We carried out a review of the data available to us about Southlands Care Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Southlands Care Home, you can give feedback on this service.
The inspection took place on 3 and 14 August 2017 and day one was unannounced. We told the provider we would be visiting on day two. At the last inspection in March 2015, the service was rated Good.
At this inspection we found the service remained Good.
Staff worked within the principles of the Mental Capacity Act in every aspect of their work with people. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.
Leadership of the home was positive and this had driven, developed and maintained a positive culture where people and staff felt they were listened to and fully involved in developing and shaping the service. The quality of the service was assessed regularly and improvements were made where required. A lessons learned approach was taken which meant the team worked together to continuously improve. This approach had seen the service consistently deliver good levels of care for people and people confirmed this to us.
We saw that people were safe. People and their relatives confirmed this. Staff had a good understanding of safeguarding and were aware of types of abuse and how to report incidents. They knew the people they supported extremely well which resulted in people feeling safe and behaving in a confident way around staff.
There were robust recruitment processes in place to assist the registered manager in making safe decisions about who they employed. Staffing levels were safe and ensured people’s needs were met. Work was currently underway to ensure call bells were responded to quickly and in a timely manner.
Staff received a thorough induction when they started work at the service which gave them the skills and knowledge to care for people. They were supported through supervision and appraisal.
People’s medicines were managed safely. Risks to people’s health and safety had been identified and detailed risk assessments and management plans were in place to guide staff. These were linked to people’s care plans.
People’s nutritional needs were identified and supported by staff. Where further input was required by healthcare professionals the staff had requested referrals.
The environment supported people’s needs and their personal space reflected their preferences and personalities. Specialist equipment was checked regularly to ensure it was safe. Regular servicing of equipment and checks of services such as gas, electric and water took place.
We saw that people mattered to staff and staff respected their privacy and dignity. People’s preferences were taken account of when planning their care and they could choose how that care was delivered. Work to record people’s preferences in their care plan had started. People had access to a wide range of activities to promote wellbeing and, development of activities for people cared for in bed had been initiated.
Complaints were managed effectively and people felt they could raise concerns and they would be listened to. Compliments reflected our findings.
Southlands is owned by BUPA Care Homes (GL) Ltd. The home is a large converted Victorian building situated within walking distance of Harrogate town centre. Southlands offers residential, nursing, respite and day care facilities for up to 68 people. All bedrooms have en-suite facility. A range of communal areas were available. This includes a number of lounge areas, coffee room, bar area, ballroom and a library. There is a large landscaped garden which contains a vegetable patch and an aviary.
The home employs a registered manager who had worked at the home for over eight 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.
The service was not consistently safe. Although most of the people we spoke with told us that they felt safe people told us they had concerns regarding staffing levels at the home. People described staff working non-stop. We saw that on one occasion staff took 20 minutes to respond to someone who had called for assistance. We observed throughout the day that care staff were consistently busy with care tasks. There was a shortage of staff due to sickness. We have asked the provider to review their system to replace staff at short notice when unplanned shortfalls occur such as covering staff sickness.
Robust recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show that staff employed were safe to work with vulnerable people.
Staff we spoke with understood how to make an alert if they suspected anyone at the home was at risk of abuse. Training had been given to staff about safeguarding procedures.
We identified issues with required medicines. On two of the three floors we found there were discrepancies in two people’s prescribed as necessary (PRN) medication. This meant that people did not always receive their medication as prescribed by their doctor.
Safety checks were carried out within the environment and on equipment to ensure it was fit for purpose. We found that the main open plan lounge/dining area was sometimes cold and people told us that they were cold during one of our visits. We have asked the registered provider to make improvements.
Staff followed the principles of the Mental Capacity Act 2005 to ensure that people’s rights were protected where they were unable to make decisions for themselves.
People were provided with nutritious food. Although several people made negative comments about some of the meals. Assistance and prompting was given by staff where necessary to assist people. Adapted cutlery and crockery were available to people for them to use to help maintain people’s independence.
