We carried out a review of the data available to us about Southleigh on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Southleigh, you can give feedback on this service.
We found the following examples of good practice.
The registered manager had taken steps to ensure staffing was sufficient to fully meet people’s needs. Staff had worked flexibly, working extra shifts and supporting other staff in different roles, for example care staff supported the domestic staff by undertaking regular cleaning duties.
Staff had a separate entrance to use that meant they did not have to pass through the main areas of the service and went straight to an area where they were able to change their clothes before starting their shift.
Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their rooms when necessary.
There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the service and outside people’s rooms.
A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.
Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe.
People’s experience of using this service and what we found
¿ The environment was old and tired and needed to be improved to ensure all areas could be cleaned effectively. The provider had commenced a refurbishment of the service but had to put plans on hold because of the COVID-19 pandemic. There was one person who had a personal lounge chair that was ripped in several places making it difficult to clean effectively. We saw cleaning schedules and hourly high touch point cleaning to ensure the service was kept as clean as possible.
¿ Safe arrangements were in place for professional visitors to the service. This included temperature checks, hand sanitisation and wearing a mask.
¿ Staff had a separate entrance to use that meant they did not have to pass through the main areas of the service and went straight to an area where they were able to change their clothes before starting their shift.
¿ Isolation, cohorting and zoning was used to manage the spread of infection. This meant people self-isolated in their rooms when necessary.
¿ There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the service and outside people’s rooms.
¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. This meant swift action could be taken if anyone received a positive test result.
¿ Policies, procedures and risk assessments related to COVID-19 were up to date which supported staff to keep people safe. All staff had completed training in relation to infection control, and recently received training about the correct use of PPE including donning and doffing.
You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southleigh on our website at www.cqc.org.uk.
Southleigh is a residential care home providing personal care to up to 15 people with learning disabilities.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, bigger than most domestic style properties. It was registered for the support of up to 15 people. 11 people were using the service. This is larger than current best practice guidance. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the residential area and the other large domestic homes of a similar size.
People’s experience of using this service and what we found
People’s rooms were personalised and communal spaces were available for people, but several areas were in need of re-decoration and maintenance.
People continued to receive safe care, and staff we spoke with understood safeguarding procedures and how to raise concerns.
Detailed risk assessments were in place to manage risks within people’s lives, and staff we spoke with felt safe supporting people with a wide range of needs.
Staff recruitment procedures ensured that appropriate pre-employment checks were carried out.
Medicines were stored and administered safely, and people we spoke with were happy with the support they received in this area.
Staffing support matched the level of assessed needs within the service during our inspection, and staff were trained to support people effectively. All staff felt well supervised and confident in their roles.
People told us they enjoyed the food prepared for them, and food and fluid intake was monitored as required.
Healthcare needs were met, and people had access to health professionals as required. Care plans outlined any support people required to manage their healthcare needs.
Staff treated people with kindness, dignity and respect and spent time getting to know them. People were supported in the least restrictive way possible.
Care plans reflected people likes, dislikes and preferences. Activities took place and people were engaged with by staff.
People and their family were involved in their own care planning as much as was possible, and a complaints system was in place and was used effectively.
Staff and management were open and honest, and worked in partnership with outside agencies to improve people’s support when required. Audits of the service were detailed and any issues found were addressed promptly. The service had a registered manager in place, and staff felt well supported by them.
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.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
More information is in the detailed findings below.
Rating at last inspection
Good (report published 01/07/2017)
Why we inspected:
This was a planned inspection based on the rating at the last inspection. The service remained rated Good overall.
Follow up:
We will 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
The service is required to have a 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. A registered manager was in post at the time of the inspection, however they were on leave and not available during the inspection. In the absence of the registered a senior member of the care staff had taken on the role of manager supported by an area manager who visited during the inspection.
People continued to receive safe care. Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs. People were consistently protected from the risk of harm and received their prescribed medicines safely.
The care that people received continued to be effective. Staff had access to the support, supervision, training and on going professional development as required to work effectively in their roles. People were supported to maintain good health and nutrition.
People had positive relationships with the staff who were caring and treated people with respect, kindness and compassion. People had detailed personalised plans of care in place to enable staff to provide consistent care and support in line with their personal preferences. People knew how to raise a concern or make a complaint and the provider had effective systems in place to manage any complaints received.
The service had a positive ethos and an open culture. The registered manager was approachable and spent time with staff and people in the home. There were effective systems in place to monitor the quality of the service.
This unannounced inspection took place on 4 June 2015. The home provides support for up to 15 people with Learning Disabilities. At the time of the inspection there were 15 people living at the home.
There was a registered manager in post. 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 told us that they felt safe in the home. Staff understood the need to protect people from harm and abuse and knew what action they should take if they had any concerns. Staffing levels ensured that people received the support they required at the times they needed. We observed that on the day of our inspection there were sufficient staff on duty. The recruitment practice protected people from being cared for by staff that were unsuitable to work at the home.
Care records contained risk assessments to protect people from identified risks and help to keep them safe. They gave information for staff on the identified risk and informed staff on the measures to take to minimise any risks.
People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely. People were supported to maintain good health and had access to healthcare services when needed.
People were actively involved in decision about their care and support needs There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People felt safe and there were clear lines of reporting safeguarding concerns to appropriate agencies and staff were knowledgeable about safeguarding adults.
Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. People participated in a range of activities both in the home and in the community and received the support they needed to help them do this. People were able to choose where they spent their time and what they did. Pictorial formats of care plans, reviews and hospital passports were in place.
Staff had good relationships with the people who lived at the home. Complaints were appropriately investigated and action was taken to make improvements to the service when this was found to be necessary. The registered manager was visible and accessible. Staff and people living in the home were confident that issues would be addressed and that any concerns they had would be listened to.
People's physical and emotional needs were clearly reflected in their care plan and staff we spoke with had good understanding of people's needs.
Systems were in place to protect people from the risk of abuse. Staff had undergone training in safeguarding and they were clear in their responsibilities to report concerns.
Staff felt well supported and appropriately trained and were provided with regular supervision.
The provider had systems in place for monitoring the quality of the service and this included asking people who used the service for their views.
We saw that people's support plans were detailed and took account of people's individual needs and how this would be supported but they lacked activities that involved them to pass the time. We saw that the provider needed to make improvements to protect the people they cared for and their carers from harm.
We saw that the provider's quality assurance programme which made sure the safety and comfort of the people they cared for needed improvements. This was particularly in the way it monitored the availability of carers, staff training and the maintenance of the building where people lived.
We last visited Southleigh in May 2011 and found that there were shortfalls regarding outcome seven, Safeguarding people from abuse. As a result we set three compliance actions to ensure compliance with with regulation 11.
We asked the management to send us information about the things that they have done since our last review in order to comply with regulation 11.
People told us that they felt safe living at Southleigh and that they would know how to raise any concerns. They told us that they were confident that they would be listened to and have their concerns addressed. They told us that they liked the staff, that they were kind, respectful and considerate towards them.
People told us that they were able to make decisions for themselves in all aspects of their lives including their preferred routines and decisions about how to spend their time. They told us about the activities that they enjoyed at Southleigh and that they were engaged in meaningful activities within the home.
People told us that they thought that the service was well run and that they were able to participate in decisions about the running of the home and that their views were listened to.