Southwoods Nursing Home

Southwoods Nursing Home provides accommodation and nursing care to up to 38 people in one adapted building. At the time of our inspection there were 28 people using the service, including a person with a learning disability.

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

Medicines were not always administered safely. Medicine records were not always completed correctly.

There was an organised governance framework in place, which monitored all aspects of care and support and the running of the home. This had been developed over the last eight months by the new management structure and was continually reviewed. However, it had not identified the concerns we found regarding medicines administration.

We have made a recommendation about the governance of medicines administration.

Systems, processes and practices safeguard people from abuse. Risks to people were assessed and their safety monitored and managed to keep people safe, and support their independence. Sufficient numbers of suitable staff were deployed to support people to stay safe and meet their needs. People were protected by the prevention and control of infection, however advice from the recent IPC audit in respect of the environment had not yet been implemented. Lessons were learnt and improvements made when things go wrong.

People's needs and choices were regularly assessed and care. Treatment and support were delivered as required, and within best practice guidance. Staff received induction, training and regular support. People were supported to eat and drink and maintain a balanced diet. Staff were well-informed about people's nutrition and dietary needs. Robust monitoring was in place. Staff teams and services worked together and were supported by detailed handover records and documentation. People were supported to access to healthcare services. Regular visits from health professionals took place. The home had commenced a programme of refurbishment, which meant people lived in an environment suited to their needs. The home had a maintenance plan for further refurbishment works; this included recent recommendations from the fire service. Dementia-friendly signage was in place for toilets and bathrooms.

Consent to care and treatment was sought in line with legislation and guidance. MCA assessments and best interest decisions were used appropriately, as were DoLS applications.

There was a clear vision and strategy for the home. The minutes from meetings with staff, people and relatives and our observation showed there was a positive, open and person-centred culture at the service.

People, relatives and staff were all actively and regularly engaged in the running of the home. Links with the local community were in place, for example, with local schools and there were plans to expand this community involvement. The new management structure was constantly reviewing and learning from all practices and areas across the home. There was a culture of learning and improving. The service had worked closely with local authority colleagues and other professionals to learn and improve.

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.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

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 requires improvement (published 27 May 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 we found improvements had been made to the oversight, monitoring and auditing to ensure people's needs were being met and records were accurate and consistent. However, at this inspection the provider was in breach of a different regulation.

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

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 and 19 April 2022. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve their governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed. 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 Southwoods Nursing Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified a breach in relation to medicines at this inspection.

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

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Southwoods Nursing Home provides accommodation and nursing care to 26 older people at the time of our inspection. The service can support up to 38 people in one adapted building.

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

We received mixed feedback from people and their relatives who told us they were happy living at Southwoods Nursing Home. However, some relatives felt there was some improvements needed regarding regular communication from the home. People received personalised care and the staff team knew people well. However, their care plans didn’t always reflect this.

Medicines were administered safely. However, the policies and procedures in place were not up to date or in line with current best practice and not all staff had their competency to administer medicines carried out. Not all staff received regular supervisions and not all staff training was up to date. We have made a recommendation about staff training.

Recruitment and selection procedures were in place to ensure suitable staff were employed. However up to date staff records were not kept and were not audited regularly to maintain best practice standards.

People had risk assessments in place however we found the providers missing persons policy was outdated and didn’t follow best practice. There were no regular systems in place for communicating with relatives regarding peoples care and support. Or for collecting people and their relative’s views.

People had care plans and they covered all aspects of people’s care needs however they didn’t all contain person centred information or include life histories and people’s personal preferences. We have made a recommendation to add more information in people’s care plans.

The environment was clean and maintained to a safe standard. Improvements to health and safety issues were ongoing at the time of our inspection and good progress was being made against action plans in place for the provider’s fire safety risk assessment and legionella water safety risk assessment.

Improvements to audits and manager oversight of the home were being put in place by the manager and these needed more time to have a positive impact on the home. Good progress was being made in areas such as managing medicines, infection prevention and control and managing and analysing accidents and incidents.

