Archived: Southfield Care Home

Southfield Care Home is a residential care home providing personal care to up to 54 people. people. At the time of our inspection there were 24 people living at the home. Southfield Care Home accommodates people in one adapted building over two floors.

People’s experience of using this service and what we found

The provider had not demonstrated continuous improvement and had failed to ensure safe and effective governance of the service. Medicines were not always managed safely which meant people were at risk of harm. The specific issues we had raised with the provider at the last two inspections had not been fully addressed.

The provider had updated the format of some care plans and risk assessments. However, we continued to find examples where information was contradictory, and records had not been reviewed to reflect changes in people’s health and social care needs.

Recruitment was managed safely. Systems were in place to safeguard people from abuse and neglect.

Over the course of the inspection we observed the atmosphere was calm and relaxed in the home. People appeared to be well cared for and we observed warm and friendly interactions between staff and people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 21 April 2022) and there were breaches of regulation.

At this inspection we found the provider remained in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on 10 and 17 March 2022. Breaches of legal requirements were found. We undertook this targeted inspection to check the provider now met legal requirements. We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Southfield Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified continuing breaches in relation to the safe management of medicines and good governance.

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Southfield Care Home is a residential care home providing accommodation and personal care for up to 54 people aged 65 and over. At the time of the inspection there were 24 people living at the home. Southfield Care Home accommodates people in one adapted building over two floors. At the time of the inspection people were all living on the ground floor.

People’s experience of using this service and what we found

Despite highlighting shortfalls at the last three inspections, the provider had failed to take enough action and people continued to be at risk of harm and poor care.

The provider was unable to demonstrate robust governance arrangements and learning had not taken place. Systems and processes designed to identify shortfalls and drive improvement were not effective and had not identified the concerns we found. Significant shortfalls identified at the last inspection had not been addressed. The provider did not demonstrate they understood their legal responsibilities.

The provider had not complied with their lawful duties to display their current inspection rating at the service and on their website.

People did not always receive their medicines in a safe way. Specific issues we had raised at the last inspection concerning the management of medicines had not been addressed. The systems in place and management oversight had failed to identify the repeated shortfalls.

The provider had not assessed and mitigated the risks to people, and people did not have an accurate and complete care record. This included hazards in the home’s living environment as well as risks associated with people’s health, safety and wellbeing. Procedures failed to safeguard people from the risk of abuse.

Safe recruitment practises were not followed as the required background checks had not been undertaken before staff started work at the home.

Most people and relatives told us they felt safe and there were enough staff to meet people’s needs. Staff were kind, respectful and caring and we observed warm and friendly interactions between people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 14 January 2022). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Southfield Care Home on our website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, safe care and treatment, medicines, staff recruitment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may return sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Southfield Care Home is a residential care home providing accommodation and personal care to people aged 65 and over. At the time of the inspection there were 27 people living at the home. The service can support up to 54 people.

People’s experience of using this service and what we found

During our inspection visits in December 2020 and April 2021 we found people did not receive safe care. At this inspection we found the provider had made some improvements, but people continued to be at risk of harm. There was a lack of detailed risk assessments and guidance for staff in relation to people’s individual risks and support needs. Some care records contained inconsistent and inaccurate information. Medicines were not managed safely. People were not always protected from abuse and neglect. Government guidance on infection, prevention and control was not always followed.

The home was not always well-led. There was no registered manager and there had been numerous management changes. The provider had made some improvements to how quality checks were carried out. However, audits were not completed consistently, and they failed to identify the repeated shortfalls we found at this inspection. Opportunities to learn lessons and make improvements to the home had not been taken.

Changes at the home meant people lived in a comfortable and clean environment. The provider had made a range of improvements to people’s bedrooms and communal and garden areas.

Staffing levels had increased, and this meant people received support when they needed it. People were generally supported by staff who knew them well. Recruitment was managed safely.

People and relatives told us they felt safe living at Southfield Care Home and staff were kind and caring.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was inadequate (published 21 May 2021). The provider completed an action plan after the last inspection to show what they would do and to improve and by when. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

This service has been in Special Measures since 21 January 2021.

Why we inspected

This was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Southfield Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines, risk management, safeguarding people from abuse and good governance at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it, and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Southfield Care Home is a residential care home providing accommodation and personal care for up to 54 people aged 65 and over. At the time of the inspection there were 33 people living at the home. Southfield Care Home accommodates people in one adapted building over two floors.

People’s experience of using this service and what we found

People continued to be at risk of harm as the provider had not assessed and mitigated the risks to people. This included hazards in the environment of the home as well as risks associated with people’s health and care needs. Medicines were not managed safely.

There were not enough staff to keep people safe. We observed staff were caring but they were rushed, and routines were task orientated. People were regularly left on their own for long periods of time and there were limited opportunities for meaningful social interactions. Staff were not always able to respond quickly where people needed care, support or comfort. People were not always protected from abuse or neglect.

