Southlands Nursing Home

Southlands Nursing Home is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 30 people.

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

Feedback from people who were supported at Southlands Nursing Home was positive. People spoken with told us they felt safe and well cared for. They did not express any concerns about living at the home.

Staff’s knowledge of the people they supported was good and they were able to tell us about the risks associated with their care and how to minimise these. However, detailed care plans and risk assessments were not always in place to guide staff, especially for new or agency staff members who may not know people well.

Although some comments from people and relatives suggested that their dignity was respected, other comments and some of our observations demonstrated that this could be improved upon. Care planning continued to require improvement as at times these did not contain sufficient guidance to support staff to understand a people’s wants, wishes and preferences.

There was a clear management structure in place and the providers senior management team had been supporting the registered manager. They were open and honest with us about the need to make improvements to the culture of the service and they had developed an action plan to support this. However, the overall rating for the service remained requires improvement and we found a breach of regulation showing appropriate and timely action had not been undertaken to make necessary improvements, following our last inspection.

Enough staff who had been recruited safely were available to meet people’s needs. Where staff were responsible for supporting people with their medicines, suitable arrangements were in place to do this safely and in accordance with best practice guidance. People were supported by staff who had been trained and understood their responsibility to safeguard people. People were protected from the risk of infection because staff used protective equipment. Incidents were used to identify improvements that could be made to people’s care and support.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff had received appropriate training and support to enable them to carry out their role safely. They received regular supervision to help develop their skills and support them in their role. People’s nutritional needs were met, and they were supported to access health care. Adaptations had been made to the home to meet the needs of people living there.

People knew how to raise concerns and told us how things had changed for the better when they had needed to do so.

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 requires improvement (published 31 January 2019).

The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to person centred care.

Please see the action we have told the provider to take at the end of this report.

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.

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.

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 always provided to people in a variety of ways which would give them the best opportunity to understand it and be able to contribute to those decisions.

The environment did not effectively meet the diverse needs of people as the layout and equipment in rooms meant the function of these could be confusing for people We have made a recommendation about adapting the environment to meet people’s diverse needs.

The provider’s recruitment process ensured appropriate checks were undertaken to check staff suitability to work in the home.

People were protected against abuse. Safeguarding policies and procedures were available to everyone who used the service. The registered manager and staff recognised their responsibilities and duty of care to raise safeguarding concerns when they suspected an incident or event that may constitute abuse.

People and their relatives felt the home was always clean and well maintained. Staff received infection control training and protective personal equipment was available and in use and regular audits of the cleanliness of the environment and equipment were undertaken.

Equipment was managed in a way that supported people to stay safe.

People told us they felt permanent staff had the skills and knowledge to care for them. Staff said they felt supported by the management team and the provider. Staff said they received support in the form of supervisions, appraisals and training. Records showed that staff had received information sharing and competency based supervisions on specific subject areas. However there was little evidence of general welfare supervisions. The registered manager had a plan in place to address this.

Where people required support to eat their meals this was provided in a manner which enable them to eat at the pace they wanted and not feel rushed. They were supported to ensure they received adequate nutrition and hydration.

People and their families were encouraged to provide feedback on the service through residents meetings and an annual survey. They were also supported to raise complaints should they wish to.

Staff worked well as a team and people were supported to maintain good health and had access to appropriate healthcare services.

People told us that they felt the home was well led and staff were positive about the registered manager who was described as open, approachable and easy to talk to. Staff were committed to meeting the needs of people and providing a service people wanted.

We found three breaches 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.

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'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 ".