Infection prevention control practices were in place. All essential visitors had to wear appropriate personal protective equipment (PPE), and complete NHS Track and Trace information. Additional cleaning of all areas and frequent touch surfaces was in place and recorded regularly by staff. Training included putting on and taking off PPE, hand hygiene and other COVID-19 related training. Additional competency and spot checks were carried out by the manager with all staff regarding safe use of PPE.

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. However, staff requires more training in this area.

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 12 February 2021) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found not enough improvement had been made to meet the breach of Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This remained a continued breach.

The overall rating for the service has not changed based on the findings at this inspection and it remains requires improvement. We have found evidence that the provider needs to make improvement. Please see the Safe, Effective and Well-led section of this full report. The provider had taken some action during the inspection to mitigate risks and continued to liaise with the inspector after the inspection to advise of further improvements scheduled and/or carried out.

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.

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.

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 have identified a breach in relation to the management of the service. Records and audits were not always in place, some policies and procedures were out of date and staff didn’t always receive supervision and training to support people effectively.

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

We found the following examples of good practice.

• Staff followed government guidance in relation to personal protective equipment (PPE) and infection prevention and control (IPC). The home had ample supplies of PPE and stock levels were monitored by the registered manager.

• All staff and people living at the service received regular Covid-19 testing. Appropriate processes were in place and followed should anyone display any symptoms of Covid-19

• Staff supported people's social and emotional wellbeing. The service had used different methods including information technology to assist communication. The provider and staff kept family members up to date about the latest guidance and their relative's health via regular telephone calls and other technology including video calls.

• Audits were in place and used to ensure the service was providing safe care and staff were following guidance. Regular observations of staffs practice had been completed.

• All staff had undertaken training in infection prevention and control. This included putting on and taking off PPE, hand hygiene and other Covid-19 related training.

Southwoods Nursing Home provides personal and nursing care for up to 38 older people in one adapted building across two floors. At the time of our inspection, the service supported 28 people.

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

Improvements had been made to provide people with a safe and clean environment. Walkways were free from hazards and the provider had carried out a comprehensive fire risk assessment. Areas of the home had been redecorated.

There was no documentation in place to record the managers review of incidents and accidents. This limited their ability to fully investigate and learn from such events.

The manager had introduced a number of checks to monitor safety and quality at the service. However, action had not always been taken to address issues identified. The manager demonstrated a willingness to make further improvements and told us they would review documentation to make sure actions were monitored in the future.

Whilst efforts had been made to seek feedback from people and relatives about their experience of the service, the manager had not taken action to address concerns raised in a recent questionnaire.

We received positive feedback from relatives about the care their family members received; they were complementary of staff and the manager. However, relatives told us they had not received any formal communication from the provider throughout the time the service was closed to visitors during the COVID-19 pandemic.

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.

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 requires improvement (published 1 January 2020) and there were multiple breaches of regulations. The provider completed an action plan after the last inspection to show what they would do, and by when, to improve.

At this inspection we found some improvements had been made and the provider was no longer in breach of regulation noted in the safe key question. Enough improvement had not been made and the provider was still in breach of regulation noted in the well-led key question.

Why we inspected

We carried out an unannounced comprehensive inspection of this service in October 2019 and breaches of legal requirements were found.

We undertook this focused inspection to check the provider had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions ‘safe’ and ‘well-led’ which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same. 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 Southwoods Nursing 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 monitor the service 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 the management of the home at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme or if we receive any concerning information, we may inspect sooner.

Southwoods Nursing Home provides personal and nursing care for up to 38 older people in one adapted building. At the time of our inspection, the service supported 27 people.

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

Robust systems of monitoring were not in place which led to issues which compromised the safety of the environment and people who used the service. For example, risks associated with fire management and legionnaires disease. Following the first day of our inspection, we liaised with the fire service about significant areas of concern. Parts of the environment and equipment remained unclean and cluttered. Limited action had been taken for some areas which were identified as requiring improvement at the last inspection. This did not demonstrate that feedback had been acted on to improve the service. Information relating to the running of the service was not well organised.

