Archived: Southfield Court Care Home

Southfield Court Care Home is a nursing home providing accommodation for up to 50 people, who require personal care. The service provides support to people who have physical health needs and conditions such as dementia. At the time of our inspection there were 34 people using the service.

The home is set out across 2 floors, each with a communal lounge and dining area.

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

We found people were at risk of harm as medicines and risks associated with people’s care were not always safely managed. Risks to people and incidents were not always identified, communicated with other staff, or reviewed to ensure safe and effective care.

Staff were not always appropriately trained to meet the needs of people and feedback about how staff were support varied. Feedback from staff suggested staffing levels were not always in line with people’s needs. We found the service was not using its governance processes effectively to review staffing levels or people’s support needs. We found evidence of good partnership working with other health and social care professionals.

The premises was generally clean. However, we found it was not suitable for the needs of people using the service, particularly people diagnosed with dementia and had strong odours throughout.

People and their relatives told us they felt the care provided was safe. Staff were trained in safeguarding and some staff could give examples of different types of abuse. People and relatives mostly spoke positively about the care provided by staff, and we saw some positive interactions between staff and people. Recruitment was managed safely, although records associated with recruitment needed reviewing to ensure the most up to date information was available.

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. However, we found conditions relating to people’s Deprivation of Liberty Safeguards (DoLS) were not always actioned in a timely manner.

There was an interim manager at the service as the registered manager was not present. The interim manager was working to address shortfalls in practice and improve governance oversight. The interim manager and regional manager were responsive to our inspection findings, and we received updates about what actions they were taking to address concerns.

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 06 October 2022). At our last inspection we recommended the provider reviewed medicines records and took action to update their practice. At this inspection the provider had not addressed this. We also made further recommendations in the responsive domain; this domain was not looked at as part of this inspection.

Why we inspected

The inspection was prompted in part due to concerns received about poor recording, staffing levels, incident management, management oversight, training and nutrition and hydration. A decision was made for us to inspect and examine those risks.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to safe care, medicines, staff training and support, person-centred care, and good governance. Please see the action we have told the provider to take at the end of this report.

We have made a recommendation about infection, prevention, and control practices.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Southfield Court Care Home is a residential care home providing personal and nursing care for up to 50 people including people living with dementia. There are communal areas and accommodation on both the ground and first floor. At the time of inspection there were 38 people living at the service.

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

We have made recommendations about the safe administration of medicines and the effective recording of people’s needs within care plans. We have made a recommendation about reviewing care plans to remove historical information. We have made a recommendation about end of life care records.

There were enough staff to meet people's needs and keep them safe. Staff had a good understanding of safeguarding processes. Infection control practice was robust, and staff wore appropriate personal protective equipment (PPE).

People and relatives knew how to raise concerns and felt these would be dealt with appropriately. The provider was well organised and had a clear vision for the service. Staff worked well with other services and appropriate referrals were made in a timely manner. Quality assurance systems were in place to enable governance of responsibilities and regulatory requirements.

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 good (published 9 July 2021).

Why we inspected

We received concerns in relation to staffing levels, record keeping and personal care. As a result, we undertook a focused inspection to review the key questions of safe, responsive and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has not changed and remains good.

Recommendations

We have made recommendations about the safe management of some medicines and about

improvements in care plan records and end of life care planning.

Follow up

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

Southfield Court Care Home is a residential care home providing personal and nursing care for up to 50 people aged 65 and over. At the time of inspection there were 31 people living at the service. There are communal areas and accommodation on both the ground and first floor. There is a unit called Beech which supports people living with dementia.

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

Overall, safe infection prevention and control (IPC) practices were in place to minimise the spread of infection. We signposted the provider to resources to develop their approach.

People’s privacy and dignity was not always maintained. The provider took immediate action to address this. We have made a recommendation the provider continues to monitor practice in this area.

Systems to monitor the service were in place and were mostly effective in identifying and addressing areas of improvement.

Relatives felt their loved ones were safe. Systems were in place to safeguard people from the risk of abuse. People received their medication as prescribed by staff who were appropriately trained.

Risks to people were effectively managed. Care plans were individualised and reflected people’s needs. Staff were recruited safely and there were enough staff to meet people’s needs.

There was a positive culture at the service. People and relatives were involved in making changes. The service worked in partnership with other agencies to ensure people’s needs were met.

