Southlands Court Residential Home

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

The service provided safe care to people. One person commented: “I feel very safe with the staff.” Measures to manage risk were as least restrictive as possible to protect people’s freedom. People’s rights were protected because the service followed the appropriate legal processes. Medicines were safely managed on people’s behalf.

Care files were personalised to reflect people’s personal preferences. Their views and suggestions were taken into account to improve the service. People were supported to maintain a balanced diet. Health and social care professionals were regularly involved in people’s care to ensure they received the care and treatment which was right for them.

Staff relationships with people were caring and supportive. Staff provided care that was kind and compassionate.

There were effective staff recruitment and selection processes in place. People received effective care and support from staff who were well trained and competent.

Staff spoke positively about communication and how the management team worked well with them and encouraged their professional development.

A number of methods were used by the home to assess the quality and safety of the service people received. The service made continuous improvements in response to their findings.

Rating at last inspection: The last rating for this service was Requires Improvement (report published in July 2018). However, the service was not in breach of any 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 Southlands Court Residential 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

Southlands Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We had previously carried out an unannounced comprehensive inspection of this service in September 2017. That inspection was the provider’s first inspection since they registered the service with CQC in October 2016. Following the inspection the service was rated as “Inadequate” overall and placed into special measures. Six breaches of legal requirements were found. We found concerns relating to people’s health, safety and welfare. This was because people were not protected from unsafe and unsuitable premises. The provider’s quality assurance systems did not effectively assess and monitor the quality and safety of the service. There were no systems to monitor fire safety and health and safety. There were not sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet people’s needs. During the last inspection the provider increased staff levels after we raised our concerns with them. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

On 6 December 2017 we then undertook a focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. We looked at the key questions, ‘Is the service safe?’ and ‘Is the service well led?’ to ensure people were safe and improvements were being made. At the focused inspection the provider had made improvements and was no longer in breach of Regulation 12 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This meant the rating has changed for the safe and well led question from Inadequate to Requires Improvement. We made that decision because we needed to ensure the improvements made were sustained over a longer period of time.

At this comprehensive inspection we found the provider continued to make improvements.

The service had a new registered manager who was registered with CQC in January 2018. 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.

People said they were happy to approach the registered manager, staff and the provider if they had a concern, and were confident that actions would be taken if required.

People were protected from unsafe and unsuitable premises. Risks for people were reduced by an effective system to assess and monitor the health and safety risks at the home. Records contained accurate and up to date information and were stored in a locked office to protect people’s information.

There were sufficient and suitable staff to keep people safe and meet their needs. Although there were times when staff were rushed. The registered manager had made changes to the shift times after consultation with the staff. They made us aware at the beginning of the inspection they had agreed with the provider to increase staff levels in the evening. The registered manager was also in discussion with staff and the provider regarding increasing the staff level during the lunchtime period.

Recruitment checks were carried out. New staff received an induction that gave them the skills and confidence to carry out their role and responsibilities effectively. The registered manager had been working with staff to complete the provider’s mandatory training. Thirteen staff had a higher level qualification in health and social care and others were being supported to undertake a relevant qualification. The staff had a good knowledge of how to safeguard people from abuse.

People’s needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were not always undertaken for all people to ensure their health needs were identified. The registered manager was aware of this and was working with staff to complete these as required. Care plans were in a new format which reflected people’s needs. They were personalised and people had been involved in their development. People were involved in making decisions and planning their own care on a day to day basis. They were referred promptly to health care services when required and received on-going healthcare support.

The service had close links with healthcare professionals who gave positive feedback regarding the knowledge and cooperation of the registered manager and staff.

There was a complaints procedure in place and people knew how to make a complaint if necessary. There had been no complaints since our last inspection.

People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place. The registered manager and staff were committed to ensuring people experienced end of life care in an individualised and dignified way.

Staff were polite and respectful when supporting people who used the service. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted. Residents meetings were held where the registered manager sought people’s feedback. The registered manager planned to send out surveys to ask people and relatives their views. People and staff spoke highly about the registered manager and management team.

