Southover Care 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.

Southover Care Home accommodates up to 22 people in one adapted building. The service specialises in caring for older people including those with physical disabilities and people living with dementia.

At our previous inspection in July 2017 we rated the service as 'requires improvement'. We found improvements were needed to the premises to ensure people lived in a place that was safe, kept clean and ensure risks were managed to protect people from avoidable harm.

The provider was asked to complete an action plan to tell us what they would do to meet legal requirement for the breach in safe care and treatment.

You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Southover Care Home on our website at www.cqc.org.uk

This inspection took place on 8 August 2018 and was unannounced. At the time of our inspection visit 18 people were in residence.

We found the provider had made the required improvements to meet the legal requirements. The overall rating of Southover Care Home has improved to ‘good’.

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 safe using the service. The provider had made improvements to the premises to ensure that people lived in a safe place. The provider had made the necessary improvements to ensure people lived in a safe place. This included new carpets and flooring, installing radiator covers, making appropriate risk assessments. The provider had also begun a programme of decoration.

All areas were clean and tidy. Staff followed the infection control procedures. Regular checks carried out on the premises, equipment used to maintain people's safety and fire safety checks.

People were protected from the risk of harm. The risks to people’s health and wellbeing had been assessed and measures put in place to manage risks to people and promote their safety and independence.

People received their medicines as prescribed. Medicines were stored and managed safely. People’s nutritional needs were met. People had access to a range of health care professionals. Staff monitored people’s health and made referrals when people’s health was of concern.

Staff recruitment procedures reduced the risks of employing staff unsuitable to work in care. There were enough staff to support people. Staff were trained in safeguarding and other relevant safety procedures to ensure people were safe and protected from avoidable harm and abuse. Staff understood their responsibilities to report concerns.

Staff continued to be supported in their role. Systems were in place that ensured staff were trained, supervised and supported in their role. Staff worked in partnership with other health care professionals to enhance people’s quality of life.

Staff gained people's consent before any care was provided. 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.

People and their family were involved in the development and review of their care, and changes were made as needed. Care plans were personalised, reviewed regularly and provided staff with guidance about how people wanted to be supported. People had the opportunity express their views about their end of life care, when needed.

People continued to be supported by kind and caring staff. They had develop

This inspection took place on 25 July 2017 and was unannounced.

Southover Care Home provides accommodation for up to 22 people. The service is designed to meet the needs of older people living with or without dementia. At the time of our inspection there were 21 people using the service.

At the last inspection, the service was rated good.

A registered manager was in post and was available throughout 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.

At this inspection, the service remained good overall. However, we found improvements were needed to the premises to ensure people lived in a place that was safe, kept clean and people’s dignity was protected. Environmental risks were not assessed or managed to protect people from avoidable harm without compromising their independence.

People were supported by staff who knew how to keep people safe, recognise abuse and how to respond to concerns. Risks in relation to people’s care and support needs were assessed. People were involved in the development of care plans to ensure care was personalised, and their safety, independence and wellbeing was promoted. Care plans were regularly monitored and reviewed.

People mostly received their medicines safely. People’s dietary needs were met. People had access to a range of healthcare services and attended routine health checks.

People’s safety was protected because staff were recruited through safe recruitment practices. We found there were sufficient numbers of staff to provide care and support when people needed it. Staff received an appropriate induction, training, supervision and appraisal.

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.

People’s privacy and dignity was respected. Staff’s approach was caring and they knew people well. People were involved in the review of their care plans which helped to ensure they received personalised care that was responsive to their needs. People maintained contact with family and friends and took part in social events, activities that were of interest to them and supported people with their religious needs.

People’s views about the quality of the service were sought in a range of ways and their comments showed that they were satisfied with the care provided. People and their relatives felt confident to raise concerns with the registered manager. A complaint process was available and advocacy support was made available to people.

The provider was meeting their regulatory responsibilities. There were effective systems in place to monitor and improve the quality of the service provided.

We found a 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.

This inspection took place on 23 October 2014 and was unannounced.

Southover Care Home provides accommodation and personal care for up 22 older people. There were 10 people using the service on the day of our inspection visit.

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 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 care home and were cared for by staff who knew how to protect them from the risk of abuse. People were supported by a sufficient number of staff and the provider ensured appropriate checks were carried out on staff before they started work. Staff received training to ensure that they could meet people’s needs.

People were asked for their consent before care was provided. Staff were aware of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Positive and caring relationships had been developed between people and staff. People were fully involved in the planning and reviewing of their care and made day to day decisions. People were treated with dignity and respect by staff and supported to maintain their independence.

People had regular access to health care professionals. People had access to sufficient quantities of food and drink. People received their medicines as prescribed and they were stored safely.

There was a positive, open and transparent culture in the home. People who used the service and staff felt able to raise any issues with the manager and they were dealt with. Staff felt valued and people felt supported. There were different ways people could provide feedback about the service which people were made aware of. There were effective systems in place to monitor the quality of the service. These resulted in improvements being made to the service where required.

Seven people lived at Southover Care Home at the time of our visit. One person we spoke with told us “I enjoy living here. My relative is here as well and other family are close by”. Another person described how they were able to request changes to the layout of their room, so they could have their belongings where they wanted them.