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 26 March 2019).

Why we inspected

The inspection was prompted in part due to concerns received. A decision was made for us to undertake a focussed inspection to review the key questions of safe and well-led only.

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service remains good.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Southfield Court Care 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.

People’s experience of using this service: Our observations during this inspection confirmed staff were friendly, kind and compassionate. People were treated with respect and dignity and examples were seen.

Additional detail was required in moving and handling risk assessments, which the regional manager said they would add immediately. Fire safety and key checks on the premises were well managed.

There were sufficient numbers of staff to meet people’s needs. Staff had been recruited using procedures which meant they were safe to work with vulnerable people.

Systems were in place to ensure the safe management of medicines and staff had been assessed as competent to carry out this role.

Lessons were learned when things went wrong. Staff told us these learning opportunities were shared with them.

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.

Training completion rates were satisfactory. The remaining gaps in training were being addressed and courses were already booked.

Staff felt confident approaching the management team who they said were supportive. Some gaps in supervision were seen at the end of 2018, although these were being addressed.

People received timely access to healthcare when they needed this support.

People received adequate nutrition and hydration which supported a healthy and balanced diet.

Care plans were easy to follow and contained enough information for staff to provide effective care.

The activities programme was suited to the needs of people living in the home. Group activities took place when external entertainers visited the home. One-to-one support was provided for people who preferred this.

Information on how to complain was on display. Complaints were appropriately investigated and responded to.

People, relatives and staff felt the management team were approachable. They felt listened to and changes were made as needed.

Systems of governance were effective through a series of audits, surveys and meetings for people and staff held in the home.

Rating at last inspection: Requires improvement in January 2018 (published 9 March 2018)

Why we inspected: This was a planned inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

Southfield Court Care Home, known to people, their relatives and staff as Southfield Court, is a purpose built care home providing accommodation and nursing care for up to 50 people. It has two floors, with lift access. There are communal bath and shower rooms located on each floor. The home is situated in Almondbury village and is approximately two miles from the town centre of Huddersfield. On both days of our inspection there were 36 people living at Southfield Court Care Home, providing care and support for people with residential needs including people who were living with dementia.

When we completed our previous inspection on 19, 20 and 21 July 2017 we found the registered provider had not taken appropriate steps to ensure staffing levels were sufficient to meet people’s needs, infection control procedures were not robust, care plans did not always contain accurate information, risks to people had not been managed effectively and some audits were ineffective.

Southfield Court was placed into ‘special measures’ and we issued requirement notices and added conditions to the registered provider’s registration regarding Regulation 17 (good governance) and Regulation 18 (staffing). Following the last inspection, we met with the provider to confirm how they were going to make improvements to Southfield Court and what actions there were going to take to improve the key questions of safe, effective, responsive and well-led. We asked the registered provider to complete an action plan to show what they would do and by when to improve the service. The purpose of this inspection was to see if significant improvements had been made and to review the quality of the service currently being provided for people. At this inspection we found the service had met these requirement notices and conditions.

The provider had taken appropriate action and was now meeting legal requirements. While improvements had been made we have not rated this key questions safe and well-led as 'Good'; to improve the rating to ‘Good’ would require a longer term track record of consistent good practice.

Southfield Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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.

At the time of our inspection the home had a registered manager in place who had been registered since 8 July 2016. 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 and relatives told us they and their family member felt safe at the home. We found there were appropriate systems in place to protect people from risk of harm.

There were sufficient staff to keep people safe and we observed call bells were answered in a timely manner. Robust recruitment procedures were in place and all staff completed an induction when they started work.

Risk assessments were completed, reviewed and changed with peoples care needs. Staff were aware of individuals’ risks and how to support people. Maintenance checks were carried out in the home to ensure it was safe.

Safe systems were in place to manage medicines so people received their medicines as prescribed.

Staff attended regular supervision and training, although some annual appraisals were overdue.

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.

People’s needs were fully met with regards to the provision of food and drink and people had access to healthcare services. There were opportunities for people to be involved in a range of activities within the home.

Throughout our inspection we observed, people were treated with kindness and compassion. Staff had a good rapport with people, whilst treating them with dignity and respect. Staff had a good knowledge and understanding of people’s needs and worked together as a team.

Care plans were detailed and provided information about people’s individual needs and preferences, although some minor updates were required.

