The inspection took place on 2 and 3 May 2018 and was unannounced. This meant the provider and staff did not know we would be coming.

We previously inspected South Quay Care Home in April 2016, at which time the service was meeting all regulatory standards and rated good. The service was rated requires improvement at this inspection.

South Quay 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.

South Quay accommodates a maximum of 58 people across two separate units. One of the units is for older people. One of the units specialises in providing care for people with a neurological condition. During our inspection there were nine people on the neurological unit and 33 people on the older person’s unit. Some people who used the service received nursing care.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Required improvements to fire doors, bathrooms and the outdoor space had not been completed by the provider.

Premises had been visited by the provider’s Resident Experience Care Specialist but, as yet, no improvements had been made.

People who required input from physiotherapy had not always received this, whilst some people who required one-to-one support from staff had not always had this planned effectively. Care staff worked extremely hard to ensure detrimental impacts on people were limited due to these provider failings.

There were sufficient staff in order to keep people safe although the provider used a dependency tool more suited to establishing staff levels for older person’s care, whereas one of the units specifically supported people with complex physical needs. We have made a recommendation about this.

Premises were generally clean with infection control practices followed and sufficient domestic staff in place.

Staff had received safeguarding training, were clear on their responsibilities and could give examples of when they had acted effectively to keep people safe.

People who used the service interacted well with staff and told us they felt safe. No relatives or external professionals we spoke with raised concerns about safety.

Risk assessments were in place and were reviewed regularly, with involvement and advice from external specialists where appropriate.

Medicines administration practices were in line with good practice and the nurse we spoke with demonstrated a sound understanding of people’s medicinal requirements.

Pre-employment checks of staff remained in place, including Disclosure and Barring Service checks, references and identity checks, as well as Nursing and Midwifery Council (NMC) register checks of nurses.

Aside from the concerns regarding physiotherapy, people had accessed external healthcare professionals such as GPs and dietitians to get the support they needed. Staff liaised well with these professionals.

Staff received a range of mandatory training and training specific to people’s needs.

People were encouraged to have healthy diets, enjoyed a range of mealtime choices and were protected from the risk of malnutrition.

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.

Relatives and external professionals confirmed staff had formed good relationships with people.

People were encouraged to remain independent and access their local community, whilst activities co-ordinators encouraged community gr

We carried out an unannounced comprehensive inspection of this service on 28 and 29 October 2014, at which two breaches of legal requirements were found. This was because staff did not always receive supervision or appraisals and appropriate assessments and applications to the local safeguarding adults team, for people who may be subject to Deprivation of Liberty Safeguards, had not been undertaken. We also found that the registered manager had not notified us of significant accidents or events occurring at the home, as he was legally required to do so.

We undertook a follow up inspection on 28 July 2015 to look at these two areas. We found that action had been taken to address the previous breaches and no further breaches were noted. We did not change the rating at this inspection because we wanted to be sure that the improvements noted at the home would be maintained. We undertook a further inspection of the home on the 19 April 2016. This was a comprehensive inspection of the home to check that the improvement previously noted had been sustained.

South Quay Care Home is registered to provide accommodation for up to 58 people and is divided into two distinct units; one unit supporting older persons, some of whom were living with dementia, which can accommodate up to 45 people, and a smaller unit offering care and respite facilities to a maximum of 13 younger people with a neurological condition. At the time of the inspection there were 32 people living on the older person’s unit and 12 people using the neurological conditions service. The neurological unit had previously been subject to a separate management and reporting system. This had changed in January 2016 and all elements of the home were the managed by the registered manager for the location.

The home had a registered manager who had been registered since September 2014. 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 they felt safe living at the home and felt the staff treated them appropriately. There were systems in place to help protect people from harm or abuse and staff had a good understanding of safeguarding issues. They told us they would report any concerns of potential abuse to the registered manager or the regional manager. Staff were also aware of the registered provider’s whistle blowing policy and knew how they could raise concerns about care.