Staff felt supported. The registered manager had started undertaking annual appraisals. They said staff supervisions had fallen behind but added they were a small team. This meant they monitored staff practice each day when they worked alongside staff. Staff meetings took place and staff felt able to discuss any issues with the registered manager.

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. Improvements had been made in relation to the Mental Capacity Act (MCA) 2005. Where people lacked capacity, mental capacity assessments had been completed. Not all staff had received training in MCA although this was planned. Best interest decisions had been made and involved relevant people but these had not always been recorded.

People were very positive about the food provided at the home. People had access to activities at the service and were encouraged to take part. Arrangements were in place for people who stayed in their rooms to have support to avoid social isolation.

Southlands Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

We carried out an unannounced comprehensive inspection of this service in September 2017. The service had been rated as “Inadequate” overall and placed into special measures. This had been the provider’s first inspection since they registered the service with CQC in October 2016. Six breaches of legal requirements were found. We found concerns relating to people’s health, safety and welfare. This was because people were not protected from unsafe and unsuitable premises. The provider’s quality assurance systems did not effectively assess and monitor the quality and safety of the service. There were no systems to monitor fire safety and health and safety. There were not sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet people’s needs. During the last inspection the provider increased staff levels after we raised our concerns with them. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

The CQC used urgent enforcement powers to impose conditions on the provider’s registration under section 31 of the Health and Social Care Act 2008 to set out what actions we required the provider to take and the timescales required. We issued an urgent Notice of Decision to impose conditions on the provider’s registration. We told the provider that they must not admit people to the service without the written permission of CQC. They must have a tool in place to determine the number of staff and range of skills required in order to meet the needs of the people using the service. We also said they must complete this assessment and keep it under regular review and send CQC the assessed numbers of staff identified each week. We also told the provider that they were required to undertake health and safety audits and send CQC each month the actions they were taking in response to these audits.

The provider had followed the imposed condition issued by CQC by sending in the required information. This included;

• A dependency tool which had been completed to assess people’s needs and the staff levels required to meet those needs

• Weekly staff rota’s to demonstrate the staff level was maintained.

• Each month the outcome of health and safety audits carried out and the actions taken.

Since the last inspection we have regularly spoken with the provider and manager and received further assurances that people were safe. They made two formal requests for people to be admitted to the service, which CQC agreed.

This unannounced focused inspection took place on 6 December 2017. We undertook this focused inspection to check that the provider had followed their plan and to confirm that they now met legal requirements. We looked at the key questions, ‘Is the service safe?’ and ‘Is the service well led?’ to ensure people were safe and improvements were being made. At this inspection, we found improvements to the service, which meant the provider was working to meet the regulations. However, we could not judge that these were fully embedded and effective due to the short time since our last visit. 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 Southlands Court Residential Home on our website at www.cqc.org.uk”

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. We have removed the Condition of Registration that was imposed following the last inspection.

The new manager was in the process of registering with CQC to become the registered manager of Southlands Court. 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. Since the inspection, the manger has undertaken a fit person interview and has been registered with CQC as the registered manager.

The manager had the support of the deputy manager. They were both very active within the service and worked alongside the staff. Since the inspection in September 2017, they had worked hard to implement the required audits and changes required by CQC as part of the condition of the provider’s registration. They had recognised and prioritised areas of concern. Since our last inspection, the manager had been working with the local authority quality assurance and improvement team (QAIT). With their support the manager had produced a service improvement plan to identify and prioritise the concerns. Staff had been kept informed of the changes being made and said they had seen improvements. The provider visited the home most weeks and was available by telephone if there were concerns.

At the focused inspection in December 2017, we found people were having their needs met in a timely way. Staff said they had seen improvements at the service since the staff level had been increased. For example, people were being transported using wheelchairs and transferred onto appropriate chairs, for example soft comfortable chairs in the lounge rather than being left in their wheelchairs. Staff comments included, “It is much better, especially in the morning, it is not a production line anymore, we have the time to speak to them.”

