This inspection took place on 04 and 05 July 2018 and was unannounced.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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

The care home accommodates up to 45 people in one adapted building. At the time of our inspection 40 people were residing at the home.

A registered manager was in place at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At this inspection we found that window restrictors and some of the thermostatic mixers that controlled hot water required updating at the home. Medicines stock balance checks and recording of the administration of ‘as required’ medicines also required clearer definition. We raised this with the registered manager and action was taken to remedy these issues immediately.

Risks to people were clearly recorded, and action to take to mitigate risk were in place to guide staff. Recruitment procedures were in place to check the suitability of staff prior to them commencing employment. People were safeguarded from the potential risk of abuse and staff knew how to manage any concerns raised. The premises were clean, free from odour and hygiene levels were maintained regularly.

People’s care needs were holistically assessed, in line with national guidance. Records showed that people were sufficiently hydrated and had access to a balanced diet. Access to other healthcare professionals was provided at times that people needed them. Staff were supported to access training, supervision and appraisal that was relevant to their role and enabled them to carry out their duties. Procedures were in place to ensure that people’s mental capacity was appropriately assessed and decisions made in people’s best interests.

People felt cared for and supported by compassionate, kind and thoughtful staff. Staff knew people’s needs well as respected people’s privacy and dignity. People were supported to make decisions and express their views in relation to their care.

The home was responsive to people’s needs, involving them and their relatives in reviews and developments in their care needs. A range of activities were on offer both inside the home and as external trips and visits. People were supported with a comfortable and dignified end of life where their wishes were taken into account. A complaints policy was in place, and records showed these were appropriately responded to.

The provider and registered manager prioritised the safety and wellbeing of people at the home, and we observed a ‘hands-on’ approach. The provider worked to improve the quality of the care delivered at the home and considered people’s views and feedback.

We undertook an unannounced inspection of this service on 6 and 7 January 2016. At our previous inspection on 24 July 2014 the service was meeting the regulations we inspected.

Southborough Nursing Home provides nursing and personal care to older people, some of whom have physical disabilities and/or dementia. Southborough nursing home can accommodate up to 45 people. At the time of our inspection 41 people were using the service.

The service had a registered manager who had been in post since May 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.

People received safe care that met their needs. Staff undertook assessments to identify the risks to people’s safety and their support needs. Management plans and care plans were developed outlining what support people required and how this was to be delivered. Care records also identified what people were able to do for themselves and people were encouraged to do things independently. Where risks to people’s safety were identified staff provided people with the necessary equipment to reduce the risk, including pressure relieving equipment and mobility aids. Staff supported people with their nutritional and health needs. Safe medicines management processes were followed and people received their medicines as prescribed.

Staff liaised with other healthcare professionals to ensure people received the specialist care they required. They followed the advice and guidance provided to ensure people received safe and appropriate care. Staff were aware of the reporting procedures if they had concerns about a person’s health or safety, and escalated their concerns to senior staff.

Staff were aware of people’s communication methods and involved them, as much as possible, in decisions about their care. Staff adhered to their responsibilities under the Mental Capacity Act 2005 and if they had concerns that a person was unable to consent to their care, capacity assessments were completed. ‘Best interests’ meetings were held to make decisions for people when they were unable to do this themselves.

There was a range of activities on offer to people, including group and individual activities. Staff were aware of people’s preferences and their daily routines. They were in the process of gathering information about people’s lives including significant people, places and events that took place, to further strengthen and tailor the support provided to people.

Safe recruitment practices were in place to ensure suitable staff were employed. There were sufficient staff deployed to ensure people’s needs were met in a timely manner. Staff received the support they required to undertake their roles and responsibilities. Staff undertook regular supervision sessions and participated in training courses. Staff meetings took place to discuss good practice.

The registered manager undertook checks on the quality of care provided, and ensured staff adhered to the service’s policies and procedures. They discussed with staff any areas identified as requiring improvement and the necessary action was implemented to address any concerns.

People, and their relatives, were encouraged and supported to feedback about the service and the care provided. The registered manager listened to suggestions made and took the appropriate action to address any concerns raised. The complaints process was made available to people and their relatives, and people told us they felt comfortable speaking with the registered manager.

This visit was carried out by two inspectors who helped answer questions we always ask; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection and from looking at records. We met and spoke with eight people using the service and visiting relatives. We also spoke with the registered manager, and six members of staff.

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

Is the service safe?

Any potential risks to people's health, safety and welfare within the home were assessed by senior staff. There was appropriate guidance for staff on how to take action to minimise these risks to keep people safe from harm or injury in the home. This information was checked regularly by staff which meant they had up to date information about how to keep people safe.

Senior staff ensured equipment used in the home was serviced and maintained regularly so that it was safe to use.

Appropriate checks on people employed to work at the home were carried out. This included carrying out security checks to ensure people were not barred from working with vulnerable adults.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and in how to submit one. This meant people were safeguarded as required

Is the service effective?

People’s views and preferences had been taken into account when staff planned their care and support. People’s records showed their care and support needs were reviewed regularly by staff. There was information and guidance for staff on how to provide care and support that met people’s needs.

