This unannounced inspection took place on 20 and 21 July 2016.

Southfield provides residential and respite care for up to 34 older people. At the time of our inspection 31 people were living there. There was a manager who had applied to CQC to become 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. There were no breaches of legal requirements at the last inspection in June 2013.

People had their medicines on time and generally they were safely managed. Care needed to be taken when staff administered topical creams. Not all staff training was up to date but the manager knew about this and training was planned. People told us they felt safe in the home. Staff knew how to keep people safe and were trained to report any concerns. People were supported by staff that were trained and had access to training to develop their knowledge.

People were provided with personalised care and were supported to make their own choices and decisions where possible. Staff knew what they valued and how they liked to be supported. Peoples care was regularly reviewed. Healthcare professionals supported people and there was good care and support for people nearing the end of their life.

People were treated with kindness and compassion and they told us staff were very good when they supported them with their care. Relatives were welcomed in the home and they supported the home to provide activities. They told us the staff were kind and understanding.

People told us the food was good and there was a choice of meals. When people required assistance with their food staff supported them and gave them time to enjoy their meal. People had activities to choose from which included quiz games, exercise classes, arts and crafts, musical afternoons and ball games. There were links with the local community and trips out were organised.

The area operations manager and the manager monitored the quality of the service with regular checks and when necessary action was taken. People and their relative’s views were taken seriously. They contributed in meetings and regular reviews of the service and improvements were made. Staff felt well supported by the manager and head of care who were available to speak to people, their relatives and staff. Staff meetings were held and staff were able to contribute to the running of the home.

We previously visited this home in November 2012. At that time we had some concerns. Staff did not consistently follow correct procedures in relation to obtaining consent for people who lacked capacity and they had a limited understanding of their responsibilities under the Mental Capacity Act 2005 (MCA). People who lived in the home were mainly satisfied with the care they received but there was some concern that call bells were not always answered promptly. Risks to people's health and welfare were not regularly reviewed. The standard of record keeping was poor. There was insufficient documentary evidence that people’s care needs were kept under review and consistently met.

When we returned to the home we found that significant improvements had been made. Staff had received training in the MCA. For those people who lacked capacity there was evidence that decisions had been taken on their behalf in their best interests. Care records were accurate and up to date and demonstrated that people received the care and support they needed.

We looked to see whether people were supported to have adequate nutrition and hydration and to see whether the provider had effective recruitment and selection processes in place. People told us they had enough to eat and drink and they enjoyed a variety of nutritious food. People were appropriately supported to eat and drink. There were effective recruitment processes in place to ensure that people received care from suitable staff.

On the day of our visit we spoke with four people who lived at the home and with three relatives. We also spoke with staff, the registered manager and the area manager. Feedback was generally very positive. People said that the staff were kind, and cared for them well. Some concerns were expressed that call bells were not always answered promptly. This was a concern that the home was aware of and was monitoring.

We looked at processes in place to ensure that people were able to give informed consent to their care, and where they lacked capacity, that staff complied with legal requirements. We found that many staff had not received relevant training and documentation was incomplete.

We observed that the home was clean and tidy and we saw staff taking appropriate steps to minimise the risk and spread of infection.

The home was fully staffed, although some of the staff we spoke to felt that at times staffing levels were not adequate to meet people’s needs.

The home had an effective complaints system which was well publicised. There was evidence that they took complaints seriously and investigated and responded appropriately to concerns.

We found that the standard of record keeping was generally poor. There was insufficient documentary evidence that people’s care needs were kept under review and consistently met. The provider was aware of shortcomings in this area and was taking action to address this.

We spoke to eight people who use the service. They gave us their views about living at Southfield. One person said “Everything is perfect” , another described home as “Lovely” and another stated that the home was “very good in the main”.

People made positive comments about the staff such as "staff are very nice" and another described the manager as “approachable” .