Although we received positive feedback about the visibility and approachability of the management team, there were significant shortfalls in the overview of the service.

We have made a several recommendations for the provider to address to improve the quality of the support provided. These include the development of a clear training policy, to review the activities available for people and to review the layout of communal areas and the storage of equipment.

People we spoke with felt safe living at the home and actions had been taken to ensure people received their medicines as required. Risk assessments were in place for identified risk to people and a more robust system to monitor accidents and incidents was in place. Staff continued to be recruited safely and safeguarding issues had been reported appropriately.

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 sought people’s consent before providing care and when decisions were made in people’s best interest, records were available to support this.

People were complimentary about the quality of the food and people were supported according to their needs and preferences. People had access to a GP and input was sought from health and social care professionals.

People told us staff were kind and caring towards them. Staff explained how they ensured people’s privacy and dignity was promoted. People’s relatives were kept informed of any changes and involved in important decisions.

Care plans were in place which described the support people required, but some of these lacked person-centred detail. We received mixed feedback about the activities available and some people had limited opportunities for stimulation, particularly those who were nursed in bed. Information was recorded about how people communicated and was available in a variety of formats. People were asked how they wanted to be cared for when they were approaching the end of their lives. The provider had a complaints procedure in place and people we spoke with felt confident in approaching the management team with any concerns.

People were encouraged to provide feedback about the quality of the service. Whilst the management team worked closely with health and social care professionals, there was limited involvement with other community organisations.

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 requires improvement (published 24 January 2019). 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.

Enforcement

We have identified continued breaches in relation to people’s safety and the governance of the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan and 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.

We carried out this inspection in response to concerns we received about the care and support being provided to people living at Southwoods Nursing Home. Information shared with CQC raised concerns about a lack of access to hot water, poor management of accidents and incidents and unsafe moving and handling practice. The inspection looked at two of the five questions we ask about services: is the service safe? And is the service well led? This is because we needed to know if people were safe in the service; and that the identified risks associated with the information we had received had been dealt with appropriately.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our ongoing monitoring or during our inspection activity, so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

At our last comprehensive inspection in February 2017 the service was rated as good.

Southwoods 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 service can accommodate up to 38 older people, some of whom may require nursing care. At the time of our inspection, 33 people were supported.

A registered manager was 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.

Where accidents and incidents occurred, the records relating to this were not detailed and follow-up actions had not been taken to respond to and mitigate potential risks.

Safeguarding concerns had not been consistently notified to the local authority when there were concerns a person who used the service may have experienced physical harm.

The management of prescribed creams was not safe. Creams did not consistently have labels to identify who they were prescribed for and the prescribing instructions. Creams were being used that were out of date or prescribed for a different person. Records for the administration of creams were not consistently completed and did not guide staff on the level of support the person required.

Equipment was being stored inappropriately and risks around cross contamination were poorly managed. A sling, still in use, was worn and frayed around the edges.

Fire drills had not been completed in line with the recommendations from a fire officer visit in 2017.

The premises were not safely maintained. Some people did not have access to hot water in their bedrooms and issues with the hot water system had been long standing. Legionella tests and checks of the hot and cold water temperatures had not been taken to ensure the risks around legionnaires disease had been assessed and mitigated.

The registered manager and provider did not have robust quality assurance systems to identify and address areas of practice where the quality and safety of the care and support provided had been compromised. Issues and concerns identified during the course of our inspection demonstrated ineffective quality assurance systems. Whilst the registered manager was responsive to our feedback and implemented action plans to address areas of concern, this demonstrated a reactive rather than proactive approach.

At this inspection we found the provider was in breach of four regulations: Safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment and the governance of the service. You can see what action we told the provider to take at the back of the full version of the report.

Risk assessments were completed when there was an area of potential risk. Staffing levels were safe. Staff responded to people in a timely manner and staff were visible throughout our inspection. Checks were completed to ensure staff were safe to work with people however elements of the recruitment process required development to ensure they were sufficiently robust. People who used the service and their relatives told us they felt safe.