People using the service were asked for their consent before care and support was provided. Where people were unable to make complex decisions about their care and support their representatives and other healthcare professionals had been involved in making decisions on their behalf which were in their best interests.

Staff we spoke with demonstrated a good understanding and awareness of the people they cared for and in particular, what was important to them.

Is the service caring?

People we spoke with had positive experiences of staff that worked in the home. Comments we received included; “Excellent. They’re very good and look after us all”; “This is my home and they (staff) are my friends”; “Can’t fault it. We’re quite a happy crowd here”; “Get on with staff, no problem. Although I sometimes get bored”

During our inspection we observed warm and friendly interaction between staff and people using the service. Staff spoke with people respectfully and took time to listen and chat with them. People that needed extra help and support moving around the home or with eating and drinking were not rushed or hurried by staff and could do so at their own pace.

Is the service responsive?

There were mechanisms in place to monitor people’s general health and wellbeing. We saw regular checks were made and documented and staff used this information to highlight and take appropriate action about underlying issues or concerns they had about an individual’s health or wellbeing. This information was shared so that all staff had the most up to date information about people’s current care and support needs.

Where people using the service and/or their relatives had issues or concerns the registered manager took appropriate action to address these. This included carrying out unannounced visits to the home to check on the care and support provided to people, by staff.

Is the service well-led?

The views and experiences of people using the service and their relatives were sought by the service. Changes and improvements to the service were made when people wanted or needed these.

The registered manager demonstrated very good awareness and understanding of the importance of quality assurance and was able to demonstrate how the service had made improvements and changes when shortfalls in the care and support experienced by people, had been identified. The provider also carried out regular checks to assess and monitor the quality of service, the outcomes from which were shared with the home’s staff.

We received information alleging that people were living at the home who were not employed there. We spoke with two nurses and four care assistants during this unannounced night visit.

We saw that staff accommodation was provided on the second floor of the nursing home and that staff living there had the required checks before they started work. Improvements could be made to ensure staff did not walk through the nursing home to access their accommodation.

Staff were aware of their responsibilities in relation to safeguarding vulnerable adults and said they had completed training in this important area. Staff told us that they had the required checks before they started work and completed an induction that gave them the information they needed to do their job.

Our inspection of 5th September 2012 found that people who use the service, staff and visitors were not protected against the risks of unsafe or unsuitable premises because the provider had not taken sufficient steps to maintain the environment. The 45 people who use the service had access to two shower rooms with four bathrooms out of use. One of the lifts had been condemned. The manager sent an action plan showing work to refurbish bath and shower rooms, redecoration of ceilings and the replacement of flooring was due to be completed by the end of January 2013.

We looked around the home and spoke with the manager during this follow up visit and saw some progress had been made with one new bathroom in use and work underway with the refurbishment of a second bathroom. The flooring in two bedrooms had not been repaired although we were told that these rooms were not being used. There were no plans for the condemned lift.

We found two broken windows were letting cold air into a corridor and a shower room which meant people who use the service could be in a draught when they had a shower.

We spoke with twenty people who use the service, one visitor, ten members of staff and the manager during our visit.

People we spoke with said they are happy with the home and staff treated them with respect, maintaining their privacy and dignity saying "staff call me by my name" and "they speak to me properly". People said "staff give me the help I need", "staff listen and help me" and "staff come when I call" saying there were enough staff to give them the help they needed.

People told us "I find there is enough to do so long as you are willing to join in", "there are activities – bingo was good, and there are the trips out which I enjoy – but I often choose to watch TV in the evenings because that’s what I like to do", "I join in with activities", "there is enough to do", "I enjoyed the recent trip out" and "I prefer to stay in my room".

Comments we received about the food were mainly positive with people saying "the food here is very good", "there’s always a choice" and "the food is ok, some days it’s lovely, some days it’s really not so good".

Relatives said "staff are helpful", "they always make me feel welcome" and "they let me know if anything changes" saying there were always activities or outings and their relatives had enough to do.

People told us the rooms are very nice and are all very clean, saying that they like their rooms.

We spoke to ten people who use the service, three visitors and twelve members of staff during our two unannounced visits to Southborough Nursing Home.

People said "I am happy living here", "I have all I need in my room", "my family come and visit", "I have enough to do", "staff respect my privacy", "it's like a family here, they provide loving care" and "my relatives chose the place - they made a good choice". "The food is alright", "the food is very good", "they ask what we want to eat", "you can have something different if you don't like what is on the menu" and "there's enough to eat here" were a few of the comments people made about the food they received. People felt there were enough staff and said that staff came when they called.

Visitors told us they were happy with the care and support provided and said "they make me feel welcome", "they always offer us drinks", "there's always staff around" and "they keep me informed". People told us that the home was always clean when they visited.

Staff said they received the training and support they needed to do their job and said there were enough staff to meet the needs of people living at the home. Staff said they provided good care and did their best to provide the care and support people expected.

We saw some good interactions between staff and people who use the service with staff clearly knowing people and how to meet their needs. The new manager is working with staff to improve the services provided.