This inspection took place on 30 March and 4 April 2017 and was unannounced. The service provides accommodation for up to 46 people with nursing care needs. There were 42 people living at the service when we visited, some of whom were living with dementia. All areas of the home were accessible via a lift and there were three lounge/dining rooms on ground of the home. There was accessible outdoor space from the ground floor. Bedrooms were a mix between single and shared occupancy.

There was a registered manager at the home. 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.

Risks to individuals were assessed and monitored. Where risks were present, the service put measures in place to reduce the risk of harm to people. Where people’s health needs changed, the service involved external professionals to ensure people received assessment and care which was appropriate to meet their needs. People had access to healthcare services as required, which helped to maintain their health and wellbeing.

People’s care plans detailed people’s preferences around their personal care routines and documented areas in which they remained independent. Care plans were regularly reviewed and people were involved in making choices about how they were cared for. Where people lacked the capacity to make specific decisions, the service had followed the principles of the Mental Capacity Act (2005) to ensure that decisions made were in their best interest and were as least restrictive as possible. Staff understood the need to gain consent before providing care and treated people with dignity and respect.

There were sufficient staff available to meet people’s needs. The service had robust recruitment processes, which helped ensure that staff were of appropriate character and experience to provide effective care for people. Staff received appropriate training, induction and supervision to carry out their role and told us they were happy with the support they received from the registered manager. Staff had received training in safeguarding and understood their responsibilities in reporting concerns through the appropriate channels, which helped to keep people safe from abuse. People and their relatives told us that staff were caring, compassionate and understood their needs well. Staff cared for people calmly, this helped to create a homely atmosphere within the service where visitors were welcomed and people felt safe and relaxed.

There were systems in place in safely mange people’s medicines to ensure they received them as prescribed. Where some people took medicines for anxiety, staff worked with people and doctors to ensure that people were only administered these medicines when necessary to keep people safe.

People’s nutritional needs were assessed to help ensure people received appropriate support. Where people required additional help to eat and drink, staff provided the assistance they required and monitored their food or fluid intake to ensure they were receiving enough to eat and drink.

The registered manager's quality assurance systems ensured that they had an insight into the daily running of the service. They monitored key areas of staff performance and the wellbeing of people to help ensure that issues or concerns were identified and addressed quickly. The registered manager had a ‘home improvement plan’, which detailed and tracked improvements identified through auditing and feedback. Formal feedback was used to make improvements to the service. Responses from questionnaires and consultation with people had led to changes, which improved the quality of the environment and the care provided. There was a complaints policy in place and people were aware how

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

The inspection was unannounced and took place on the 4 and 5 August 2014. On our last inspection on 25 April 2014 no concerns were noted.

South Haven Lodge is a care home with nursing services. The service provides accommodation for 46 older people who require nursing or personal care. There were 45 people receiving a service when we carried out this inspection. People may have mental health concerns, dementia, physical health and mobility needs. There is a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

People’s medicines were administered safely, however the systems supporting administration of topical medicines, applied to people’s skin, required improvement. Body maps were not used to show staff areas where each topical medicine should be applied. Some people’s photos on their medicine administration records were not signed or dated. The medicines took a long time to be administered in the morning and could impact on their effectiveness if there needed to be a specified time period the medicines needed to be given.

People told us they were happy to live in South Haven Lodge. They found the staff to be caring and attentive. Some people remarked on how safe they felt. They told us they were involved in their care plans and knew how to change elements of their care if they needed to. We saw how comments they made about aspects of the service were responded to and the provider had responded positively. Changes that had been requested had been put in place.

Staff were aware of the needs of the people who they supported. There was an effective care planning system in place which reflected the assessed needs of people. Staff involved people, where possible, in identifying how they wish to be supported and what was important to them. We saw staff delivered care with compassion and understanding and spending time with them when requested.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. These safeguards protect the rights of people using services by ensuring that if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm. We observed people’s freedoms were not unlawfully restricted. Staff were aware of when a DoLS application needed to be made.

Staff received appropriate training to deliver care to meet the needs of people. There was a robust recruitment process in place which ensured staff underwent appropriate checks before commencing employment. There was a comprehensive induction process for new staff which gave staff the necessary skills, knowledge values and philosophy of the service.

We saw positive examples of care that were consistent with the care plans for individual people. Staff told us about the personalised care they delivered and how they involved people in the care they delivered. Staff were aware of people’s likes and dislikes and ensured people were offered choices. Where people did not have the capacity to make decisions for themselves the manager demonstrated how they involved professionals and relatives in delivering care in the best interest of the person.

The registered manager and provider undertook regular audits to assess the quality of care consistently. The provider encouraged feedback from people, their relatives and professionals. This information was used to make improvements to the service.

