Southdown Nursing Home

Southdown Nursing Home is a residential care home providing personal and nursing care to 24 people at the time of the inspection. The service can support up to 25 people in one adapted building.

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

The service had improved since our last inspection, where we found chemicals were not always stored safely, there were insufficient measures to control the spread of infection and there was not a satisfactory quality assurance system in place. At this inspection we found the provider had taken sufficient action to address these areas.

Although the provider had made improvements since our last inspection, some aspects of the service needed to be improved further. Some risk management plans lacked detail about how to care for people safely. Incidents were not always recorded in the same place which may have impacted on monitoring and learning lessons from incidents. Some improvements were needed to the staff recruitment processes. However, staff knew how to care for people safely and we had no immediate concerns about people’s safety. Staff knew how to keep the home environment safe, including storage of hazardous substances and infection control. Medicines were managed safely and safeguarding concerns were handled appropriately. There were enough staff to care for people safely.

The provider now undertook a wide range of regular checks such as safety checks, care plan audits and food quality checks. They involved people, relatives and staff by gathering their views and making improvements based on their feedback. There was an open culture that promoted person-centred working. The provider worked well in partnership with others.

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. The provider assessed people’s needs thoroughly and worked well with other agencies to plan and deliver effective care. Staff received the support they needed through training and supervision. People’s healthcare and nutritional needs were met.

Some minor improvements were needed to the decoration of some parts of the home. We have made a recommendation about tailoring the decoration of the service to the needs of people living with dementia as part of planning this.

People received care from staff who were kind and empathetic. Staff knew people well and made an effort to engage them in conversation. Staff valued people and treated them with respect. People received support to express their views and make choices about their care and support. Staff promoted people’s privacy, dignity and independence.

People received care and support that was personalised and met their needs. Diverse needs including religious and cultural needs were met. People’s needs and preferences were recorded and met with respect to end of life care. Staff provided people with accessible information in suitable formats, including information about how to complain. The provider responded appropriately to people’s concerns. People had access to a range of suitable activities and had the support they needed to stay in touch with loved ones.

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 15 October 2019) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

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.

At our previous inspection on 13 December 2017 we found the provider was in breach of the regulation in relation to good governance. The provider did not always act on concerns in a timely manner and some people told us there was not an open and transparent culture. We also found the service required improvement in several areas including medicines management, staffing, following best practice guidance in providing a suitable environment for people living with dementia, and person-centred care planning. At this inspection, we found the provider had made improvements in all of these areas but was still in breach of the regulation in relation to good governance because the provider’s systems for identifying shortfalls in the quality and safety of the service were not robust enough.

Southdown 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 care home accommodates up to 25 people in one adapted building. It provides personal care and nursing to older people, some of whom may be living with dementia. At the time of our inspection there were 21 people using the service. Because the service is operated by a sole provider who takes responsibility as the registered person for issues relating to the management of the home, Southdown Nursing Home is not currently required to have a registered manager.

Although the provider had made improvements to the safety of the service since our last inspection, we found at this inspection that the service was not always safe because there were no formal systems to ensure good hygiene and control the spread of infection, other than in the kitchen. The provider had not addressed a safety issue involving a broken floor tile and chemicals were not always stored securely. The provider did not obtain all of the information they are required to use when checking the staff they recruited were suitable to work at the home.

We found the provider was in breach of the regulation in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report. We are considering what action to take in regards to the continued breach of the regulation in relation to good governance and will report on this when it is complete.

The provider assessed risks to people on an individual basis. People had detailed risk management plans so staff knew how to keep them safe. These were designed to allow people as much freedom and choice as possible while ensuring they were safe from avoidable harm.

The provider had systems to ensure there were enough staff to care for people safely. People and their relatives felt the service was safe and there were robust procedures to safeguard people from abuse. Medicines were managed safely.

The provider could not always produce evidence that they complied with legal requirements about obtaining consent from people before providing care to them. Where people lacked capacity to consent, the provider could not always demonstrate that they had followed appropriate procedures to determine decisions were made in people’s best interests.

