The inspection visit at Southview Lodge Residential Care Home took place on 16 and 21 November 2016 and was unannounced.

Southview Lodge Residential Care Home is a large detached residence, situated in a semi-rural location close to Hesketh Village. The home provides 24 hour personal care and accommodation for up to 30 older people. All bedrooms and communal areas are accessible on the ground floor. There is a large garden to the front and rear of the property, with outdoor seating areas and ample car parking. At the time of our visit, 27 people lived at the home.

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.

At the last inspection on 25 February 2015, we found the provider was not meeting the requirements of the regulations in respect of person-centred care, safe care and treatment, premises and equipment, need for consent, staffing, good governance and the notification of incidents.

During this inspection, we found the provider had made improvements in all these areas and was meeting the requirements of the regulations.

We looked at the recruitment of four staff members. We found appropriate checks had been undertaken before they had commenced their employment confirming they were safe to work with vulnerable people.

Staff spoken with and records seen confirmed a structured induction training and development programme was in place. Staff received regular training and were knowledgeable about their roles and responsibilities. They had the skills, knowledge and experience required to support people with their care and social needs.

We found the registered manager had systems to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices.

The registered manager completed individual risk assessments for people who lived at the home. This helped to ensure risks were identified and measures put in place to reduce risks to people’s safety and wellbeing. Written plans of care provided a good level of guidance for staff with regard to supporting people safely.

The registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

The environment was maintained, clean and hygienic when we visited. The provider had undertaken work to refurbish communal areas, as well as toilets and bathrooms. The ‘secret garden’ to the rear of the home had been landscaped and provided a pleasant outdoor area for people to make use of in good weather.

We found sufficient staffing levels were in place to provide support people required. We saw staff members could undertake tasks supporting people without feeling rushed. The provider had increased staffing levels in the evening in response to feedback from people who lived at the home and staff.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing in place.

People who were able told us they were happy with the variety and choice of meals available to them. We saw regular snacks and drinks were provided between meals to ensure people received adequate nutrition and hydration.

People told us they enjoyed the activities organised by the service. These were arranged both individually and in groups. The provider had made links with local community

This inspection took place on 25 February 2015 and was unannounced. This meant the provider did not know we would be visiting the service.

Southview Lodge Residential Care Home is a large detached residence, situated in a semi-rural location close to Hesketh village. The home provides 24 hour personal care and accommodation for up to 30 older people. All bedrooms and communal areas are accessible on the ground floor. There is a large garden with an outdoor seating area and ample car parking. At the time of our inspection there were 28 people who lived at the home.

The home had a registered manager in post; they registered with the commission in December 2010.

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.

The home was last inspected on 03 June 2013 when the service was found to be compliant with the regulations we inspected against.

Assessments of people’s needs and their written plans of care did not always reflect people’s current circumstances. Plans of care focused on people’s needs and did not fully reflect their preferences, likes and dislikes.

Some equipment in the home had not been thoroughly cleaned and there were areas of the home which required maintenance to ensure they were safe. We found a fire escape between the two main communal areas of the home was obstructed. The layout of the lounge areas did not lend itself to encouraging interaction between people.

We saw the home had implemented safe practices for managing people’s medicines. However, there were no protocols in place for medicines that were prescribed for use ‘as and when’ required.

We found that staff did not fully understand their responsibilities in regard to gaining consent to care and treatment, in line with the Mental Capacity Act 2005, when someone may lack the capacity to make a decision for themselves.

The home had not employed an activities coordinator and people told us there were not many meaningful activities provided by the home that met their needs. People told us they had not been asked for their opinions about the service provided. However, people also told us that staff knew them well and knew their preferences.

Staff told us they felt well supported and enjoyed their work. However, we found that staff were not supported by means of regular supervision to discuss their performance, training and aspirations.

The provider had not ensured that they notified us when significant events happened at the home, such as injuries to people who lived there.

Although there were systems to assess the quality of the service provided in the home we found that these were not always effective.

We found a significant number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in respect of the assessment, planning and delivery of care; unsafe or unsuitable premises; cleanliness and infection control; consent to care and treatment; statutory notifications and the operation of systems designed to assess, monitor and improve the quality and safety of the services provided. These also amounted to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People who lived at the home told us they felt safe and did not have any concerns about the way they were treated. The provider had implemented suitable policies and procedures to safeguard people. However, staff were not fully conversant with Local Authority Safeguarding policies and procedures, including reporting procedures. We have made a recommendation about this.