People had not been protected from the spread of infection because systems and processes were not in place.

Safe recruitment practises were not followed as the required checks had not been undertaken before staff started work at the home.

The provider had not complied with their lawful duties to display their current rating at the service.

Systems to assess, monitor and improve the service were not effective. Shortfalls identified at the last inspection had not been addressed. The provider did not demonstrate they understood their legal responsibilities. Governance systems were ineffective, and the provider did not have oversight of key safety issues.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 29 January 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection not enough improvement had been made and the provider was still in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

You can read the report from our last inspection, by selecting the ‘all reports’ link for Southfield Care Home on our website at www.cqc.org.uk

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report. We met with the provider after the second day of the inspection. We discussed our concerns about the staffing levels and shortfalls in infection prevention and control practises. The provider sent us an action plan and assured us they would increase staffing levels immediately and take action to mitigate infection control risks.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safeguarding, infection prevention and control, assessing and managing risk to people, medicines, staffing, recruitment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will act in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Southfield Care Home is a residential care home providing personal care to 39 people, most of whom were aged 65 and over at the time of the inspection. The service can support up to 54 people. Southfield Care Home accommodates people in one adapted building.

People’s experience of using this service and what we found

People were not always safe. Government guidance on the prevention and control of infection was not always followed which meant people were at risk of catching an infection. None of the people using the service had COVID-19 when we visited. The provider was supporting people and staff to have regular COVID-19 tests. Relatives of people using the service told us they had been supported to keep in touch during the pandemic.

Overall people were receiving their medicines as prescribed. However, we found the systems for the overall safe management of medicines were not robust enough.

We found risks to people’s health and safety were not always managed properly, this included risks to people’s nutrition and skin integrity.

Recruitment checks were not thorough and did not ensure staff were safe and suitable to work in the service. There were not always enough staff to meet people’s needs and keep them safe. Staff had not been provided with all the training they needed to carry out their duties and were not always supported in their roles.

There was a lack of effective and consistent management of the service. The registered manager left in January 2020 and since then there had been three managers, none of whom had registered with CQC.

The provider’s systems for assessing and monitoring the safety and quality of the services provided were not effective in identifying shortfalls and improving the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good, (published 12 February 2019).

Why we inspected

This inspection was prompted in part due to concerns received about management and staffing. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from the previous comprehensive inspection for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

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

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to infection prevention and control, medicines, staffing, recruitment and good governance.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions of registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Southfield 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.

Since the last inspection the registered manager had resigned and the deputy manager had been appointed to the post of manager and was in the process of being registered with the Commission (CQC). 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.

This inspection took place on 19 December 2018 and the 11 January 2019 and was unannounced. Our last inspection took place on 24 October 2017 and at that time the service was rated ‘Requires Improvement’ overall with no breaches or regulations. This rating was made because although the service was on a journey of improvement, it was too early for the provider to be able to demonstrate the improvements made could be sustained over time. At this inspection we found the provider had succeeded in ensuring the new policies and procedures were now fully embedded and they had a clear vision about the future direction of the service.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had regular safeguarding training and were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the manager’s attention, they had taken appropriate action to make sure people were protected.

The manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

Staff were respectful to people, attentive to their needs and treated people with kindness and respect. The atmosphere in the home was calm and relaxed. Staff knew individual people well and were knowledgeable about their needs, preferences and personalities.

People were supported to have 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.

Care plans were person centred and sufficiently detailed to ensure staff provided appropriate care and treatment. People’s care and support was kept under review and wherever possible people were involved in decisions about their care and treatment. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff to support people when they needed assistance and people received support in a timely and calm manner. There was a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Adequate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them to maintain a feeling of homeliness.

There were a range of leisure activities for people including events in the home and in the local community and it was apparent people enjoyed a full and active social life. People told us they enjoyed the food and there was a good choice at every mealtime.

There was a complaints policy available which detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

Further information is in the detailed findings in the full version of the report.

Our last inspection took place on 7 and 8 March 2017 and at that time we found the service was not meeting four of the regulations we looked at. These related to safe care and treatment, fit and proper person employed, staffing and good governance. The service was rated ‘Inadequate’ and was placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and treatment. This is reflected in the overall rating for the service which is now ‘Requires Improvement.’

There was a registered manager in post. 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.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected.

Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s care plan showing how they should be supported to manage these risks. Systems were in place to ensure people received their prescribed medicines safely.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were clear lines of communication and accountability within the home and they were kept informed of any changes in policies and procedures or anything that might affect people’s care and treatment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

People told us they enjoyed the food and we staff were proactive in supporting people to maintain their fluid and food intake, especially people identified as being at risk of malnutrition.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital consultants, community health nurses, opticians, chiropodists and dentists.

Relatives told us they were made welcome and encouraged to visit the home as often as they wished. They said the service was good at keeping them informed and involving them in decisions about their relatives care.