We used the Short Observation Framework for Inspections (SOFI) and observed four people for an hour. We spoke with three people who use the service and a relative of someone using the service. One person said "It's a very nice place and the girls are lovely." Another person told us they liked the food and the friends they had made in the home. The relative told us "I am so grateful they have given me my husband back for another year."

We spoke with four members of staff, the manager and the operations manager. One member of staff said "The staff work well together and it's great to be a part of the team." Another member of staff said "You are really well supported to do your job". One member of staff said "It's great to see people make progress and regain skills."

We saw people were involved in making decisions in their daily lives and could see they were being listened to by staff. Their needs were identified in a care plan which staff followed when delivering care. People's health needs were identified and responded to if they changed.

Staff were aware of safeguarding and helped people to remain safe. Concerns were reported and the management responded appropriately. We saw concerns were referred to the local safeguarding authority who worked with the provider to address the issues identified.

The service managed the administration of medicines safely and ensured people received their medicines appropriately. Staff received appropriate support and training.

We spoke with four people who lived at the

home. They all confirmed that their privacy and dignity was maintained at all times and that staff always knocked on the door before entering their rooms. People told us of instances when their choices had been respected. For example, the home was due to undergo refurbishment at the time of inspection. People told us that they were involved in the process of choosing the décor for their rooms.

We observed that people had a copy of ‘My Life Story’ attached to their care plans which was completed by residents or their relatives in order to provide a fuller picture of the person’s individual preferences and needs. Not all were completed as we were told that some people no longer had the mental capacity to undertake them and no relatives were on hand to help.

We also spoke with five visitors who came to the home regularly, always arriving unannounced. They told us that the care was of a high standard and felt that people were well looked after.

To help us understand the experience of people using the service, we used our Short Observation Framework for Inspection tool (SOFI). This allowed us to spend time watching what was going on in a service and to record how people spent their time, the support they got and whether or not they had positive experiences. Using this, we found that staff had the necessary time and skills to care for people well.

People said that they had no concerns about how their nursing and personal care needs were met. They said that if they were unwell then staff would contact a doctor for them. People said staff were available when they needed them and knew what care they required.

We also spoke with other health and social care professionals involved in the care of people. They stated that they had no concerns about how people’s health and care needs were met.

People told us they had a choice about what they had for their meals and could influence menu planning both informally and through resident’s surveys. They also told us that meals were served where and when they chose.

We were not able to speak with people who use the service due to the nature of their disability.

We were not able to speak with people who use the service due to the nature of their disability.

Staff said that people’ choices with regards to where they eat their meals are restricted. A visiting professional said that they had not seen anyone using the dining/lounge area on any of the occasions they had visited over the last three 3 months.

The relatives of one person said that they were very happy with the care and support that their family member receives. They told us that when staff speak to their relative she always smiles and that they take that as an indication that she is not afraid.

Southampton Safeguarding Adults Team have told us that incidents that have occurred in June and July are a cause for concern.

We were not able to speak with people who use the service due to the nature of their disability.

Staff told us that they respect and involve people in making decisions about the care and support they receive. They also told us that they have received guidance about nutrition and those people who are at risk. For example one said “the manager has given us really good guidance about supporting people with their dietary needs. We have been given information about the use of thickening products and how to use this, people now have a greater range of fortified drinks and care plans now contain a lot more information about people’s dietary needs and meal preferences”.

Staff also confirmed that they monitor how people are cared for to ensure they are safeguarded from harm. Both the manager and staff also informed us that people with very high needs are only supported by permanent staff, with agency workers not allowed to undertake this role. They said this was to ensure consistency of care.

Staff said that they receive lots of support from management to carry out their roles. For example one said “things have got so much better since the new manager has been here, we all now work as a team. We have started to have supervision both formally and informally. The manager is very approachable”.

Southampton City Council safeguarding team have told us that they are still working with the service, that improvements have been made to service provision and that the voluntary suspension is still in place as the service now have to evidence that the improvements made can be sustained.

We were not able to speak to the majority of people who use the service due to the nature of their disabilities. Those that were able said that they liked the meals provided. One person told us they do not get the support they need to eat independently.

Southampton City Council safeguarding team have informed us of investigations they have been carrying out at this service since June 2010. Concerns have been around preferences, wound care, moving and handling practices, fluid and nutritional needs and staffing. The service agreed to a voluntary suspension of placements in September 2010 and the decision taken to move people with high level needs in December 2010 as it has been evidenced that their needs are not being met safely and consistently. It is the view of the safeguarding team that there is systemic poor practice at the service and that each time a new area of concern is raised the service responds to the issues but are not identifying these themselves.

We have been told by a relative of a person living at the service that they had concerns about the care their relative has received, but that improvements have been made recently.

Management of the service confirmed that there have been issues at the location. They expressed the view that improvements have been made.