Systems had been put into place regarding fire safety at the service. A fire risk assessment had been completed, fire drills carried out and fire training for staff. The provider had an external company undertaking fire equipment checks. Personal emergency evacuation plans (PEEPs) had been put into place to ensure people were kept safe in the event of a fire.

The manager and deputy manager had completed general risk assessments, falls, manual handling and infection control risk assessments for individuals. They were putting in place skin integrity and nutritional risk assessments as part of their new care records system.

Since our last inspection the provider has had a safety grill placed over the pond in the courtyard at the centre of the service. Along with the door alarms fitted during our last visit to alert staff, the grill had ensured people’s safety when using the courtyard area. In order to protect people from the risk of scalds from hot water in the basins in their rooms an external plumber had fitted thermostatic controls to hot water taps.

An environmental risk assessment had been undertaken to ensure the environment was safe. Audits had been completed and systems had been put into place to undertake regular monitoring in order to mitigate further risks. These included monitoring checks in relation to bedrails and beds to ensure they were safe, checks to ensure window restrictors were in place and effective to keep people safe from falling out of windows.

The manager had ensured notifications had been reported to CQC in accordance with the regulations. They had also started to review the service’s policies and procedures to ensure they were effective and reflected the practice at the service.

Medicines remained safely managed. We reminded the provider that action had not been taken to put in place photographs for all people on the medicine records. This is good practice to identify people to ensure they receive the correct medicines.

People were protected by staff that were aware of the signs of abuse and would report concerns. However not all staff had received training in adult safeguarding, this had been scheduled for staff to attend. There were safe recruitment processes in place. The manager monitored accidents and incidents and looked at patterns and trends to reduce the likelihood of a recurrence.

We found a continued breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to good governance. There had been improvements at the service, although the provider and management team recognised further work was needed to embed the new quality assurance systems they had put in place. We will carry out a further inspection within the next six months to check the remaining requirements have been met.

The service is required to have a registered manager as a condition of registration. Southlands Court did not have a registered manager at the time of inspection; the previous registered manager last worked at the home in June 2017 and had since left the employment of the provider. The assistant manager had taken up the position of manager in August 2017. They have submitted an application to CQC to become the registered manager at the service. 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.

People’s health, safety and welfare were put at risk because there were not sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet their needs. The CQC wrote a letter to the provider on 21 September 2017 because of the inadequate staffing levels at the service. We were so concerned about some of the findings during the first two days of our inspection visits that, on 21 September 2017, we wrote to the provider setting out our concerns. We asked them how they planned to ensure people living at Southlands Court were being kept safe. The provider’s response acknowledged the concerns raised and gave a commitment to addressing them. They said action was being in some areas. The provider gave CQC assurances in their response that they would increase the staffing at the service. On the third day of our inspection the provider had increased the staffing levels at the home. However they had not undertaken any assessment to demonstrate how the new staff levels were adequate to meet people’s needs.

However, CQC did not feel the response gave adequate assurance to improve the safety systems. The CQC therefore used urgent enforcement powers to impose conditions on the provider’s registration under section 31 of the Health and Social Care Act 2008 to set out what actions we required the provider to take and the timescales required.

On the 28 September 2017 we issued an urgent Notice of Decision to impose conditions on the provider’s registration. We told the provider that they must not admit people to the service without the written permission of CQC. They must have a tool in place to determine the number of staff and range of skills required in order to meet the needs of the people using the service. We also said they must complete this assessment and keep it under regular review and send CQC the assessed staffing levels identified each week.

Since CQC issued the conditions on the provider’s registration the provider has undertaken the required audits and risk assessments and has submitted the actions they have taken to CQC as required. We have since the inspection spoken with the provider and manager and received further assurances that audits have been completed and systems have been put into place to undertake regular monitoring in order to mitigate further risks.

People were not protected from unsafe and unsuitable premises. The provider’s quality assurance systems did not effectively assess and monitor the quality and safety of the service. There were no systems to monitor fire safety and health and safety. The provider had not completed any environmental risk assessments or monitoring checks to ensure the environment was safe. In particular, we highlighted scald risks related to the hot water supply and the possible risk to people of the large pond in the courtyard accessible to people which had not been assessed. No monitoring checks had been undertaken in relation to bedrails and beds to ensure they were safe. No checks were undertaken to ensure window restrictors were in place and effective to keep people safe from falling out of windows.

