Southborough Nursing Home

Updated 10 December 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

Inspection team

This inspection was carried out by 3 inspectors.

Service and service type

Southborough 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.

Registered Manager

This provider is required to have a registered manager to oversee the delivery of regulated activities at this location. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered managers and providers are legally responsible for how the service is run, for the quality and safety of the care provided and compliance with regulations.

At the time of our inspection there was a registered manager in post.

Notice of inspection

Inspection activity started on 10 November and ended on 20 November 2022. The inspection visit took place on 15 November 2022 and was unannounced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and health professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke in person with the registered manager, 14 people using the service, 6 relatives, 10 staff and 8 health professionals to get their experience and views about the care provided. We reviewed a range of records. They included 5 people’s care plans and risk records and 5 staff files in relation to recruitment, training and supervision. We also checked a variety of records relating to the management of the service, including staff rotas, audits, quality assurance, policies and procedures. We observed activities and lunch.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.

Updated 10 December 2022

About the service

Southborough Nursing Home is a care home that provides nursing and personal care for up to 45 older people in one adapted building. At the time of our inspection there were 37 people using the service including those living with dementia.

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

People, their relatives and staff said that Southborough Nursing Home was a safe place for people to live and staff to work in. Risks to people were regularly assessed, reviewed and minimised and this meant they were able to take acceptable risks, and enjoy their lives safely. Accidents, incidents and safeguarding concerns were reported, investigated and recorded. The home provided enough staff to support people and meet their needs. Staff were appropriately recruited and trained including how to safely administer medicines. The home used Personal Protection Equipment (PPE) safely, effectively and the infection prevention and control policy was up to date.

The home was led and managed in a transparent, open, and positive way and had an honest culture. The provider’s vision and values were clearly set out and staff understood and followed them. Staff and management areas of responsibility and accountability were identified, made clear and a good service was maintained and regularly reviewed. Thorough audits were conducted, and records kept up to date. Wherever possible community links and working partnerships were established and kept up to minimise social isolation. The provider met Care Quality Commission (CQC) registration requirements. Healthcare professionals said that the service was well managed and met people’s needs in a professional, open and friendly way.

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

The last rating for this service was Good (published 21 July 2018). The overall rating for the service remains good. This is based on the findings at this inspection.

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

We did not inspect the key questions of effective, caring and responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.