The registered manager told us they made improvements when things went wrong. Complaints were investigated and responded to appropriately. Relatives told us if they needed to complain they would speak to the registered manager.

The registered manager used national guidelines to inform care and support practice at the home. They also gathered feedback from people, relatives and staff via engagement surveys.

We saw the registered manager was visible working with the team, monitoring and supporting the staff to ensure people received the care and support they needed. People who used the service, relatives and staff spoke positively about the management team. Effective quality systems were in place to identify issues and drive improvement when required, although we noted some minor areas had not been identified as part of the audit process.

Southfield Court is a care home registered to provide nursing and residential care for up to 50 people. It consists of one building with two floors accessed by passenger lifts. All rooms are single with ensuite facilities. There were 44 people living at the home at the time of this inspection.

Each floor of the home has lounge areas, a dining area and shared bathrooms and toilets. There is an enclosed garden area to the rear of the building, but it had not been tended for some months prior to this inspection and was therefore not used by people.

Southfield Court was last inspected in December 2016. At that time the home was rated as Requires Improvement overall as it was deemed to be Requires Improvement in the key questions of Safe, Responsive and Well-led, and Good in key questions of Effective and Caring. We served two warning notices after the inspection in relation to continuous breaches of the regulations relating to person-centred care and staffing. We also asked the registered provider to send us an action plan to tell us how they were going to tackle a continuous breach of the regulation relating to good governance.

At this inspection we found some improvements had been made, but identified other concerns. We found continuous breaches of the regulations relating to staffing and good governance, and new breaches of the regulations relating to safe care and treatment, and safeguarding people.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The home had a registered manager. At the time of this inspection she had been on a period of extended leave since November 2016 and had started working two days a week commencing the week before this inspection, in preparation for returning to work four days a week in August 2017. During the registered manager’s absence the deputy manager had been the acting manager, with support from various staff from the registered provider.

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.

Feedback from people and relatives about staffing levels was mixed. The number of staff deployed had increased as 17 people were admitted between April and May 2017. The home aimed to staff at levels higher than required by the dependency tool used but we saw this was not always effective. We observed people in communal areas for periods of time with limited staff interaction.

People and their relatives told us the home was clean. We noted occasional smells which did not persist. During the week of this inspection soap in a person’s ensuite bathroom had run out for two nights and one day, which meant staff had not washed their hands when supporting the person with care during this time.

Not all risks to people had been assessed and managed appropriately. The settings of air mattresses used by people to reduce their pressure ulcer risk were not in their care plans and staff did not know what they should be. Measures put in place to safeguard people from others who experienced behaviours which may challenge were not always effective.

Most aspects of medicines management and administration had been done safely. We identified some issues which the acting manager said they would address immediately.

Most care plans we sampled were detailed and person-centred, although others were not. We identified inconsistencies between some people’s care plans which made it difficult to understand what their needs were.

Our observations and records showed people’s access to meaningful activities was limited. This was a finding at the last inspection in December 2016.

Complaints made by people and their relatives had been managed and responded to appropriately.

Staff employed by the home had access to the induction, training and supervision they needed to provide effective care to people. Records showed none of the agency staff used in 2017 had received an induction to the home.

The acting manager had contacted relatives to request evidence of any Lasting Power of Attorney they held for people at the home. Mental capacity assessments and best interest decisions were in place for most people, but we did identify some gaps. People who needed Deprivation of Liberty Safeguards authorisations had them in place.

Most feedback about the food and drinks at the home was positive. Staff at the home, including the chef, were knowledgeable about people’s dietary needs.

Records showed, and people’s relatives told us, they had access to a range of healthcare professionals in order to help support their holistic health needs.

People and their relatives told us permanent staff at the home respected people’s privacy and dignity, and promoted their independence. We observed interactions between staff and people which were warm and caring.

Care staff knew people well as individuals and had developed good relationships with relatives who visited regularly. Most people and relatives said they had been involved in care planning but this was not evident in care records. The registered manager said she would address this.

Care staff could describe what was important in terms of good end of life care. End of life care had been discussed at a residents’ and relatives’ meeting in 2017; a healthcare professional from the community team had attended to share information about end of life care and answer questions.

Efforts to drive improvement at the home since the last inspection by the registered provider had not been effective. We saw measures had been put in place to address concerns in the weeks prior to this inspection, but they had yet to take effect.