People received care and support in line with national guidance. Staff received the training and support they needed to do their jobs effectively. People had access to healthcare services when they needed them and people’s nutritional needs were met. The environment was adapted to meet people’s needs, although some areas were in need of refurbishment.

People received care and support from staff who were friendly, respectful and caring. Staff made an effort to build good relationships with people and help them feel at home. Staff considered people’s individual needs when providing information to them, so people understood and were able to make decisions about their care.

Staff were empathetic and gave people emotional support when they needed it. They respected people’s privacy and dignity and promoted their independence by encouraging them to do as much for themselves as possible.

People had personalised care plans containing detailed information about what their care needs were, how they liked their care to be delivered and how staff should manage any healthcare conditions they had. People were involved in planning their care and the provider took into account people’s wishes, preferences and diverse needs. There were systems to ensure information about people’s changing needs was shared reliably amongst the staff team. Staff made sure people were comfortable when they reached the end of their lives and the home worked with relevant organisations to help ensure they provided end of life care in line with current best practice.

People took part in a variety of activities. This included trips out, visits from other organisations who provided activities, group activities planned by an activities coordinator and one-to-one time spent with staff. The provider established links with the wider community to help people feel involved.

People and their relatives knew how to complain and said they would feel confident doing so. The provider had a complaints procedure and systems to ensure they took appropriate action and identified any trends in complaints. People felt the home had an open and person centred culture where they were able to speak up about any concerns they had. The provider used a variety of tools to share information with people, their relatives and staff, to collect feedback and to plan changes and improvements to the service based on this feedback.

Southdown Nursing Home accommodates up to 29 older people in one adapted building. At the time of inspection 20 people were using the service, many of whom were living with dementia and some had a learning disability.

Southdown Nursing Home is not required to have a CQC 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 our last comprehensive inspection on 28 and 29 November 2017 we identified a breach of regulation relating to good governance. At a focused inspection on 10 March 2017 we found the provider remained in breach of the regulation relating to good governance. In addition, we found they were in breach of regulation relating to safe care and treatment. At a focused inspection on 23 May 2017 we found the provider had taken sufficient action to address both breaches of regulation.

We undertook an unannounced comprehensive inspection of this service on 13 December 2017. We found that whilst the provider had embedded their governance framework this did not ensure that actions identified as requiring improvement at our previous comprehensive inspection were implemented. This included in regards to the medicines management, complaints escalation process and recording actions taken following incidents. There were also insufficient systems in place to ensure good practice guidance was sought and embedded. We recommend the provider implements good practice guidance regarding safe management of medicines and providing a dementia-friendly environment.

An open and transparent culture had not been established and some staff, people and relatives felt the management team were not open to receive feedback.

Care records on the whole provided accurate information about people’s needs. However, we identified for some people care records were not in place in regards to individual’s specific care needs and did not always contain information regarding people’s preferences. Information was not always made available to people in an easily accessible manner, particularly for people living with dementia and/or those who had a learning disability.

A formal tool was not used to review people’s dependency levels in order to establish staffing levels. Our observations showed people received prompt support, however, feedback from staff was that at times this was more difficult particularly at night and at weekends. The provider had not implemented the Care Certificate to ensure staff new to care understood their roles and duties. Nevertheless, a training programme was in place and staff received regular supervision and appraisal.

Staff worked with other health and social care professionals in order to meet people’s needs. This included in regards to people’s healthcare needs, their dietary requirements and in regards to care decisions for people who lacked capacity. Staff adhered to the Mental Capacity Act 2005. 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. Staff were aware of people’s needs, including the level of support they required to manage and mitigate any risks to their safety. An activities programme had been embedded at the service and people were observed as being engaged and enjoying the activities on offer.

The management team had built working relationships with the local authority and the clinical commissioning group. They had embedded practices from the new models of care vanguard initiative. The management team also worked with and followed advice from the local authority in regards to any safeguarding concerns that arose.

Nevertheless, we found the provider was in breach of legal requirements regarding good governance and you can see what action we have asked the provider to take at the back of this report.

