives were positive about the management of the service.  Staff told us “They (The provider) have been so supportive since I have come back to work. The manager is great, so approachable. He is always contactable and visible which is good.” Another comment made was “The manager is very supportive and adapted my shifts when I needed them changed.” One relative told us “I feel very confident in the management of the home.” Another staff member told us “The management is brilliant, I would never hesitate in raising any issues – it’s always acted upon.”  Before the inspection, we asked 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. They did not return a PIR prior to this inspection; however the PIR was received shortly after the inspection.