A range of audits were in place to monitor the safety and quality of the service. Representatives of the provider visited the home regularly and had oversight of the service provided and any concerns raised.

People, their relatives and staff were provided with opportunities to feedback about the service and how any feedback had been acted upon was communicated back to them by the provider.

We found breaches of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Southfield Court is a purpose built care home providing accommodation and nursing care for up to 50 older people, some of whom are living with dementia. There were 35 people using the service at the time of this inspection.

The service is required to have 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.

The service had a registered manager in post who had commenced employment with the service in March 2016. The registered manager had commenced maternity leave in November 2016 and at the time of this inspection the deputy manager was managing the service with the support of the regional manager and a CHAP (care home advanced practitioner) on one day of the week.

Our inspection on 9 and 24 March found the registered provider was not meeting the regulations relating to the safety of premises. At this inspection we found improvements had been made and people were protected because the necessary fire safety checks were being regularly completed and maintenance was being completed in a timely manner.

At our inspection on 9 and 24 March we found there were not always enough experienced staff available to respond to people who required assistance in a timely manner. At this inspection we found less agency staff were being used, however we found sufficient staff were not always deployed to meet people’s assessed needs. This was a continuing breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our previous two inspections found the registered provider was not meeting the regulations relating to the management of medicines. At our inspection on 13 and 14 December 2016 we checked and found improvements had been made and medicines were now managed in a safe way for people.

We also found practice in the prevention and control of infections had improved since our inspection on 9 and 24 March 2016. We found effective measures were now in place to protect people from the spread of infections

Staff had a good understanding about how to safeguard adults from abuse and who to contact if they suspected any abuse.

Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence, although some risk assessments were not up to date.

Our inspection on 9 and 24 March 2016 found the registered provider was not meeting the regulations relating to supporting staff. On this inspection we checked and found improvements had been made and staff received sufficient training and supervision to support them in their role.

People’s capacity was considered when decisions needed to be made. This helped ensure people’s rights were protected.

People told us they enjoyed the food and we observed staff supporting people to eat and drink. People had access to external health professionals as the need arose.

We observed staff interacting with people in a caring, friendly and professional manner. Staff were able to clearly describe the steps they would take to ensure people’s privacy and dignity.

At our inspection on 9 and 24 March 2016 we found people did not always receive care that was planned to meet their assessed needs and there was a lack of meaningful activities for a number of people who lived at the home. At this inspection we found improvements had been made in some areas, such as increased evidence of activities for some people, however we found a number of people’s care records had not been updated to reflect their changing needs and provide direction for staff. This was a continuing breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Peoples care plans detailed their likes and dislikes and people were supported to make choices about their care.

Relatives told us they knew how to complain and told us staff were always approachable. Comments and complaints people made were responded to appropriately.

Our inspection on 9 and 24 March 2016 found the registered provider was not meeting the regulations relating to keeping accurate records. On this inspection we checked and found some improvements had been made, however some care plans did not reflect people’s current needs and some records were inconsistent.

The registered provider had a system in place to audit and monitor the service to check whether the service provided was to a high standard, however this system had not been fully effective and not all breaches of the regulations had been addressed since our last inspection. This was a continuing breach of Regulation 17of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff told us they felt supported by the management team and relatives told us they felt the service had improved since our last inspection.

The service held meetings with staff, and the relatives of people who lived at the home to gain feedback about the service provided to people.

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.

You can see what action we told the provider to take in relation to the breaches in the regulations at the back of the full version of the report.

Southfield Court is a purpose built care home providing accommodation and nursing care for up to 50 older people, some of whom are living with dementia. There were 46 people using the service on the first day of our inspection and 39 people on the second day.

The service is required to have a registered manager. There had been no registered manager at the home since 8 April 2015. 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.

A temporary peripatetic manager had been managing the service until August 2015, when a new permanent manager came into post. This manager left the service in January 2016 and since that time three peripatetic managers had managed the service. At the time of inspection a new manager had been appointed and was in post on the second day of our inspection.

People who used the service we spoke with were unable to tell us if they felt safe due to cognitive or sensory impairment, however the visitors we spoke with told us they felt their relative was safe at Southfield Court.