People who used the service and staff felt the service was well-led. People’s relatives and staff told us both the registered and deputy manager were approachable and supportive. Staff meetings were held and people’s feedback was sought on the running of the service.

This is the first time the service has been rated requires improvement.

At the last inspection on 17 October 2016, we asked the provider to take action to make improvements to administering people’s medicines and this action had been completed.

Southwoods provides accommodation for up to 38 people who require nursing care and personal care. It is situated close to the centre of Northallerton. At the time of our inspection there were 33 people using the service.

The service had 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.

Checks were carried out in the home to make sure people lived in a safe environment. The service had a map in place of the home and the bedrooms were colour coded to guide rescue personal to the type of support people needed to evacuate the building. Risk to people had been identified and actions had been taken to reduce any risks to people and staff alike.

Before staff worked in the home they had also been checked to seek if they were suitable. We found the service had carried out appropriate checks and where concerns were identified in a reference these had been addressed by the registered manager.

People were given their medicines in a safe manner based on good practice guidance and a robust policy devised by the service with support from other clinicians in the area.

The food provided to people appeared appetising. Permission was sought from people to switch off the TV so that they could eat their meal uninterrupted.

Family members were listened to and were able to advocate on behalf of people using the service. We saw people’s care planning had been influenced and adapted by family members who knew them well.

We found there were enough staff on duty to meet people’s needs during our inspection. We reviewed the staff rotas and found there was a consistent level of staffing provided.

Accidents and incidents in the home were reviewed by the registered manager to understand if anything could be done to prevent any re-occurrences. This meant people were kept safe.

The staff had addressed people’s end of life wishes. We saw people had plans in place which reflected their needs and wishes.

Staff in the service were caring. They knew about people’s likes and dislikes and understood the best way to manage behaviours which challenged the service. We saw they ensured people’s privacy and dignity were respected. Staff spoke to people using appropriate tone of voice; we saw they kneeled down to have face to face communication with people and people responded warmly to staff.

Staff told us they felt supported by the manager. We found they also received supported through regular supervision, training and appraisal.

The service had in place a complaints procedure which had been followed by the registered manager and outcomes of the complaint had been provided to the complainant.

People’s care plans were detailed and person centred. They included people’s emotional and physical needs and their end of life wishes.

The home had in place partnership working arrangements with other professionals to ensure people’s needs were addressed. The staff had made referrals to different services and the advice given had been incorporated into people’s care planning.

Surveys about the home had been carried out by the registered manager; the results of the surveys were available to all in an easy to read format. We saw people had been complimentary about the home.

We found records in the home were accurate, reflected people’s needs and were up to date.

We undertook this unannounced focused inspection on 17 October 2016, to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southwoods Nursing Home on our website at www.cqc.org.uk

Southwoods Nursing Home is registered to provide personal and nursing care for up to 38 older people. At the time of our inspection the service was providing care to 33 people.

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 this inspection we found that improvements had been made to the way staff administered medicines and this was now done safely. Competency checks took place to ensure staff administered medicines safely and there had been no serious medicine errors since our last inspection. Medicines were stored safely and records relating to oral medicines and controlled drugs indicated that these had been administered in accordance with prescribing instructions.

Improvements were needed to ensure that clear written information was available to support the safe use of topical medicines [medicines applied externally], medicines used only when required and medicines used covertly [without the person knowing]. The recording of the administration of topical medicines and transdermal patches also needed to improve, to ensure that these medicines were being administered correctly and as prescribed.

The medicine policy and procedure had been updated recently by the registered manager, but did not adequately reflect current best practice guidance, such as the NICE (National institute for Health and Care Excellence) guidelines on managing medicines in care homes.

These findings evidenced a repeated breach of Regulation 12 Heath and Social Care Act (Regulated Activities) Regulations 2014, and we have required that the provider and registered manager make further improvements to the management of medicines.

This inspection raised questions about how the provider and registered manager monitored the safety and quality of the service, to effectively identify and make improvements when needed.

Arrangements were in place to review and update policies and procedures annually, but did not currently ensure that up to date best practice guidance was always incorporated appropriately.

