Southcrest Nursing Home

Southcrest Nursing Home is a care home that provides nursing and personal care for up to 40 people within one large adapted building. It provides care to people requiring general nursing care some of whom live with dementia and have physical disabilities. At the time of our inspection, 31 people were living at the home.

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

There were some elements of care documentation which required reviewing further to ensure the information provided was personalised and an accurate account of people’s care to guide staff. More could be done to provide people with consistent recreational and social activities to meet their interests and stimulate people’s senses.

People's care and support had been enhanced by the provider and management team working together to make improvements since our last inspection. Work was continuing to drive through further improvements required as identified at this inspection. The registered manager understood time was needed to embed improvements and sustain these.

People's safety was protected from abuse by staff who knew what procedures to follow to keep people safe from harm. Staffing arrangements were reviewed to promote people's safety and individual needs.

Improvements were made since our last inspection to infection prevention and control practices. Staff were provided with training and protective equipment to manage the risks associated with infection prevention and control. People were provided with assistance to take their medicines and their health was promoted by staff who worked alongside the relevant professionals.

Systems for the safe recruitment of staff were robust. Staff received an induction which was based on the providers expectations of their staff team and ongoing management support to assist staff to continually improve in their roles.

People's individual needs and requirements were assessed prior to them moving into the home. People had support to eat and drink safely and comfortably, and contact had been made with doctors where required to obtain advice about meeting people's nutritional needs.

The provider had made improvements following our previous inspection to ensure people's rights under the Mental Capacity Act were understood and promoted by staff and management.

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. People's consent was sought by staff who knew people's preferred communication styles to aid their understanding in making everyday choices and decisions.

Staff supported people to be pain free at the end of their lives and for their wishes to be followed at this important time in their lives. Relatives were welcomed into the home and included in their family member’s care. Incidents and complaints were analysed, and learning was shared with staff. People living at the home and their relatives were encouraged to raise issues around quality and safety.

The registered manager was open and responsive to making ongoing improvements and achieving good quality care.

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 20 December 2018) and there were multiple breaches 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 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.

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

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.

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

Southcrest Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a 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 is registered to provide accommodation with nursing care for up to 40 older people some of whom are living with dementia. The accommodation is split across three floors within one large adapted building. At the time of our inspection, there were 28 people living at the home.

There was a registered manager in post who was present during our 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.

The provider needed to improve infection control practices at the service to better protect people from the risk of infections. People shared hoist slings and these were not always cleaned in between using them for different people. Plans to minimise the known risks to individuals were not always sufficiently clear, and the security of the home’s front door had not been fully risk assessed. Written guidance on the use of people’s ‘as required’ (PRN) medicines was not always clear or up to date. Staff had not been consistently inducted in line with the requirements of the Care Certificate and did not benefit from consistent supervision and appraisal with a senior colleague or member of the management team.

Further work was needed to create a more dementia-friendly environment within the home. Staff did not always protect people’s personal information, by ensuring this was accessible by authorised persons only. People and their relatives expressed mixed views on the support people had to participate in stimulating and enjoyable activities, and pursue their interests. The information recorded in people’s care plans was not always accurate or sufficiently personalised, lacking details of their known wishes and preferences. The management team and nurses lacked insight into the Accessible Information Standard. Staff needed to adopt a more consistent approach to identifying people's preferences and choices for their end-of-life care, through discussion with them and their relatives. The provider had failed to notify us of a serious injury and a safeguarding concern involving people who lived at the home. The provider needed to improve the overall effectiveness of their quality assurance activities.

The provider undertook regular checks on the condition of the premises and care equipment in use to promote people’s safety. Staffing levels and staff deployment were monitored and adjusted, on an ongoing basis, in line with people’s current care and support needs. Staff recognised the need to remain alert to and immediately report any form of abuse involving the people who lived at the home. Any changes in the risks to people were communicated effectively across the staff team. Staff recorded and reported any accidents, incidents or unexplained injuries involving people living at the home. The management team reviewed these reports to identify learning and prevent things from happening again. The provider completed pre-employment checks on prospective staff to ensure they were safe to work with people.