Our inspection on 8 and 10 August 2015 found the registered provider was not meeting the regulations relating to the safety of premises. The provider sent us an action plan outlining the improvements they would make. At this inspection we found people were still not protected against the risks of unsafe or unsuitable premises because the necessary safety checks were not being regularly completed and we found the service was still not meeting this requirement. This was a breach of regulation 12 (2) (d) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Relatives we spoke with told us they were unhappy with the number of different agency staff at the service, leading to a lack of consistent care for their relative. We found there were not always enough experienced staff available to respond to people who required assistance in a timely manner. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our inspection on 8 and 10 August 2015 found the registered provider was not meeting the regulations relating to the management of medicines. On this inspection we checked and found improvements had not been made. This was a breach of regulation 12 (2)(g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe management of medicines

We found poor practice in the prevention and control of infections. This was a breach of Regulation 12 (2) (h) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Staff had a good understanding about safeguarding adults from abuse and who to contact if they suspected any abuse. Risks assessments were individual to people’s needs and minimised risk whilst promoting people’s independence.

Our inspection on 8 and 10 August 2015 found the registered provider was not meeting the regulations relating to supporting staff. On this inspection we checked and found improvements had not been made. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People’s capacity was considered when decisions needed to be made. This helped ensure people’s rights were protected when decisions needed to be made.

People told us they enjoyed the food and we observed staff supporting people to eat and drink. People had access to external health professionals as the need arose.

We observed staff interacting with people in a caring, friendly and professional manner. Staff were able to clearly describe the steps they would take to ensure the privacy and dignity of the people they cared for and supported.

The home employed an activities organiser to organise and enable people to participate in activities. However; there was a lack of meaningful activities for a number of people who lived at the home. People did not always receive care that was planned to meet their assessed needs. These issues were a breach of Regulation 9 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People were able to make choices about their care. Peoples care plans detailed the care and support they required and included information about peoples likes and dislikes, however there were some gaps in recording.

Relatives told us they knew how to complain and told us staff were always approachable. Comments and complaints people made were responded to appropriately.

Relatives we spoke with felt consistent management had not been in place for some time and they were unhappy with the lack of direction and consistency for their relative.

Our inspection on 8 and 10 August 2015 found the registered provider was not meeting the regulations relating to keeping accurate records. On this inspection we checked and found improvements had not been made. This was a breach of Regulation 17of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The registered provider had a system in place to audit and monitor the service to check whether the service provided was to a high standard, however this system was not effective and had not picked up and addressed the problems we found at the last inspection in August 2015.

This was a breach of Regulation 17of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

The service held meetings with staff, and the relatives of people who lived at the home to gain feedback about the service provided to people.

On the second day of our inspection the new manager was actively addressing the issues we found. However, it was too early to say if improvements would be sustained.

You can see what action we told the provider to take in relation to the breaches in the regulations at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The regional manager and deputy manager told us the home manager had been in post for two months and was applying to become the registered manager for the home. The home manager was on leave on the day of the inspection.

When we visited Southfield Court in January 2014 we found the social needs of people who lived at the home were not being met, due to the lack of regular social activities. We asked the provider to make improvements. We went back on this visit to check whether improvements had been made.

Before this visit we had received information of concern about infection control and cleanliness, staff training and medicines management at the home. We looked at these areas during our visit and found no evidence to support this information, with the exception of the management of medicines, where we have asked the provider to make improvements.

We considered all the evidence we had gathered under the outcomes we inspected.

We used the information to answer the five key questions we always ask;

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

This is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People were protected from abuse and avoidable harm.

Staff were suitably qualified and had the knowledge and experience needed to carry out their role. Staff we spoke with knew how to recognise and report abuse or allegations of abuse.

People were cared for in an environment that was safe, secure, clean and hygienic. We saw some parts of the building were not well maintained. The deputy manager told us there were ongoing refurbishment plans in place at the home. We saw evidence which confirmed this. For example new furniture was being delivered on the day of our visit for a downstairs lounge which had recently been redecorated and re-carpeted.

There were sufficient numbers of suitably qualified staff to meet the care needs of the people who lived at the home.

We found several small issues with medications, mainly around safe storage.

Is the service effective?

From our observations and from speaking with staff, people who lived at the home and relatives we found staff knew people well and were aware of peoples care and support needs.

We found staff had received appropriate training to meet the needs of the people who lived at the home.

