Southgate Beaumont is a ‘care home’. The accommodation is purpose-adapted with passenger lift access to both residential floors, each of which have separate facilities. People living in this care home receive accommodation along with nursing and 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.

The service had a registered manager, which 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.

The service is registered to provide accommodation for up to 52 people. There were 50 people using the service at the start of this inspection. The service specialises in the care of older people and is operated by a national care provider.

This was an unannounced comprehensive inspection, to make sure the service was providing care that is safe, caring, effective, responsive to people's needs, and well-led.

At our last inspection of this service in March 2017, we found one breach of legal requirements. These was in respect of safe care and treatment, specifically for the management of wounds and pressure ulcers. The provider completed an action plan to show what they would do and by when to improve the rating of key question of 'Is it Safe?' to at least ‘Good.’ At this inspection, we found the necessary improvements had been made to addresses the previous regulatory breach.

At this inspection, most people using the service praised it, but a minority expressed broad or specific dissatisfactions to us that we looked into further. People’s representatives were generally happy with the service and said they would recommend it, and community healthcare professionals provided positive feedback.

We found people’s call bells were sometimes not answered in a timely manner. We also raised concerns about our observations of one person’s continence care, which the provider investigated and concluded was not in keeping with the clinical standards expected of the service. Therefore, despite some positive feedback and observations about caring approaches at the service, people’s dignity was not consistently respected as the approach of the service sometimes left people feeling uncared for.

Some people’s feedback and our checks of how the service handled concerns and complaints led us to conclude that these were not always listened and responded to, to improve on care quality.

There were recent occasions when the numbers of care and nursing staff working in practice did not quite meet planned staffing levels. We also found that recruitment checks of new staff were not sufficiently robust at ensuring they were safe to work with people using the service. These practices put people at unnecessary safety risk.

Where there was doubt that anyone had capacity to consent to aspects of the care and support the service proposed to provide them, the service did not always act in line with the principles of the Mental Capacity Act 2005 that helps to ensure actions are taken in people’s best interests.

Providers and registered managers must notify CQC about certain changes, events and incidents that affect their service or the people who use it. However, we had not been notified about two people using the service in 2018 experiencing significant injuries. This meant we did not have full oversight of the risks associated with the service.

Systems were in place to ensure that ongoing learning took place in response to accidents. However, this was not always conveyed to people involved in the accident or their representative under Duty of Candour expectations.

There were many auditing processes at the service that fed into a service improvement plan that was kept under review. However

We undertook an announced inspection on 28 and 29 March 2017 of Southgate Beaumont. Southgate Beaumont is registered to provide nursing care and accommodation for a maximum of 52 older people. At this inspection there were 46 people living in the home.

At the last inspection on 16 and 18 December 2014 the home was rated ‘Good’. At this inspection we found the service remained ‘Good’.

The service had 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 legal requirements in the Health and Social Care Act 2008 and the associated regulations on how the service is run.

Risks assessments were being carried out to keep people safe. For one person with a risk of skin complications, action plans were in place to minimise the risk of serious skin complications. However, some actions were not being carried out to minimise this risk such as repositioning within a specific timeframe. For another person with pressure ulcers, timely intervention had not been made to a health professional to ensure the person received immediate care and support.

Staff were not always deployed effectively throughout the first floor. Some people raised concerns with response time to call bells and we saw some delayed responses to answering call bells. After the inspection, the registered manager sent us an action plan that detailed how staff would be deployed throughout the first floor so that they would be more readily available to answer call bells.

Medicines were being managed safely.

Staff had the knowledge, training and skills to care for people effectively. Staff received regular supervision and support to carry out their roles.

Staff sought people's consent to the care and support they provided. People's rights were protected under the Mental Capacity Act 2005. Deprivation of Liberty safeguarding application had been made for people that, due to their own safety, required supervision when going outside.

People had the level of support needed to eat and drink enough, and to maintain a balanced diet.

People were able to access healthcare services and attend routine medical appointments and health monitoring with staff support.

Staff encouraged positive, caring relationships with the people who lived at the home.