People’s individual needs and requirements were assessed before they began using the service, to ensure the provider could meet these effectively. Any risks or complex needs associated with people’s eating and drinking were assessed and plans put in place to manage these. Staff monitored any changes in people’s general health and helped them access community healthcare services. The management team recognised people’s rights under the Mental Capacity Act and sought to promote these.

Staff treated people with kindness and compassion, and were attentive to their needs and requests. The management team had an ‘open door’ policy, and encouraged people and their relatives to share their views on the service.

Staff had guidance on how to promote effective communication with individuals. The management team promoted a positive and inclusive culture within the service, which valued people’s individual differences. People and their relatives understood how to raise any concerns or complaints with the provider, and felt comfortable doing so.

The registered manager spoke about their work with clear commitment and took steps to keep themselves up to date with best practice guidelines and legislative changes. People and their relatives knew who the registered manager was, and felt they were approachable. Staff felt they had the management support and direction they needed to succeed in their roles, and felt their efforts were valued by the management team. The community health and social professionals we spoke with described a positive working relationship with staff and management. The provider took steps to involve people, their relatives and staff in the service provided.

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

Southcrest is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Southcrest accommodates up to 40 people in one adapted building, with areas for people to spend time together or more privately as they choose. Accommodation and care is provided to older people, including those living with dementia. There were 32 people living at the home at the time of our inspection.

There was a registered manager in post and they supported the inspection process on the day of 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.

At our last inspection on 17 December 2015, we gave the service an overall rating of Good. At this inspection, we have rated the key questions Safe and Caring as Requires Improvement which has meant the overall rating has changed to Requires Improvement.

Some individual staff practices did not always promote people’s safety in aspects of infection prevention and control. There were some areas of the home environment where on-going action was required to continue to reduce the risks of people falling accidently. Although the registered manager had assessed staffing levels to make sure there were enough staff there were examples throughout our inspection where people's individual needs were not responded to in a timely way. This was to ensure people's safety was maintained and people received individualised care in a timely way.

People's information was not always stored to make sure their privacy and confidentiality was maintained. We found some individual staff practices did not always reflect a thoughtful approach when supporting people with their needs.

Further work was in needed to improve the regularity of fun and interesting things for people to do which were personalised to meet their individual needs.

People had no concerns about their safety. Risks to their safety had been identified and staff had training in how to recognise and report abuse. The registered manager reviewed accidents and incidents to look for opportunities to improve staff practices for the future.

Effective recruitment processes were in place and followed by the management team. Staff were recruited in a safe way and had relevant training and support to develop their skills in meeting people's needs.

People had their medicines when they needed them and staff had been trained to manage medicines safely. Staff had written guidance to support people with their medicines so that they were administered safely at the right times and in the right way.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the provider’s policies and systems supported this practice. Staff respected people's right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place to support the ethos of people’s decisions being made in their best interests.

People were able to access a range of healthcare professionals when they required specialist support and they were provided with meals which met their nutritional needs. People's diverse needs were met by the adaptation, design and decoration of their home.

People were supported by staff to keep their dignity and maintain their privacy when assisting people with their needs. People and their relatives were involved in planning the care and support provided. Staff listened to people and understood and respected their needs. Staff reflected people's wishes and preferences in the way they supported people at the end of their lives.

People told us that they were happy living at the home. They knew how to raise any concerns if they needed to and we saw arrangements were in place to listen and act upon any concerns. The registered manager had an open and inclusive way which encouraged staff to speak out if they had any concerns. Quality monitoring systems were in place and the registered manager had made improvements so that the home was run in the best interests of the people who lived there.

Further information is in the detailed findings below.

Southcrest is registered to provide accommodation with nursing and personal care for a maximum of 40 people. There were 34 people living at the home on the day of our inspection. People’s rooms are spread over three floors which are accessed by stairs or a passenger lift. People have access to the communal areas on each floor and to the garden area.

A registered manager was in post at the time of our 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. Although the registered manager was not present for this inspection we received assistance and support from the deputy manager.