We spoke with people, relatives and their visitors who all told us they were happy with the care provided at the home. They confirmed people's care, treatment and support needs were being met. One relative told us their mother had been in hospital prior to moving in to the home and her weight had dropped to 6 stones. They said, 'Since mum has been here she's been putting weight back on. We're really pleased. She was also on oxygen 24 hours a day when she was in hospital, now she only needs it at night.'

This showed us people's care treatment and support at the home achieved good outcomes.

Is the service caring?

People who lived at the home were supported by kind and attentive staff. Care assistants were patient and encouraging when they were supporting people.

We observed staff interactions with people in two of the lounges during the morning and we observed lunchtime in the two dining rooms. We saw that staff were caring, patient and encouraging when they spoke with people. At lunchtime we saw several staff helped people to eat their meals, this was not rushed and people were allowed to go at their own pace.

One of the relatives we spoke with told us, 'Mum's been here for about six weeks. The staff are very, very kind and always pleasant. The management are absolutely lovely.' This person's mother said to us, 'I couldn't have come to a better place. The food's good and you get a choice. It gets a bit lonely at times but that's no different to when I was at home.' This confirmed what we observed during the visit. Care staff encouraged people to be independent as possible. This showed us staff treated people with compassion, kindness, dignity and respect.

Is the service responsive?

Since our inspection in January 2014, dedicated activity hours had been increased from one person working 22 hours a week to two people working 30 hours a week between them. However, we did not observe many activities going on through the day. The regional manager told us there were plans for care workers to receive training in delivering activities and engaging more with people. They also told us they would look into getting more dedicated activity hours at the home.

People were supported to maintain relationships with their friends and relatives. Some people told us there were not a lot of activities at the home; other people said they had seen activities happen fairly regularly. One friend told us they regularly took the person who lived at the home out. The friend told us, 'They (the people living at the home) are not getting much stimulation. She goes to bed early because there's nothing else to do.'

Care and support was provided in accordance with peoples' wishes. We saw from the care records and daily records that people's preferences, interests and diverse needs were taken into consideration.

This meant the home was well-organised so that it met peoples' care needs. However some improvements were required in order to meet everyone's social and emotional needs in the form of meaningful activities.

Is the service well-led?

The leadership and governance of the home assured the delivery of high quality care for the people who lived there.

We saw the home had quality assurance processes and systems in place to monitor the care provided to people. For example we saw evidence of consultation with people, their relatives and care staff.

The home manager had been in post since February 2014. The regional manager told us they would be applying to be the home's registered manager as soon as possible.

Most people we spoke with confirmed they had been listened to and, as a result changes had been made. However, one person told us they had been asking for their friends' pictures to be put up on the wall for a couple of weeks, following a change of bedroom. They said nothing had happened and the pictures were of great sentimental value. When we pointed this out to the two managers they asked the handyman to do it straight away. As a result the handyman spoke with the person concerned to see how they would like their pictures. The pictures were in place before we left the home.

Staff told us they were clear about their responsibilities and felt well supported by the manager. They told us they had regular staff meetings and their views were taken into consideration.

This showed us the home supported learning and innovation and the managers promoted an open and fair culture.

There were enough qualified, skilled and experienced staff to meet people's needs. However, the social needs of people were not being met. This was because there were insufficient dedicated activity hours to meet the social needs of people receiving the service.

People were cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard.

At lunch time people were offered a choice of what to drink and eat. For those people who could not make up their mind what to eat, the staff brought samples of the dishes on offer to the table and this assisted people to choose what they would like whilst maintaining their independence.

People visiting the service told us they were pleased to see the permanent staff who had been absent from work, now returning. Although there had been concerns about the use of agency staff, the visitors told us their relatives were well looked after.

We spoke with three relatives and these are some of the things they told us:

'I am kept informed about my relatives wellbeing, when I was away staff phoned me everyday to let me know everything was alright. We have relatives meetings once a month at the last meeting the acting deputy manager came to the last part of the meeting to answer any questions. They were very professional and we were impressed and reassured by them.'

'I am involved in my relatives care plan and kept informed about any changes. Food is very important to my relative and staff make sure it is served in the way they prefer. The activities are very limited it's a long time since we had a proper activities person. I wouldn't want my relative to be anywhere else.'

'We spoke with 10 members of staff. They told us that they enjoyed working at the home but felt staff were stressed and morale was low. Most of the staff we spoke with thought they needed more carers on duty to meet people's needs.