The premises were effectively maintained and safety checks undertaken on a regular basis. Remedial work on some building and safety issues was being undertaken at the time of the inspection. Some people and staff highlighted that staff could be busy, although people said they were supported with their care in a timely manner and we did not witness long waits when call bells rang. Proper recruitment procedures and checks were in place to ensure staff had the correct skills and experience to support people at the home. Staff told us they had access to a range of learning. They told us, and records showed that regular supervision took place and people had an annual appraisal.

People’s wellbeing was monitored and they had access to general practitioners and other health professionals. Where necessary specialist advice was sought. Medicines were managed safely and effectively.

People told us they had sufficient food and drink. We observed meals served at the home to be hot and appetising. Alternatives to the planned menu were also available to people. People who required special diets or assistance with their dietary intake were effectively supported.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure peo

We carried out a previous comprehensive inspection of this service on 28 and 29 October 2014, at which two breaches of legal requirements were found. This was because staff did not always receive supervision or appraisals and appropriate assessments and applications to the local safeguarding adults team, for people who may be subject to Deprivation of Liberty Safeguards, had not been undertaken. We also found that the registered manager had not notified us of significant accidents or events occurring at the home, as he was legally required to do so...

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 28 July 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘South Quay Care Home’ on our website at www.cqc.org.uk’

South Quay Care Home is registered to provide accommodation for up to 58 people and is divided into two distinct units; one unit supporting older persons, some of whom were living with dementia, which can accommodate up to 45 people, and a smaller unit offering care and respite facilities to a maximum of 13 younger people with a neurological condition. At the time of the inspection there were 28 people living in the unit supporting older people and 11 people in the unit supporting neurological conditions.

The home had a registered manager who had been registered since September 2014. 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.

At our focused inspection on 28 July 2015, we found that the provider had followed their plan which they had told us would be completed by the April 2015 and legal requirements had been met.

We saw evidence that assessments had been made of those people who may be subject to Deprivation of Liberty Safeguards (DoLS) and, where necessary, applications had been made to the local authority safeguarding adults team. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. The registered manager told us assessments were currently in progress, but that no formal DoLS applications had been granted at the current time.

Staff told us they had access to regular supervision and appraisals and we saw a matrix had been produced to ensure that regular supervision sessions were undertaken and recorded.

We had received a number of notifications from the provider in relation to accidents or incidents at the home. We saw that the issues recorded on the home’s systems matched the notifications logged in the Commission’s recording system.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time. We spoke to the regional manager about this and she told us she would look to address this issue.

We looked at the care records of six people who used the service. We saw that there were care plans in place related to people's assessed individual needs and that these had been reviewed on a monthly basis.

We spent time observing the care delivered by staff and found that it reflected the information contained within people's care plans. We found that food and fluid charts, positional change records and bedrail monitoring records were up to date and contained no gaps. Daily records were up to date and contained good detail. We examined the medication administration records (MARs) for the unit and found these were up to date and contained no gaps in signatures.

We observed that staff checked with people that they were happy with how they were being treated and offered them choices. One relative told us, “The staff talked through the care for my mum when she first came in. The staff always talk to me and chat and tell me things and keep me updated.”

People's needs were assessed and care was planned and delivered in line with their assessed needs. One person told us, “I love it here. You are treated like one of the family. The staff are great; I have full praise.” Another person said, "The treatment in here could not be better.”

On the day of our inspection there were adequate numbers of staff on both units to meet the needs of people who lived at the home. One relative told us, “I feel there is always enough staff about. I am here every day and there always seems to be someone around.”

The provider had systems in place to monitor care delivery and ensure the health, welfare and safety of people who used the service was maintained.

We examined in detail the records of five people who used the service and an additional four sets of records to check particular issues relating to consent and records keeping. We found in some cases records maintained within people’s rooms were incomplete.

We spoke with 11 people who lived at the home to find out their thoughts on the care provided at South Quay. All people who we spoke with were complimentary about the care they received there. One person told us, “I like living here because of the company. The staff are nice and I’m well looked after. I have no complaints.” Other comments included, “The staff are lovely,” “We get first class food, no grumbles there” and “There’s no trouble with anything.”