We undertook this focused inspection on 23 May 2017 to check they had followed their plan and to confirm 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 ‘Southdown Nursing Home’ on our website at www.cqc.org.uk

Southdown Nursing Home provides accommodation, personal and nursing care to up to 28 older adults. At the time of our inspection 20 people were using the service, some of whom were living with dementia.

At this inspection we found improvements had been made to address the concerns identified at our inspection on 10 March 2017. Pressure ulcer care had improved with risk assessments being regularly reviewed and preventative measures being carried out. People with wounds received appropriate treatment and staff regularly reviewed wounds to ensure they were healing.

New processes had been introduced to review the quality of service delivery and ensure accurate and complete recording of the care delivered. We saw additional audits had been introduced to review key aspects of care, including care records. Accurate daily support records were maintained, including repositioning charts and food and fluid charts.

The provider had worked with health and social care professionals from the local authority and clinical commissioning group (CCG) to improve the quality of the service. The provider had met the breaches identified at our previous inspection.

We undertook a focused inspection on the 10 March 2017 to check they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

Southdown Nursing Home provides accommodation, nursing and personal care to up to 28 older people, some of whom have dementia. At the time of our inspection 24 people were using the service.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the provider had not taken sufficient action to address the breach of regulation identified at our comprehensive inspection on 28 and 29 November 2016 and there remained ineffective processes in place to review and monitor the quality of care records. In addition to the continued breach of legal requirement relating to good governance, we identified people were not protected from the risk of unsafe care and treatment because sufficient processes were not in place to help prevent and manage pressure ulcers.

We found the provider was now in breach of two legal requirements relating to good governance and safe care and treatment. You can see what action we have asked the provider to take in regards to the breach of safe care and treatment at the back of this report. We are considering what action to take in regards to the continued breach of good governance and will report on this when it is complete.

After our comprehensive inspection in November 2016 the service was rated ‘good’ overall and for four of the key questions, with only the key question ‘is the service well-led?’ rated ‘requires improvement’. However, due to the concerns identified at this inspection the service is now rated ‘requires improvement’ overall and for the two questions ‘is the service safe?’ and ‘is the service well-led?’.

Southdown Nursing Home is registered to accommodate up to 29 older people who require personal and nursing care. At the time of our inspection 19 people were using the service.

The service is owned by an individual provider who also fulfils the manager’s role. It does not therefore require 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.

Accurate and complete care records were not maintained in regards to food and fluid intake for those at risk of malnutrition, dehydration or recurrent urinary tract infections, and accurate records were not maintained for those who required regular repositioning to reduce the risk of pressure ulcers. The current care record audits did not include a review the quality of daily monitoring forms and therefore there were not robust systems in place to review the quality of all care records.

The management team had plans to analyse key performance data to identify any learning to prevent incidents and complaints from recurring but this was not embedded at the time of our inspection.

Governance processes were not strong enough to ensure all areas of service delivery were reviewed and to ensure accurate and complete recording. The provider was in breach of the legal requirements relating to good governance. You can see what action we have asked the provider to take at the back of this report.

Staff were knowledgeable about the people they cared for. They were aware of the level of support they required and how this was to be provided. Nursing staff had developed clear and detailed support plans for each person and these were regularly reviewed to ensure they reflected people’s current needs.

Staff assessed the risks to people’s safety and developed plans to manage and mitigate those risks. Staff had communicated with people the risks to their safety and what processes were in place to support them to remain safe, this included reminding people of what equipment was used to promote their independence whilst keeping them safe. Staff were aware of their responsibilities to safeguard people from harm and worked with the local authority safeguarding team if there were any safeguarding concerns.

Staff provided people with prompt support when needed and regularly asked if they needed any assistance. They cared for people in a polite and friendly manner. Staff adjusted their style of working to meet people’s individual needs including their method of communication. Staff respected people’s privacy and dignity.