Staff were seen to be attentive and kind to people and they respected people’s individuality, privacy and dignity.
Care plans we looked at were up to date. Risks to people’s health and wellbeing had been identified. These risks were being monitored and reviewed which helped to protect people’s wellbeing. People’s physical health was monitored. This included the monitoring of people’s health conditions and symptoms, so that appropriate referrals to health professionals were made.
Activities were available to people on a daily basis as the home employed an activities co-ordinator. We observed various activities taking place during our visit to the home.
We received information from Healthwatch. They are an independent body who hold key information about the local views and experiences of people receiving care. CQC has a statutory duty to work with Healthwatch to take account of their views and to consider any concerns that may have been raised with them about this service and none were raised .We also consulted the Local Authority to see if they had any concerns about the service. They had carried out a visit in March 2014, where a number of recommendations were made regarding record keeping, mental capacity assessments and staff training. A follow up visit from the Local Authority established that all recommended improvements had been implemented and were sustained by the provider. The Local Authority confirmed they had no concerns with the home.
We looked at the care records in detail of seven people and a range of other supplementary records. We spoke with nine members of staff, the management team and two people who lived at Southlands Nursing and Residential Home.
Additional staff had been recruited and we saw many care plans and risk assessments had been re-written and were now relevant, up to date and reflected guidance from external healthcare professionals. We saw that appropriate, timely action had been taken when a person's care need had changed.
People were now supported to eat and drink sufficient amounts to meet their needs. We looked in the rooms of 20 people; the majority of whom were cared for in their room. We saw all the rooms now had jugs and appropriate drinking cups with fluid in them. The records we looked at indicated the provider had reviewed the way people's nutritional needs were being assessed and had made changes to ensure people received sufficient food and fluid each day.
People were cared for in a clean environment.
During our inspection we spent time with the management team who discussed the service improvement plan (SIP) that had been put in place. We saw this plan was reviewed, updated and monitored regularly to bring about improvement. The provider had brought in a team of people to support the home staff in delivering the improvements identified in the SIP.
People were not supported or provided to eat and drink sufficient amounts to meet their needs. We have asked the provider to address these issues. We have also made the Local Authority Commissioning and Safeguarding teams aware of our concerns.
People were not prevented from the risk of infection because appropriate guidance had not been followed and there were inefficient systems in place to reduce the risk and spread of infection. We reported our findings to the Environmental Health team at the Local Authority. We have asked the provider to address these issues.
Appropriate arrangements were in place in relation to recording and administering medicines. Our checks found the stock levels corresponded with the medication administration records (MARs). We also saw that short term medicines such as antibiotics and 'when required' medicines were administered, as prescribed.
The provider did not have an effective system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service and others. We have asked the provider to address these issues. We have also made the Local Authority Commissioning and Safeguarding teams aware of our concerns.
We observed that people living at the home were well dressed and appeared relaxed and happy. Staff engaged with people in a calm and person centred way. The people we spoke with told us that they received the care they needed and that they were well looked after.
All the people that we spoke with, when asked, told us that they felt safe and that their concerns would be listened to. All the people we spoke with told us that the manager had an 'open door' policy and they could raise concerns at any time. One person told us "The staff provide reassurance for me".
We reviewed four staff files. All the files contained the relevant pre-employment checks. This meant that staff were recruited safely with relevant checks being completed to ensure that they were suitable to work in the care industry.
People's complaints were fully investigated and resolved, where possible, to their satisfaction. We saw evidence that the provider had a system in place for tracking and responding to complaints received. The manager told us that they monitor minor issues that are raised. This helped to improve the experience for people living at the home.
People told us that the staff were always pleasant and respectful. Staff gave people the time they wanted or needed and they never felt rushed.
Some relatives told us that they were always welcome and staff seemed pleased to see them. They thought relatives were extremely lucky to be in the home and they got the help they needed. Some relatives were unsure of the staff as they had just moved from another home as it had closed.