There were enough suitably qualified, skilled and experienced staff on duty during our inspection. However, people we spoke with told us, and staff confirmed that at busier times the staff team could be quite pushed to meet the needs of all the people who lived in the home. We have made a recommendation about this.

We found the provider had not fully consulted people and taken their preferences into account with regard to mealtimes. We have made a recommendation about this.

People were supported to be independent and their privacy and dignity was promoted by a caring and patient staff team. We witnessed many positive interactions between staff and people who lived at the home during the inspection.

The provider had implemented a suitable policy and procedure for handling complaints. People told us they felt confident to raise complaints with the service.

You can see what action we told the provider to take at the back of the full version of the report.

People told us:

"They [staff] always treat me with respect."

"I'm asked about what I like and what I like doing."

"I'm well looked after...I go to the social club often."

"I'm very happy here...There's always something going on."

Relatives said:

"We are kept up to date on how [relative] is doing...We got all the information we needed before they came here."

"[My relative] is well looked after, I don't need to worry about them...Since they've been here their health and wellbeing has improved...No complaints...It's calm, quiet and lovely here...It feels like a great big family."

We found that people and their families were involved in the care planning process, with their needs and preferences taken into account in the way care and support was delivered. People were treated with dignity and respect.

The provider undertook comprehensive assessments of people's needs. These translated into person centred plans of care and support which met people's needs. People's independence was promoted as far as possible and people were involved in local community activities.

We found the home had implemented appropriate policies and procedures with regard to cleanliness and infection control. We found the level of cleanliness in the home to be of a good standard.

The provider had robust systems in place to audit, monitor and assess the standard of the service that was provided for people. Feedback was sought from people and their relatives on a regular basis.

During this inspection we also checked if improvement actions from the last inspection carried out in March 2012 had been completed. Some of these matters we needed to check did not necessarily relate to people’s views and experiences. Therefore at this visit we did not ask people to comment on all of the outcomes we looked at.

During this visit we found that a comprehensive risk assessment was in place and had been completed for one of the bedrails in use. We found that this assessment was not consistent in practice as there were two other bedrails fixed to people’s beds that the use of had not been assessed.

People we spoke to told us the food was good. One relative we spoke with told us, ‘’ the food served is good, I have seen in the kitchen.There is fresh food delivered nearly every day’’.

During our visit we observed people were content and relaxed. One person we spoke with said, "Staff are very kind, I really like it here".

We saw from the actions set out in the last inspection for the provider that the majority of actions had been met and improvements generally made. One relative that we spoke with told us, ‘’Overall, I think they are brilliant and provide excellent care to my mother’’.

People told us they had no complaints about the service but would be happy to raise their concerns with the staff or managers. One person told us, "I'm happy living here and I would tell the manager if something was wrong".

The purpose of this visit to the home was to check up on the progress made on some of the improvements we asked them to make at the last inspection in June 2011. As such we did not focus as much as we would normally on the views of people living in the home, as the matters we needed to check did not necessarily relate to people's views and experience. However those people we spoke with told us they were generally happy in home and that staff treated them properly and with respect.

One relatively new person said they had settled in and 'everything was all right'. Another person said, "it's very nice; I'm very happy and contented", "I'm very well looked after; I've no complaints - I'm happy the way I'm looked after". This person also said. "Staff were very nice and gentle". Someone else said, "I'm well looked after and I like it here" and, "The food is good; there is enough choice".

The residents told us that they felt they had satisfactory choices in their daily lives such as in food, rising and retiring times and whether or not to spend time in their rooms during the day. However we were told that 'there wasn't much going on' in terms of activities.

Residents also felt that the staff were attentive and were usually available when needed. People felt they sometimes had to wait for attention but not for too long and that this was acceptable.

People living in Southview Lodge told us that in general they were happy in home. One said that “it’s alright living here” and another said “it’s nice here”.

People spoken with were satisfied with the food served and comments were made such as “I like the food and there's plenty of it”, and “the food is good”. People we spoke to confirmed there was a choice of main (hot) meals on the menu at lunch time and people's individual tastes and preferences were catered for.

The residents told us that they felt they had satisfactory choices in their daily lives such as in rising and retiring times and whether or not they spent time in their rooms. However we were told that "there wasn't much going on" in terms of activities.

Residents in general spoke positively about the staff and felt they treated them properly and looked after them in a way that respected their privacy, dignity and independence. Residents also felt that the staff were attentive and were available when needed. One said, "they come when needed both day and night. Another said, "I don't need much help but staff are always around if needed".

We were told that residents felt their views were listened to and that they knew who to speak to if they were not happy with something.