Staff adhered to the principles of the Mental Capacity Act 2005. The management team organised for ‘best interests’ meetings to be held if they felt people were unable to consent to decisions about their care. The management team liaised with the local authority to ensure people were only deprived of their liberty when required to maintain their safety.

Staff provided people with the level of support they required at mealtimes to ensure they received adequate nutrition and remained hydrated. Staff liaised with other healthcare professionals to meet people’s health needs and there was regular support from the visiting GP. Staff administered people’s medicines as prescribed and safe medicines management was followed.

The management team had reviewed their processes for capturing incidents and complaints. This had improved reporting processes. We saw appropriate action was taken to respond to incidents to ensure a person’s safety and to investigate any complaints received.

The management team welcomed feedback from people, relatives and staff about the quality of service provision. There were regular meetings with people, their relatives and staff. Staff felt well supported by the management team and felt able to have open and honest conversations with them.

The provider adhered to their Care Quality Commission registration responsibilities and submitted statutory notifications as required about key events that occurred at the service. The provider had also displayed the rating from their previous inspection at the service so people and their relatives could access this information.

We undertook a focused inspection on the 30 August 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

Southdown Nursing Home provides accommodation, nursing and personal care to up to 28 older people, some of whom have dementia. At the time of our inspection 20 people were using the service.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 provider had made the necessary improvements and was now meeting the regulations inspected. Medicines management processes had been strengthened to ensure they were safe and people received their medicines as prescribed. Accurate stock checks were maintained and medicines administration records were completed accurately. Protocols had been developed for ‘when required’ medicines.

Processes to review the quality of service provision had improved, particularly in regards to medicines management. Arrangements were in place with the local pharmacy for full medicines audits to be carried out. The provider was also in the process of embedding and improving the quality of care record audits.

The provider was now adhering to the requirements of their registration with the Care Quality Commission and submitting statutory notifications as required.

We undertook a focused inspection on the 5 May 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 saw that whilst some improvements had been made the service was still in breach of some regulations. Safe medicines management processes were not consistently followed. We found medicine administration records were not complete and there were some stock discrepancies indicating medicines had been administered, but this had not been recorded. There were no written protocols for people who were prescribed ‘when required’ medicines and there was a risk that people would not receive their pain relief when they needed it.

Systems to monitor the quality of service delivery had been improved and the service had liaised with other healthcare professionals to develop these systems. However, at the time of our inspection sufficient action had not been taken to fully implement these systems and these were not effective enough to identify and address the concerns we identified, particularly for medicines management practices.

The provider had not adhered to all the requirements of their registration with the CQC. They had received authorisation from the local authority to deprive some people of their liberty, but they had not submitted the associated statutory notifications. They had met the requirement to display their rating and we saw that a copy of their previous CQC inspection report was available in the communal hallway.

Improvements had been made in regards to providing person centred care. Staff had consulted with people about what activities they would like to participate in and the service had developed an activities programme, which was in the process of being embedded at the service. We observed that arrangements had been made to have local performers come to the service to entertain people. People’s social and recreational needs were now being met.

We observed that staff spoke to people politely and respected their privacy. Staff supported people to maintain their dignity and we observed that people were well-presented. At lunchtime we observed that staff encouraged and enabled people to eat independently.

The provider remained in breach of the legal requirements relating to safe care and treatment, good governance and notifications. We are taking further action against the provider in relation to notifications and will report on this when our action is completed. You can see what action we have asked the provider to take to address the breach of regulation in relation to safe care and treatment and good governance at the back of this report.

We used SOFI as a method to help us understand the experiences of people using the service. We observed that people's experience of the service was overall positive.

We found improvements had been made since the last inspection in the way the home managed care plans. People's care plans were comprehensive and staff had very good knowledge of individual needs and the ways that people like being supported.

It was evident from the practices we saw during our visit that the people using the service were well supported by the staff that worked there and treated with respect.

At this visit we saw that there was not always an assessment of peoples care needs and information about how they should be supported, in place. Changes in peoples assessed needs were not always being identified and addressed. This meant that staff did not always have access to up to date information and there was a possibility of people receiving unsafe or inappropriate care.