There was a quality assurance monitoring system in place that was designed to continually monitor and identified shortfalls in service provision. Audit results were analysed for themes and trends and there was evidence that learning from incidents took place and appropriate changes were made to procedures or work practices if required.

This inspection took place on 7 and 8 March 2017 and was unannounced.

Southfield Care Home provides accommodation and personal care for older people. Most people who live at the home live with dementia. The service is registered to accommodate up to 54 people. On the day of our inspection there were 42 people living at the home. The service is situated in Great Horton on the outskirts of Bradford.

The service had a registered manager who had worked at the home for many years. 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.

We found the home was poorly maintained and not always cleaned effectively which put people’s health and safety at risk. In December 2016 the registered provider had been served a fire enforcement notice due to poor fire safety at the home. There was no action plan in place to address these concerns. Window restrictors did not comply with current health and safety guidance.

We saw some good practices in relation to how medicines were managed and administered in the home. However, we identified concerns in relation to the management of medicines prescribed to be given on an ‘as required’ basis.

We saw evidence that action was being taken to reduce risks in relation to people’s health and wellbeing. However, what was happening in practice was not reflected within risk assessments and care plans. This risked that staff would not take consistent and effective action to reduce risks.

People told us they felt safe living at the home and there were sufficient staff to ensure their needs were met. The registered provider did not use a formal method to continually assure levels of staff were sufficient to meet people’s needs.

Recruitment systems were not sufficiently robust to ensure only staff suitable to work with vulnerable people and in the caring profession were employed.

Safeguarding procedures were in place and staff had attended training and were able to explain their responsibilities with regard to keeping people safe

People told us the food was good quality and they received a healthy and varied diet. Where people were nutritionally at risk we saw they were closely monitored and staff ensured they consumed a fortified diet. We found information within care records was often duplicated or not up to date in relation to people’s nutritional needs. This put people at risk of receiving inconsistent and inappropriate care.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). Staff had completed Deprivation of Liberty Safeguards (DoLS) applications where they needed to deprive people of their liberty. However, we could not be assured that staff consistently worked in accordance with the principals of MCA. Where staff had made decisions on behalf of people who did not have capacity, they were not always able to evidence these decisions were in the person’s best interest.

Staff received regular training, however, the training provided was not effective. We saw examples where staff would have benefitted from additional training and were concerned that staff had to complete training on seven key topics in one day. We were unable to see evidence that new staff had received induction training or that staff had received effective supervisions.

Staff worked closely with a range of health and social care professionals to ensure people maintained good health. However, we saw that the relationship with the local district nursing team had broken down and the registered manager had not taken appropriate action to resolve issues and improve communication with them.

People spoke about staff in positive terms and told us they were very caring. Staff knew people well and had worked hard to develop positive relationships with the people they cared for. Staff interacted with people in ways which were appropriate to people’s individual preferences.

People told us they were treated with respect and we saw staff helped to promote and preserve people’s independence, privacy and dignity.

People who used the service and their relatives told us they felt involved in making decisions about their care and felt they had control over their day to day routine. Their feedback was regularly sought and used to improve the quality of care.

Care records were not always accurate, complete and contemporaneous. This meant they did not always reflect people’s preferences and needs. We also found a lot of duplicated information in people’s care records which made reviewing the person’s current needs difficult.

Although we found quality assurance systems in place designed to continually monitor the service provision, these were not sufficiently robust or fit for purpose. The office used by the registered manager was disorganised and information was at times difficult for them to provide on request.

The registered provider had not addressed some areas for improvement previously raised by the Commission and other organisations. We found a lack of clear accountability for driving improvement and poor communication between the registered manager and registered provider.

The registered provider did not effectively monitor the quality of the service or hold the registered manager to account.

People who used the service and staff spoke highly of the registered manager and we found they were open and honest. However, their leadership was often reactive, rather than proactive. This meant they did not always seek opportunities to continually improve the service. The registered provider had recently employed an external consultant to support the registered manager in their role and carry out audits.

We identified four breaches of legal requirements. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We saw people were provided with choices about how they spent their day. We saw people were engaged in activities of their choice. For example a fish and chip lunch outside in the garden.

The staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

We found people had care plans and risk assessments in place. The care plans and risk assessments were accessible to staff and/or the people who used the service. Two people who used the service told us they were 'very happy' with the care and treatment they had received at Southfield Care Home.

At the inspection in February 2013 we had concerns the provider did not have an effective system to regularly assess and monitor the quality of service people received. At this inspection we found improvements had been made and there were now systems in place to monitor the quality of the service they provided.

During our inspection some people were not able to tell us their full experience of living at the home. So we observed how staff talked with people and provided their care and support. We saw staff being warm and accepting of people.

One person told us they 'would have to go a long way to find staff better than this'. Four relatives told us the staff was kind and respectful. One commented the staff were like an 'extended family'.

Although we found people had experienced care, treatment and support that met their needs. We found the formal systems in place which monitored and assessed the quality of the service provided needed to be improved upon.