We saw care plans were well written and person centred. The care plans covered people’s individual needs and included the wishes of the person for how they would like to be cared for as well as detailed guidance for staff carrying out the care. People were involved in updating their care plans. Improvements had been made in the recording of the administration of medication.

We saw appropriate checks were undertaken before staff began work. Staff told us there were enough staff on duty to meet people's needs. One person we spoke with confirmed this.

We saw audits of care plans and medication records had been carried out, as well as health and safety audits.

Although people we spoke with told us that they were happy living at the home and generally felt that their needs were met, we found that care and treatment was not effectively planned and delivered in a way that ensured people's safety and welfare and minimised the risk from potential harm.

People who used the service were generally complementary about staff who worked at the home, however, we found that the people using the service could not be assured staff employed to care for them were suitably qualified, skilled and experienced.

We found that the provider had failed to ensure that there were always enough qualified, skilled and experienced staff to meet people’s needs.

Although the provider had some systems in place to identify risks relating to the health, welfare and safety of people using the service, we found that these were not effective in identifying and managing risks. The provider did not always take action to ensure the safety of people using the service.

People we spoke with told us that they liked living at the home. One person told us "the people are nice here”. Three of the people we spoke with told us they were happy living at the home and felt that their needs were met. However, we found that peoples care and treatment needs were not always assessed to ensure their needs were met. We also found that systems to protect people from risk were inadequate.

We found that there were not always enough staff available to meet people’s needs. Three of the six people we spoke with told us that they often had to “wait around for someone to come”. Staff supported this telling us “we could do with more staff, people’s needs have changed and we don’t always have enough staff to manage”.

This was a focused visit to check if the compliance actions made following our previous visit in November 2012 had been addressed.

We found that the provider had put systems and processes in place to ensure that risks to peoples' health and wellbeing were identified and managed. These included systems to ensure staff were recruited safely.

We found that staff had a clear understanding of when and how to undertake capacity assessments to ensure that people could be assured that if decisions were made on their behalf, that they were always in their best interest. However, we found that the provider was not protecting people from receiving treatment that was inappropriate.

People had in place nutritional risk assessments which accurately reflected their current needs and nutritional requirements. Staff told us that they felt confident in assessing people’s nutritional needs.

People we spoke with told us that they liked living at the home and that they felt safe in the home. One person told us "the staff are lovely, they are very nice to us" and other person told us "it's very easy to talk to them here".

We found that the homes general environment and quality of food provided to people had improved since our inspection in March. However there were still some improvements needed. The provider was not fully protecting people from the risks of inadequate nutrition.

Whilst the provider had in place some systems and processes to assess and monitor the quality of service provision, we found that they did not always act on concerns raised.

Additionally, a lack of staff knowledge in regards to capacity assessments meant that people could not be assured that their rights were protected. We also found that the provider did not have in place evidence of effective recruitment and selection processes which would ensure that people were suitably qualified, skilled, experienced and fit to work in social care.

People told us that they were not always listened to. They also told us that some care workers did not treat them with respect. One person said, “Some do and some don’t treat you with respect.” People told us that their care needs were met and some had seen their care plans and agreed to them. One person said, “I am happy with the care.”

People were given regular meals and drinks but said they would like more choice and more fresh produce. One person said, “People don’t eat the fruit because they don’t like the ones they (the home) buy.” People were cared for in a homely environment, one said, “They’ve made it nice.” People also told us that they felt cold at times.

We carried out this inspection because we had concerns about the care, nutrition, premises and staffing levels. We visited twice over a four week period, on the first occasion with a representative of the local authority.

People told us the routine in the home was flexible and they had in say in how and when their care was provided. One person told us, “We can have a bath or a shower whenever we want.” Another said, “Everyone goes to bed and gets up at different times. You can stay in bed all morning if you want.”

People said activities were provided by the care staff. One person told us, “We have all sorts of activities, usually in the morning when the staff aren’t too busy.” Another person said, “Sometimes we have a coffee morning and play bingo or have a quiz.” During one of our visits staff played a floor game with people which was popular and provided a lot of laughter.

On our first visit people told us that on occasions food was badly-prepared and difficult to eat. One person said, “The food isn’t very good – it’s not cooked properly. It’s amateur cooking. We often have to send our meals back as they’re too hard for us to eat. There’s a lot of food wasted because of that.”

People also said the home sometimes ran out of essentials, for example tea and marmalade. They said they had little choice at mealtimes and there was nothing hot on the menu for breakfast. One person said, “I have never had a cooked breakfast here – I think they should serve one. We have bacon for meals sometimes but I would like it for breakfast. I would also like eggs at breakfast.”

When we returned a few weeks later all the people we spoke to said the food had improved and there was more choice. One person said us, “The food has bucked up from what it was. It’s much better presented and the meat has improved and is more tender.” Another person told us, “You can have what you like now. The breakfasts are much better now they’ve started doing eggs.”

People told us they liked the way the home looked and found it comfortable. However three people though improvements were needed. One person said, “They need a lot of repairs here.” Another person showed us damaged fittings in their room. And a third person thought the lighting in the dining room was poor.

People told us they liked the staff team and though they provided good care. One person said, “The staff are lovely and they really help me. I couldn’t manage without them.” Another person commented, “The staff work very hard – all of them.”

One person acknowledged that the home had had staffing problems but these had now been addressed. They told us, “There’s been a high turnover of staff, which we’ve had to put up with, but those who’ve stayed are good.”