About the service:

Southlands Nursing Home is a residential care home that was providing personal and nursing care to 24 people aged 65 and over at the time of the inspection. Southlands can accommodate up to 32 older people.

People’s experience of using this service:

• Improvements had been made since the last inspection and previous breaches of regulations had been met. However some work was needed to fully embed the providers governance systems to ensure they were fully effective and to ensure that people's records were fully person centred and responsive to their needs. The manager had an action plan to address areas of improvement and monitored this plan regularly.

• People were safe because improvements had been made to the assessment of risks to people and the plans developed to mitigate the risks. Their medicines were managed well and they received these as they needed them. The staff supporting them had been recruited in a manner which aimed to ensure only those suitable to work with vulnerable adults did so.

• People were supported by staff who were kind, caring and who understood their likes, dislikes and preferences. Staff ensured people had choices and respected their right to make their own decisions. Where they needed external health input they were supported to receive this. People were cared for by staff who were well supported and received appropriate training and supervision to meet people’s needs effectively.

Rating at last inspection:

Requires Improvement (report published December 2017)

Why we inspected:

This was a planned inspection based on our last rating. In the previous inspection, we found a three breaches of regulations. The provider informed us what they would do to meet the regulations. This inspection planned to follow up on these areas. We found improvements had been made and there were no longer breaches of the regulations.

Follow up:

As this is the second time this service has been rated as requires improvement we will request a plan from the registered person on how they intend to achieve good by our next inspection. We may decide to meet with the provider following receipt of this plan. We will continue to monitor all information received about the service to understand any risks that may arise and to ensure the next inspection is scheduled accordingly.

This inspection took place on 6 and 7 November 2017 and was unannounced. At our last inspection in July 2015 we found the service was not meeting the legal requirements for the safe management of medicines. Following the last inspection, we asked the provider to complete an action plan to show what they would do to address a breach of Regulation 12 that we found, and ensure they were meeting the legal requirements in relation to the management of medicines. This had improved at this inspection and was no longer a breach.

Southland’s Nursing home 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. The home can accommodate up to 32 older people and some who live with a physical disability in one adapted building. There were four communal areas, including three lounges and a dining room. The provider advised us that they were keen to ensure people could have single rooms and as such they were not accommodating more than 30 people.

A registered manager was in post during the 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.

Risks associated with people’s needs were not always appropriately assessed and actions taken to reduce the risk were inconsistent. Records were not clear, accurate or contemporaneous.

People told us they were always asked for their permission before personal care was provided. However people’s ability to make decisions was not always assessed in line with the Mental Capacity Act, 2005 (MCA). Care staff and the registered manager had received training in respect of the MCA and were able to demonstrate an awareness of the principles. However, registered nurses understanding needed improvement.

There were systems in place to monitor quality and safety of the service provided, however, these were not robust and did not identify the concerns we identified during this inspection.

Prior to people moving into the home, assessments were undertaken to ensure the service could meet the person’s needs. Policies were in place for care planning which guided staff to ensure people’s diverse needs were considered and where needed support was planned. One of three nurses and and the registered manager were not able to tell us what evidence based guidance they used to support their care planning on. This meant there was a risk people would not receive care and support that was evidenced to be effective.

People told us that staff knew them well and this was apparent throughout our discussion with staff about people. Whilst some care plans were in place, these at times lacked information and guidance for staff and were not always person centred, accurate and up to date. Activities were delivered based on individual needs at the time of the inspection.

No formal system was used by the provider to assess the level of staffing and skill mix needed and some people expressed concerns about the time it took for staff to respond to their calls for help. Observations throughout the two days showed that staff responded promptly to call alarms and people’s requests and there were sufficient staff to meet people’s needs. We have made a recommendation about how staffing needs are calculated.

People and their relatives provided positive feedback about staff. Observations reflected people were comfortable and relaxed in staff’s company. People were cared for with kindness and compassion. Their privacy and dignity was respected and they were encouraged to be involved in making decisions about their care. However, at times information was not alw

This inspection took place on 16 July 2015 and was unannounced.