The registered manager and other staff completed audits and monitoring activities. However, audits had not always been effective at identifying areas for improvement and had not resulted in action plans to ensure that issues identified were addressed effectively.

The provider carried out visits and talked regularly with staff to monitor the service and people’s satisfaction levels. There was currently no other formal scrutiny or external support provided to the service, although this had been tried in the past with limited success.

These findings evidenced a breach of Regulation 17 Heath and Social Care Act (Regulated Activities) Regulations 2014, and we have required that the provider and manager make improvements to ensure that good governance systems are in place.

We will undertake a further comprehensive rating inspection in the near future to monitor what action the provider has taken to make improvements.

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

Below is a summary of what we found. The summary describes what people using the service, their relatives and staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continuously improve.

The home had appropriate policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. We also found that relevant staff had been trained to understand when an application should be made, and how to submit one. This meant people would be safeguarded as required.

When people were identified as being at risk, their care plans showed the actions that would be required to manage these risks. These included the provision of specialist equipment such as pressure relieving mattresses, hoists and walking aids.

The service had been well maintained and we found that it was comfortable and clean. This meant that people were not put at unnecessary risk.

Recruitment practices were safe and thorough. Policies and procedures were in place to make sure that any unsafe practice was identified; this helped to protect people who used the service.

Procedures were in place for dealing with emergencies and staff were able to explain these to us.

Is the service effective?

People's health and care needs were assessed with them, and they were involved in

developing their plans of care. People told us they were included in making decisions about how their care and support was provided.

New staff had received relevant induction training which was targeted and focussed on improving outcomes for people who used the service. This helped to ensure that the staff team had a good balance of skills, knowledge and experience to meet the needs of people who used the service.

Is the service caring?

People told us they were supported by kind and attentive staff. People we spoke with said that staff were kind and "friendly". One person said 'It's like a 5 star hotel; the staff are wonderful; I have been spoilt to death.'

We saw that staff acted in a kind and respectful way People looked well cared for and appeared at ease with staff. The home had a relaxed and comfortable atmosphere.

Is the service responsive?

People's needs were met in accordance with their wishes. We saw evidence of the service ensuring people were able to continue with interests and hobbies; for example assisting people to complete crosswords.

The service provided specialist equipment to meet people's needs; for example the service had sourced bariatric equipment for individuals who needed it.

People we spoke with knew how to make a complaint if they were unhappy.

People using the service, their relatives and other professionals involved with the service completed an annual survey. This enabled the manager to address any shortfalls or concerns.

Is the service well-led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result we could see that the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and the quality assurance systems in place. This helped to ensure that people received a good quality service. They told us the manager was supportive and promoted positive team working.

We saw that people appeared relaxed and comfortable with their surroundings and with staff. We saw that staff spoke at a pace which met people's needs and engaged with people in a calm and patient way.

We talked to people about the meals provided and without exception they said that the quality of food was very good. They said there was always a choice.

We spoke with relatives who were very satisfied with the care and support that was provided. One person said "They look after us very well". Another person said 'Staff are thoughtful and considerate. I have been involved in decisions about the care provided and communication between me and the home is very good'.

We saw that medicines were kept safely and that appropriate arrangements were in place for the recording and administration of medicines.

We spoke with staff who were able to demonstrate a good understanding of the needs of the people who lived at Southwoods. They told us that they were well supported by managers of the home and there were good opportunities for training.

In this report the registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

People looked cared for and they were clean and comfortable. Comments made by people who used the service included 'I feel really well, and it's all down to the staff looking after me.' And 'The girls ask if I need anything and remind me in a nice way about things I may have forgotten to do. They always treat me with care and talk very nicely to me.'

When we talked to the staff on duty they were knowledgeable about the care and support people needed. The care records we inspected had been completed properly and some new recording systems had been implemented since our last inspection.

At the time of the inspection the manager and clinical lead nurse were interviewing for new staff. This was in addition to extra staff who had already been appointed at the beginning of the month. The staff on duty said that things had improved greatly since the previous inspection.