At the last inspection on 5 August 2015, the service was rated Good overall with the key question in ‘safe’ rated as Requires improvement. This was because staff’s medicine administration practices did not consistently show people's medicines were managed safely. The registered manager and her team had made the required improvements identified at our last inspection to ensure people had their medicines administered safely to meet their health needs

At this inspection we found the service remained Good overall. However, the rating in the key question of ‘safe’ remains as Requires improvement. This was because the preventive practices to ensure avoidable risks of potential cross infections and environmental trip hazards were not consistently reduced. Other risks associated with people's care were identified and staff were knowledgeable about those risks and how to manage them. People were consistently protected from the risk of harm by staff who understood their responsibility to report any concerns about people’s welfare.

People had various reasons for feeling safe while they lived at the home which included staff who had knowledge of their care needs and being available to support their requests. The differences in the staff teams skills had been assessed alongside the numbers of staff required so people’s care and safety was not compromised. Where staff vacancies existed the registered manager showed they were taking action by methods of the on-going recruitment of staff to decrease the need for agency staff. This would be an aid to strengthen people’s opportunities to build relationships with staff and receive care from staff they were familiar with.

People were confident their care and health needs were effectively responded to and met by staff who had the knowledge to do this. Staff had been provided with the training and support they required to support people's specific needs. Staff also worked closely with doctors and where required dieticians and speech and language therapists to ensure they knew about people's nutritional preferences, allergies and special dietary requirements. People enjoyed their meals and were able to choose what they wanted to eat.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the provider’s policies and systems supported this practice. Staff respected people's right to consent and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place to support the ethos of people’s decisions being made in their best interests.

People were complimentary about how staff supported them with kindness and thoughtfulness by staff who knew them well. People were confident staff practices were inclusive so people were supported to be involved in making their own choices in all areas of their daily life. Staff supported people to keep their dignity and encouraged people to remain as independent as possible with their privacy and confidentiality respected.

The caring nature of the management was reflected in the areas of on-going improvements. They had identified areas of the home environment had signs of wear and tear which included bathroom suites and showers. There was work in progress to the home environment so people could enjoy their surroundings and their home was a pleasant place to live.

People's care and support continued to be individual to them. The deputy manager and staff told us further work was in hand to improve the regularity of fun and interesting things for people to do. A new activities coordinator had been employed to support people to follow their individual recreational interests together with continuing to provide occasions where people were able to choose to be part of a group activity.

Staff continued to work for the benefit of people who lived at the home and supported a positive and open culture. People and their relatives felt involved in what happened and gave positive comments about the quality of care which was offered. People knew how to make a complaint if they wished to do so. The registered manager used quality checks to drive through actions which were based on continuous improvements. The registered provider was updated regularly by the management team so they were able to check their systems continued to be effective in assessing and monitoring the quality of the care provided.

Further information is in the detailed findings below.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. Some improvement in how staff involved people was identified. Staff knew about the needs of the people they were caring for. We looked at care records and found that these contained guidance for staff on how to meet their needs.

People told us that they enjoyed the meals provided and that they were offered regular drinks. This meant that the risk of people becoming dehydrated was reduced.

We found that infection control procedures were in place to ensure that the home was clean.

We found that medicines were kept safe and given to people as prescribed.

The registered manager was aware of shortfalls in some staff training and supervision.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

We spent time with the manager who at the time of our inspection had not applied to become registered as manager with the Care Quality Commission (CQC).

We saw two visitors who told us that they were happy with the care and support that their relative had received. Throughout the inspection we observed examples of staff supporting people and offering reassurance while carrying out care tasks. Staff were aware of how they were able to maintain and promote people's privacy and dignity.

We saw that care plans, risk assessments and other records were in place to give staff guidance and direction about the level of care required to meet individual needs.

We found that improvements had taken place to make sure that appropriate checks happened before new members of staff started to work at the home.

Staffing levels remained as highlighted within the previous inspection report. Although no overall dependency assessment was available the manager assured us that care needs had reduced. This was not however the belief of some members of staff.

Since our last inspection the manager had introduced effective systems to assess the quality of service provided for people.