We carried out this review to check the improvements made to staffing levels and refurbishment of the premises. On this occasion we did not seek the views of people who used the service.

This inspection focused on people living in the elderly care unit. We spoke with people who lived in the unit for older people. They told us that they were encouraged to make decisions about their care and support. People told us that they were well looked after and had access to doctors, dentists and other health professionals. People we spoke with said that there was a good choice of food and it was well cooked and presented. People said that they felt safe living in the home. They said that they were satisfied with their accommodation. All of the people we spoke with said that the home was kept clean.

People told us that there were not enough staff in the home and this sometimes inhibited them from asking for things or ringing their nurse call bells. They said the staff that were there worked hard and were gentle and pleasant to them.

This inspection took place on the 28 and 29 October 2014 and was unannounced. An inspection undertaken on 3 October 2013 found there was a minor breach of Regulation 21, appertaining to records kept by the home. A further inspection, conducted on 21 January 2014, found this issue had been addressed and there were no further breaches of legal requirements.

South Quay Care Home is registered to provide accommodation for up to 58 people and is divided into two distinct units; one unit supporting older persons, some of whom were living with dementia, which can accommodate up to 45 people, and a smaller unit offering care and respite facilities to a maximum of 13 younger people with a neurological condition. At the time of the inspection there were 25 people living on the older person’s unit and 10 people using the neurological conditions service.

The home had a registered manager who had been registered since September 2014. 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 they felt safe living at the home and felt the staff treated them appropriately. There were systems in place to help protect people from harm or abuse and staff had a good understanding of safeguarding issues. They told us they would report any concerns of potential abuse to the registered manager or the regional manager. Staff were also aware of the registered provider’s whistle blowing policy and knew how they could raise concerns about care. The premises were effectively maintained and safety checks undertaken on a regular basis. A process was in place to assess people’s needs and this information was used to determining appropriate staffing levels. Proper recruitment procedures and checks were in place to ensure staff had the correct skills and experience to support people at the home. Medicines were dealt with safely and effectively.

People told us they had sufficient food and drink. They said the meals at the home were good and they could have alternatives to the planned menu, if they wished. They also told us they felt staff had the right skills to support them. Staff told us they had access to learning, although highlighted this relied heavily on ELearning at the current time. However, we found some staff had not had access to regular supervision, to review their support and training needs and ensure they were working safely. In some cases there had been no supervision for over nine months.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005. These safeguards aim to make sure people are looked after in a way that does not inappropriately restrict their freedom. We saw evidence that assessments and best interest meetings had taken place in relation to people’s care and health needs. However, we found the registered provider had not yet instigated a process to assess whether people were being detained in line with the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards. The local safeguarding adults team confirmed that they had not been approached by the registered manager in relation to managing the implementation of the recent Supreme Court ruling in relation to DoLS.

People told us they were happy with the care provided. We observed staff treated people patiently and appropriately. Staff had a good understanding of people’s individual needs. People’s wellbeing was monitored and they had access to general practitioners, dentists and opticians, along with a range of other health professionals. Where necessary specialist advice was sought. People said they were treated with dignity and respect and staff were able to demonstrate how people’s dignity was maintained during the provision of personal care.

People had care plans that reflected their individual needs and these were reviewed to reflect changes in people’s care requirements. There were a range of activities offered for people to participate in. People told us they knew how they could raise a complaint, if they needed to. Complaints and concerns were dealt with by the registered manager, using a full and proper process.

The registered manager carried out regular checks on people’s care and the environment of the home. Staff were positive about the leadership of the home and felt well supported. The registered manager held regular meetings with staff groups and people who used the service, to allow them input into the running of the home. However, the registered manager had not notified the Care Quality Commission (CQC) of significant accidents or incidents and important safeguarding issues.  

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. This related to supporting workers. You can see what action we told the provider to take at the back of the full version of this report.