Southlands Nursing Home is registered to provide accommodation, nursing and personal care services for up to 32 older people and people living with a physical disability. There were two rooms for people who needed support to regain their independence following an illness or injury. At the time of our inspection there were 25 people living at the home. They were accommodated on two floors with a shared dining room and two shared lounges on the ground floor. There was an enclosed garden with shade for sitting out.

There was a registered manager in place. 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.

Staff administered medicines apart from skin creams according to people’s prescriptions. However records kept did not demonstrate that creams were always administered according to people’s needs.

The service had arrangements in place to protect people from risks to their safety and welfare, including the risk of avoidable harm or abuse. Staff were aware of what to do to keep people safe, and care plans and risk assessments contained appropriate guidance.

Staffing levels were sufficient to support people safely and in a calm, professional manner. The service followed recruitment processes to make sure only workers suitable to work in a care setting were employed.

Staff were supported to obtain and maintain the skills and knowledge they needed to support people to the required standard. Staff were informed about the need to obtain people’s consent to care and treatment, and they were aware of the legal requirements where people lacked capacity to make certain decisions. If people were at risk of being deprived of their liberty in order to keep them safe, the registered manager applied for authorisation under the Deprivation of Liberty Safeguards.

People’s health and welfare were supported by access to appropriate healthcare services when required, and by the provision of a healthy diet with choices. People were supported to eat and drink enough.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy and dignity, and helped them maintain as much independence as possible.

Staff assessed, planned and delivered care and treatment that met people’s needs and took into account their choices and preferences. Care plans were individual to the person, and were evaluated regularly and in response to people’s changing needs. People’s care and support took into account their hobbies and interests. People were supported to participate in events in the local community.

Complaints were logged, responded to and followed up with the person making the complaint. Information in complaints was used to improve the service people received.

The registered manager had effective management systems and systems were in place to monitor and assess the quality of service people received.

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 end of the full version of this report.

We carried out a routine inspection on 20 February 2014 and there were 25 people living at the home. During our inspection we spoke with the registered manager, the deputy manager, a registered nurse and two other members of staff. We spoke with five people who lived at the home and three visitors.

Care was provided over two floors with mainly single occupancy rooms available. Some rooms had en-suite facilities. We saw that people were able to personalise their rooms with their own possessions and could access their rooms whenever they chose. Many people chose to remain in their rooms throughout the day, however there were five communal lounge, dining or activity areas for people to use.

We saw that a wide variety of foods were on offer to people living at this home. A four week rota of menus was used to offer a choice of meals and other options for people with specific dietary needs or preferences.

We saw that the home offered people a wide variety of planned and social activities throughout the day. People were offered choice in the activities they joined and we saw that people were encouraged to participate. People told us that there was plenty to do if they wanted to join in.

We saw that clear person-centred care plans were in place to support people and we found that staff had a good awareness of people’s needs. Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes. We saw that staff treated people in a kind and gentle manner respecting their dignity at all times.

We found that the provider had robust infection control procedures in place to ensure that people were protected from the risk of infection.

People told us they were happy living at this home. One person told us, “The staff are fabulous, I would be lost without them.”

People we spoke with told us that they were treated with respect and they were able to exercise individual choices in their care and treatment. Records we looked at confirmed that people were involved in the decision making process.

People's needs were recorded in a plan of care that was kept under review. Risks to people's safety were assessed and plans to reduce and monitor risks to both people using the service and staff were recorded.

We observed that staff were respectful and caring and demonstrated an understanding of individual needs in the planning of care and treatment. One person told us, " I couldn't be made more comfortable if they tried, staff here make sure all my needs are met ".

People we spoke with told us that they felt safe at the home and that there were enough staff to meet their needs. One person told us, " If I have to ring my bell, someone always comes, they don't leave you waiting for long ".

Everyone said that they were treated with respect and that their views were listened to and acted upon. They also told us that they felt safe living at the home.

People said they were happy with the care they received and activities arranged by the home.

Everyone said they were happy with the staff and that they treated them with kindness.

People told us that their views were sought on a daily basis when care and support was given. They also said that views were obtained via residents’ meetings and surveys.