People were treated in a respectful and dignified manner by staff who understood the need to protect people's human rights.

There was a programme of activities. These activities took place regularly.

People received care that was shaped around their individual needs, interests and preferences. Care plans promoted a person-centred approach, and staff followed these plans.

We identified a breach of regulation relating to risk management. You can see what action we have asked the provider to take at the back of the full version of this report.

At the last inspection of the service on 23 August 2013 we had concerns because proper steps were not being taken to ensure people were protected against the risks of receiving inappropriate or unsafe care and treatment. Some staff we spoke with were not aware of people's dietary needs. Records showed that quality audits had been made but some actions had not been carried out or completed.

At this inspection we spoke with 15 people or their representatives, reviewed care records for ten people and spoke with nine staff and the manager.

We found people were protected against risks of receiving care or treatment that was inappropriate or unsafe. Staff worked with people with care and were respectful. People’s welfare and safety was being maintained. One person said “I am having a lazy morning, out of choice. At 93 I deserve to choose, the staff are very flexible.”

People were protected from risks of inadequate or inappropriate nutrition. Most people we spoke with were satisfied with the menu and quality of food. Staff we spoke with were aware of people’s dietary needs. One person told us “food is reasonable and there is lots of choice.”

The provider was assessing and monitoring the quality of service. Views were obtained from people, those acting on their behalf and staff. Risks were identified and managed relating to the health, welfare and safety or people. Some improvements had been made and action plans were in place to deal with issues that had been raised.

People's needs were assessed and most care and treatment was planned and delivered in line with most aspects of the person’s care plan. We saw that staff were stretched at times. This was confirmed by people and relatives we spoke with. One relative told us “staff do not provide enough mental stimulation for my relative as staff are too busy.”

Concerns had been raised by people regarding the menu and quality of food. A new chef had recently been employed and there had been recent changes to the menu. One person told us “the food is quite nice.” Some staff we spoke with were not aware of people's dietary needs.

We saw that people’s dependency levels had been assessed and staffing levels had been increased since our previous visit. A permanent manager and staff had been recruited.

Staff were appropriately supported by the provider and acting manager to deliver care and treatment to people safely and to an appropriate standard. This included supervisions, planned appraisals and appropriate training.

People who use the service and their representatives were asked for their views about their care and treatment. Records showed that quality audits had been made by the regional manager but some actions had not been carried out or completed.

The provider had a system in place for identifying, receiving, handling and responding to complaints and comments made by people using the service and those acting on their behalf.

We carried out this inspection because the Care Quality Commission (CQC) received recent concerning information about staffing issues at the home. We spoke with all the staff on duty during the inspection and most of the people using the service who were able to talk with us. We also observed how people with communication problems were being supported at the home.

People who use the service told us that staff were often “rushed” but tried their best to assist them when they needed help. One person told us, “the staff are jolly good but there’s not enough of them.” Another person commented, “sometimes you have to wait a long time,” and added, “I’m put to bed quite early.” Staff we spoke with told us they were concerned about staffing levels at the home and said they were rushed because people’s needs had increased. We checked care plans at the home and found that dependency levels of individuals were not being routinely monitored or recorded.

Most people who use the service told us that the staff who supported them were kind and helpful. However some people told us that a few staff were rude to them. Comments included, “they just rush in and out,” and “some are good and some are bad.”

Staff we spoke with told us they did not feel supported by the organisation and we saw that staff were not receiving regular supervision or appraisals.

People who use the service were positive about the care and treatment they received at the home. They confirmed that staff assisted them when they needed support with their care and that staff were helpful.

One person told us, “I get on well with them. Some are good and some are excellent."

People told us that they had noticed a reduction in the use of agency staff at the service.

We observed that the majority of people with higher care needs were sitting in their rooms rather than being nursed in bed. We saw that this was having a positive effect on their well being as they could see what was going on around them and sitting in a chair made eating and drinking more comfortable.

Care plans were being reviewed on a regular basis and updated accordingly in order that staff had up to date information about the care needs of people they supported.

People confirmed that the management and staff sought their views about the quality of service provision.

