We inspected this service on 18 and 19 October 2016. Southerndown provides accommodation and nursing care for up to 87 older people. The service comprises of two separate units “Elderly Frail” general nursing unit and “Memory Lane” for people living with dementia. At the time of our visit 71 people were using the service.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

At our last inspection in August 2015 we found people were not always protected from the risk of infection. Staff used the same body sling to assist two people with transfers and we found the sluice rooms on each floor of the home were not being kept clean. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found the provider had implemented the improvements required and all previous issues with regard to the infection control had been addressed.

People’s risk assessments and support plans were detailed and contained clear information for staff. People’s care records were reviewed every month or when the person's care needs had changed. Where people had pressure reliving mattresses in place, there was no recorded guidance in relation to settings required for an individual. There was no evidence that regular checks of the settings of mattresses took place to ensure these were set appropriately for people. This meant people could be at risk of developing pressure sores. The registered manager immediately organised for these to be reviewed and updated.

Accidents and incidents were recorded and investigated. The registered manager had a system to monitor the accidents to identify any trends or patterns. People received their medicines as prescribed and in line with the organisation’s medicines policy. We observed that medicines were given to people in a professional and safe manner.

There were sufficient staff on duty to meet people’s needs. People were assisted promptly and with no unnecessary delay. There was a safe recruitment system in place that helped the management ensure people were cared for by suitable staff. People were supported by staff that were knowledgeable about their responsibilities and had the relevant skills and experience. Staff told us they were well supported and records confirmed they received regular supervision sessions.

Staff demonstrated knowledge of principles and their responsibilities of the Mental Capacity Act 2005. Mental capacity assessments were completed where required and we saw the evidence on people's files. Where people were at risk of having their liberty deprived appropriate applications were sent to the local authority for authorisation.

People were supported to maintain a balanced and nutritious diet. People at risk of malnutrition had appropriate assessments and we saw the detailed records were kept of their food and fluid intake. People were supported to access a range of healthcare professionals and their input was incorporated into people’s care plans. People’s needs were assessed before they came to live at the service. People’s care plans contained information about people’s individual health and social care needs, their wishes and preferences.

People were cared for by staff that respected their privacy and dignity and promoted people’s independence. Staff spoke about people in a warm and professional manner and they were enthusiastic about working at the service. People we spoke with told us they were happy with the care and complimented the staff.

People knew how to make complaints and provider had a complaints policy and procedure in place. The registered manager ensured when a complaint had been raised it had bee

We inspected Southerndown on the 17 August 2015. Southerndown provides residential and nursing care for older people over the age of 65, a number of the people living at the home were living with dementia. The home offers a service for up to 87 people. At the time of our visit 75 people were using the service. This was an unannounced inspection.

We last inspected in May 2013 and found the provider was meeting all of the requirements of the regulations at that time.

There was a registered manager in post on the day of our inspection. 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 were not always protected from the risks of infection and staff did not have access to equipment and facilities to prevent the spread of infectious diseases.

People told us there was not always things to do and that life in the home could be boring. Some people went periods of time without any contact with care staff. There was an activity co-ordinator in post, and another activity co-ordinator was due to start at the home shortly.

People were supported and cared for by kind, caring and compassionate care staff. Staff knew the people they cared for and what was important to them. Staff supported people to stay as independent as possible.

People received their medicines as prescribed. Staff kept an accurate record of where people had received their medicines.

Staff protected people from the risks associated with their care. Staff had clear guidance to protect people from pressure area damage.

There were enough staff deployed by the provider to meet people's needs. Staff received the training and support they needed to meet people's needs. Staff had clear leadership to ensure people received personalised care daily.

The provider was aware of improvements which were needed in the home, and had made arrangements to improve the quality of service, including the recruitment of staff. The registered manager had effective systems to monitor the quality of service people received.

People told us they felt safe in the home, staff had a good understanding of safeguarding and the service took appropriate action to deal with any concerns or allegations of abuse.

People and their relatives told us their complaints were acted on by the management team. Relatives felt staff were approachable.

People had access to appropriate food and drink and were supported to access external healthcare services.

Staff had good knowledge of the Mental Capacity Act and Deprivation of Liberty Safeguards. People who were being deprived of their liberty were being cared for in the least restrictive way. However, where people had given consent around their care, this had not always been documented.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with eight people who used the service and one relative. All the people we spoke with were happy with the care and treatment they received. One person said "it is good here, I like the food too". Another said "I've been here four years, I like it, the carers are excellent". The relative we spoke with said "my mother is in good hands here". People told us they felt safe, well cared for and that they felt involved in their care. One person said "I get up when I want and go to bed when I want. It is my choice".

We spoke with nine care workers who told us they were happy working at Southerndown and felt supported. One said "definitely good, lots of help and support". All the care workers we spoke with told us they received induction training and felt well prepared to carry out their jobs. They also told us they felt there was sufficient staff on duty. We saw care workers administering care to people and saw this was done in a respectful, involved and caring way.

We looked at eight care plans and found them to be person centred, up to date and well maintained. All risks had been adequately assessed and any control measures required were in place.

Overall, the nursing care and treatment provided to people met their treatment needs, but staff did not have time to stop and chat to people. One person's relative told us, "I have never seen anyone talking to her. Since the summer I have noticed that residents just sit in lounge areas on their own, no staff talk to them." People with dementia were not always being observed or stimulated which meant they were not protected from harm. We found that improvements in quality monitoring were necessary. We found that record keeping had greatly improved since our inspection in October 2012.

David Groves was the registered manager for this location. The provider had applied to the commission to cancel the registration for Adrian Coles. The name was still showing on the report because at the time of our visit the cancellation application was still being processed.

We found that people’s food and fluid intake was being monitored and people were being checked regularly to ensure their health needs were being met. A visiting GP told us "Staff are well supervised and the home is good at wound management". Staff we spoke with told us they had received relevant training for their role and where new clinical skills were required to care for people, this training was readily available.

We found that some people living in the home were not getting up and going to bed at a time of their choosing and were not asked what their preferred time might be. One person told us "They tell me when to get up, I can't choose…”. Also some people did not have their privacy, dignity and independence respected because they were either left partially dressed or sitting on commodes when staff were not available to help. Another person told us “They leave me on the commode to go to someone else".

The numbers of staff on duty and the way in which staff were organised and allocated to work with people meant that people living in the home were not having their needs met. We also found that there were some omissions and inconsistencies in record keeping that needed to be improved.

People told us they were satisfied with the quality of care provided by the home. They felt that staff "did their best" and generally looked after them well, respecting their individual choice and opinions. People said they were encouraged to remain as independent as possible. They told us they were able to participate in making decisions about their care and to say how they wished to be supported.

People said they had comfortable bedrooms that they could personalise and the home was always clean and well maintained.

Relatives said that the home appeared friendly and relaxed and the staff team were always "warm and welcoming".

We spoke to six people that live in the home and one relative on the day of inspection. People that live in the home made a number of positive comments about the service such as, "staff are good", " they are kind", "the food’s quite nice" and "my laundry always comes back quickly". A relative told us that "staff are attentive". However, there were also negative comments about the service. One person told us that "there aren't enough staff" and "you have to wait your turn".