Southmoor Lodge 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. Southmoor Lodge provides personal care in one adapted building for up to 40 older people, including some who may be living with dementia.

At our last inspection in January 2017 we rated the service as Requires Improvement. People who used the service were not fully protected from harm or abuse or risks associated with unsafe or ineffective care. The provider did not have effective arrangements for service monitoring, evaluation and improvement when required. These were breaches of Regulations 11, 12, 13 and 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014.

Following the last inspection we asked the provider to complete an action plan to show what they would do and by when to improve the service. This was because the provider needed to improve the key question about how they ensure the service is safe, effective and well led. This was the first time the service was rated as Requires Improvement. At this inspection we found the provider had made improvements to meet the relevant requirements.

We carried out this inspection on 12 March 2018. The inspection was unannounced. There were 23 people living at the service. We rated the service as Good.

There was a registered manager 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People felt safe and they received safe care at the service. People were protected from the risk of harm or abuse by sufficient staff who were safely recruited.

Staff understood people’s safety needs associated with their care, environment and any medicines they needed to take, which were detailed in their written care plans for staff to follow. Staff supported people safely and consistently when they provided their care and in the least restrictive way. This helped to reduce any known risks to people’s safety.

The environment and care equipment was clean, well maintained and free from observable hazards to people’s safety. Staff were provided with relevant equipment, guidance and training, which they used and followed to help ensure this. Emergency contingency plans were in place for staff to follow for likely foreseen emergencies to ensure people’s safety, which they understood.

People received effective care from staff who were trained and supported to ensure this.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff understood people’s health conditions, related care needs and supported people to maintain and improve their health and nutrition. This was done in consultation with relevant external health professionals and staff followed their instructions for people’s care when required.

People were supported in the way they preferred and needed to eat and drink sufficient amounts they enjoyed, which met with their dietary needs and choices.

Environmental facilities provided sufficient space, relevant aids and adaptations for people to move around safely and as independently as possible. People were comfortable and satisfied with their own rooms, which they could personalise to their own taste.

Staff understood and promoted the principles of equality, dignity, choice and rights when they provided people’s care. Staff were kind, caring and compassionate and had established good rapport and relationships with people and their relatives.

Peopl

We inspected the service on 5 January 2017. The inspection was unannounced. Southmoor Lodge Care Home is registered to provide personal care to a maximum of 40 older people. On the day of our inspection 26 people were using the service.

The service did not have a registered manager in place at the time of our inspection and had not had one since September 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 were supported by staff who knew how to recognise abuse and how to respond to concerns. However risks in relation to people’s daily life were not properly assessed or planned for.

People were supported by enough staff to ensure they received care and support when they needed it, but were not regularly given the opportunity to engage with staff. Medicines were not always managed safely to ensure people received their medicines as prescribed.

People were supported by staff who did not all have the knowledge and skills to provide safe and appropriate care and support. People were supported to make decisions but people who did not have the capacity to make decisions were not protected because the provider did not adhere to the Mental Capacity Act 2005 (MCA).

People were supported to maintain their nutrition and staff were monitoring and responding to people’s health conditions.

People lived in a service where their emotional needs were not always recognised and they were not being supported to enjoy a stimulating social life. People knew how to raise concerns and felt these concerns would be listened to.

The systems in place to monitor the quality of the service and to bring about improvements had failed. The management team were approachable and were working hard to bring about improvements. People were given the opportunity to give their views on how the service was run.

We found the provider was in breach of a number of regulations and this resulted in people not being supported in line with the MCA, not having risks to their wellbeing assessed and planned for, not always being protected from harm and living in a service which did not have effective systems to identify these shortfalls. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 20 January 2016 and was unannounced. Southmoor Lodge Care Home is a purpose built establishment situated in the village of Walkeringham. It is registered to provide accommodation for people who require nursing or personal care to a maximum of 40 people, many of whom are experiencing conditions associated with old age. At the time of inspection 34 people were using the service.

The service has 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

People’s medicines were not always managed so that they could receive them correctly People felt safe and were supported by staff who could recognise the signs of abuse and knew how to report any concerns. Risks were identified and assessed. Any accidents and incidents were investigated to prevent future reoccurrence. Recent staff recruitment and changes to the way in which staff were deployed ensured that there were enough staff with the right skills and experience to meet people’s needs.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The DoLS are part of the MCA. They aim to make sure that people are looked after in a way that does not restrict their freedom. The safeguards should ensure that a person is only deprived of their liberty in a safe and correct way, and that this is only done when it is in the best interests of the person and there is no other way to look after them. The registered manager had applied the principles of the MCA and DoLS appropriately.

While people or their relatives had not always been involved in the writing of people’s support plans, people had signed their care plans and, staff always asked people before they provided support. The catering arrangements in the service had recently changed and people spoke positively about the new meal arrangements. People’s food and fluid intake was monitored and guidance to manage this effectively was requested from external healthcare professionals when required. People had regular access to their GP and other health care professionals.

People were usually treated with dignity and respect; however, we saw instances where people’s dignity was compromised. We saw some people’s personal information left unattended in a public area and on some occasions staff did not use respectful terms when referring to the support needs of those they were working with. Where people showed signs of distress or discomfort, staff responded to them quickly. Friends and relatives could visit those living at Southmoor Lodge at any time. People could have privacy when needed.

People were supported by staff who had received the appropriate training to support people effectively. Staff received regular supervision of their work.

A range of activities was available which were based around people’s hobbies and interests. We saw people being encouraged to maintain their independence by staff providing support. A complaints procedure was in place and people felt comfortable in making a complaint if needed.

There was a positive atmosphere within the home and people were encouraged to contribute to decisions to improve and develop the service. Staff were aware of how they could contribute to reduce the risk to people’s health and safety and took action when they needed to. A new manager was coming into post to replace the registered manager, and the regional manager had made plans to enable the transition between managers. There were processes in place to check on the quality of the service and address deficiencies that were found.