Records in relation to the care and treatment of people using the service were accurate and being appropriately completed.

People told us they knew about their care plan and that they could see this when they needed to. One person told us, “my daughter has seen my care plan."

We used a number of different methods to help us understand the experiences of people using this service. People who use the service were mostly positive about the care and treatment they received at the home. People told us there had been a lot of staff changes which sometimes made it difficult for new staff to know all their care needs.

People who could not communicate verbally with us appeared to be relaxed and indicated to us that they were comfortable and not in pain.

People with higher care needs who had been assessed as being at risk from developing pressure ulcers and who needed support with nutrition and hydration were not always receiving the support and treatment as required and detailed in their care plan. We judged this had a major impact on people using the service because people were being put at risk of receiving care and treatment that is inappropriate or unsafe.

We talked to staff and looked at storage and record keeping of medication. The management had ensured that medication procedures were being followed appropriately.

The service did not have an effective quality monitoring system which meant the provider was not regularly identifying and monitoring risks in relation to the care and treatment of people using the service.

The service was not always ensuring that records in relation to people’s care and treatment needs were being accurately and appropriately completed.

People who use the service expressed satisfaction with the care provided and they indicated that their care needs had been attended to.

They told us that staff knew their needs and they felt they were treated with respect and dignity.

The views of people using the service can be summarised by the following comments, “The staff are always polite and friendly and respect my choices and wishes” and “The staff are very good here. They do their best to help me when I need it”.

Although people we spoke to told us they were satisfied with the care they received, we found that people with higher care needs who had been assessed as being at risk of developing pressure ulcers were being put at risk because care records were not always being appropriately completed.

People who use the service told us that they felt safe at the home. They told us they had no concerns about their care but would speak with a relative or the staff if they needed to.

People were positive about the activities available at the home and there was a weekly activity list on display.

People who use the service told us that they were happy with the staff who supported them. We observed friendly and supportive interactions between staff and people living at the home.

People told us that the management and staff often asked them about the quality of care provided by the service and they confirmed that quality assurance questionnaires were sent to them on a regular basis.

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. Southgate Beaumont is registered to provide care and accommodation for a maximum of 52 older people. At this inspection there were 47 people living in the home.

The home has 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 and associated Regulations about how the service is run.

Two inspectors carried out this inspection. On both days of the inspection staff were welcoming and people in the home appeared relaxed and well cared for. We saw staff talking with people in a friendly and respectful manner. One person said, “The home is regularly cleaned. There is enough staff - usually.” Another person commented, “The staff are respectful to me.”

Four social and healthcare professionals who provided us with feedback stated that their clients were well cared for and they had no concerns.

Throughout the inspection we saw that staff interacted in a pleasant and friendly manner with people. Staff continuously checked to ensure that people were safe and their needs met. Staff respected people’s privacy and knocked on bedroom doors to ask for permission before they went in.

People had been carefully assessed and appropriate care plans were prepared with the involvement of people and their representatives. Their physical and mental health needs were closely monitored. There were regular reviews of people’s health and the home responded appropriately to changes in people’s needs. People were assisted to attend appointments with health and social care professionals to ensure they received treatment and support for their specific needs.

Staff had been carefully recruited and provided with the training they needed to enable them to care effectively for people. Staff we spoke with demonstrated a good understanding of the needs of people. People and their relatives informed us that staff were able to meet the needs of people and they were satisfied with the management of the home.

The home had a safeguarding policy. Staff had received training and knew how to recognise and report any concerns or allegation of abuse. Senior staff had followed safeguarding procedures when safeguarding allegations had been brought to their attention.

Staff assessed people’s preferences prior to their admission and arrangements were in place to ensure that these were responded to. The home had resident’s meetings and one to one discussions to ensure that people could express their views and their suggestions were addressed. The home carried out annual satisfaction surveys. The record of complaints examined by us indicated that concerns expressed had been promptly responded to.

We found the premises were clean and tidy. The home had an Infection control policy and measures were in place to prevent infection. There was a record of maintenance carried out in the home and essential inspections on equipment used. The home was well furnished and bedrooms were comfortable.