There was no system in place to ensure the service was meeting fire regulations. These included staff training, fire drills and environmental checks. Individual plans to ensure people were kept safe in the event of a fire had not been drawn up.

There was not a system in place to protect people from the risks associated with their care needs. There were no risk assessments regarding people’s nutritional needs, skin integrity, falls risk or manual handling risks. Therefore it was not possible to provide guidance and direction for staff about how to support people and ensure that care and treatment was provided in a safe way.

Staff had recorded accidents promptly in the accident books and the actions they had taken at the time. However there was no assessment or review of people’s falls and accidents to monitor and mitigate future risks. Where people had had a serious injury or numerous falls these incidents had not been reviewed and analysed to look for ways to keep people safe from further harm.

People did not receive person-centred care that met their needs and reflected their choices and preferences. Care plans did not contain information about people’s care needs and had not been updated to reflect people’s changing needs. Some care plans had not been reviewed by staff since October 2016. People and relatives where appropriate had not been involved in reviewing care, support and treatment plans to ensure they reflected the way people preferred to receive their care. Records showed and health professionals confirmed that staff referred people to health professionals regularly and recorded their visits. However care plans were not updated to reflect their guidance. One person’s care plans did not demonstrate how decisions had been made regarding the consistency of their diet and whether the speech and language team (SALT) had been involved in the decision.

People received a nutritious diet and enough to eat and drink to meet their individual needs. The manager was working with staff to make improvements to the menu and choices available for people.

Health professionals gave positive feedback about the care provided at the service, in particular the end of life care received by one person. People said they felt safe and cared for in the home. During our visits staff were kind and caring in their approach to people and treated people with dignity and respect. However they had not ensured that people’s dignity was maintained at all times.

People and their families were not being given sufficient opportunities to be actively involved in developing the service. Although people could provide feedback on an ad hoc basis, there were no regular resident or family meetings and no regular surveys to ask people and visitors their views.

Activities were available for people most days. There was a staff member designated to undertake activities which included one to one activities with people in their rooms to help avoid social isolation. The manager had been working with staff to further improve the activity provision at the service. The provider had purchased a minibus which had meant people were able to go on outings.

People who lacked mental capacity to take particular decisions were not protected. The provider had not acted in accordance with the Mental Capacity Act 2005 (MCA). The provider had not ensured where someone lacked capacity to make a specific decision, a capacity assessment and a best interest assessment was carried out. Where a power of attorney (POA) was appointed for a person, there was no system to identify whether the POA was authorised for making care and treatment decisions, finances or both. Therefore staff might not be aware whether a relative had the right to make a decision on behalf of a person living in the home.

The manager and deputy manager had been working to ensure there was a safe system in place for the management and review of medicines. They had recognised there were areas for improvement and had taken action to put measures in place. The improvements included ensuring medicines were ordered in a timely manner, a stock balance maintained and audits carried out.

The staff training records did not demonstrate staff had the knowledge and skills they needed to support people’s care and treatment needs. The manager had identified there were numerous gaps in staff training records. They were taking action to arrange training to ensure staff had received the provider’s mandatory training.

Since they had taken over, the manager had ensured new staff being recruited had all the necessary checks made before they commenced employment. Systems were put into place during our inspection to check agency staff identification when they arrived at the home. An induction for agency staff was also introduced so they knew how to support people and what to do in an emergency.

The manager had recognised the importance of actively involving staff in developing the service. They had held staff meetings and one to one supervisions with staff and said they would be held regularly to discuss concerns and changes which were being implemented.

The policies and procedures in use at the service were ineffective because they did not reflect the current practice. There was an off the shelf template of policies and procedures which the provider and the manager said they would use to put in place accurate policies and procedures that would give staff clear guidance about the practice expected.

The complaints procedure did not guide people how to raise a concern and the process t