The inspection took place on 9 and 12 November 2018. The first day of our inspection visit was unannounced.

Southcrest 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.

The service is registered to provide accommodation with nursing care for up to 40 older people some of whom are living with dementia. The accommodation is split across three floors within one large adapted building. At the time of our inspection, there were 28 people living at the home.

There was a registered manager in post who was present during 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.

The provider needed to improve infection control practices at the service to better protect people from the risk of infections. People shared hoist slings and these were not always cleaned in between using them for different people. Plans to minimise the known risks to individuals were not always sufficiently clear, and the security of the home’s front door had not been fully risk assessed. Written guidance on the use of people’s ‘as required’ (PRN) medicines was not always clear or up to date. Staff had not been consistently inducted in line with the requirements of the Care Certificate and did not benefit from consistent supervision and appraisal with a senior colleague or member of the management team.

Further work was needed to create a more dementia-friendly environment within the home. Staff did not always protect people’s personal information, by ensuring this was accessible by authorised persons only. People and their relatives expressed mixed views on the support people had to participate in stimulating and enjoyable activities, and pursue their interests. The information recorded in people’s care plans was not always accurate or sufficiently personalised, lacking details of their known wishes and preferences. The management team and nurses lacked insight into the Accessible Information Standard. Staff needed to adopt a more consistent approach to identifying people's preferences and choices for their end-of-life care, through discussion with them and their relatives. The provider had failed to notify us of a serious injury and a safeguarding concern involving people who lived at the home. The provider needed to improve the overall effectiveness of their quality assurance activities.

The provider undertook regular checks on the condition of the premises and care equipment in use to promote people’s safety. Staffing levels and staff deployment were monitored and adjusted, on an ongoing basis, in line with people’s current care and support needs. Staff recognised the need to remain alert to and immediately report any form of abuse involving the people who lived at the home. Any changes in the risks to people were communicated effectively across the staff team. Staff recorded and reported any accidents, incidents or unexplained injuries involving people living at the home. The management team reviewed these reports to identify learning and prevent things from happening again. The provider completed pre-employment checks on prospective staff to ensure they were safe to work with people.

People’s individual needs and requirements were assessed before they began using the service, to ensure the provider could meet these effectively. Any risks or complex needs associated with people’s eating and drinking were assessed and plans put in place to manage these. Staff monitored any changes in people’s general health and helped them access community healthcare

This inspection took place on 16 April 2018 and was unannounced.

Southcrest 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.

Southcrest accommodates up to 40 people in one adapted building, with areas for people to spend time together or more privately as they choose. Accommodation and care is provided to older people, including those living with dementia. There were 32 people living at the home at the time of our inspection.

There was a registered manager in post and they supported the inspection process on the day of the 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 our last inspection on 17 December 2015, we gave the service an overall rating of Good. At this inspection, we have rated the key questions Safe and Caring as Requires Improvement which has meant the overall rating has changed to Requires Improvement.

Some individual staff practices did not always promote people’s safety in aspects of infection prevention and control. There were some areas of the home environment where on-going action was required to continue to reduce the risks of people falling accidently. Although the registered manager had assessed staffing levels to make sure there were enough staff there were examples throughout our inspection where people's individual needs were not responded to in a timely way. This was to ensure people's safety was maintained and people received individualised care in a timely way.

People's information was not always stored to make sure their privacy and confidentiality was maintained. We found some individual staff practices did not always reflect a thoughtful approach when supporting people with their needs.

Further work was in needed to improve the regularity of fun and interesting things for people to do which were personalised to meet their individual needs.

People had no concerns about their safety. Risks to their safety had been identified and staff had training in how to recognise and report abuse. The registered manager reviewed accidents and incidents to look for opportunities to improve staff practices for the future.

Effective recruitment processes were in place and followed by the management team. Staff were recruited in a safe way and had relevant training and support to develop their skills in meeting people's needs.

People had their medicines when they needed them and staff had been trained to manage medicines safely. Staff had written guidance to support people with their medicines so that they were administered safely at the right times and in the right way.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the provider’s policies and systems supported this practice. Staff respected people's right to consent to and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place to support the ethos of people’s decisions being made in their best interests.

People were able to access a range of healthcare professionals when they required specialist support and they were provided with meals which met their nutritional needs. People's diverse needs were met by the adaptation, design and decoration of their home.

People were supported by staff to keep their dignity and maintain their privacy when assisting people with their needs. People and their relatives were involved in planning the care and support provided. Staff listened to people

This inspection was carried out on 11 September 2017 and was unannounced.

Southcrest is registered to provide accommodation with nursing and personal care for a maximum of 40 people. There were 34 people living at the home on the day of our inspection. People’s rooms are spread over three floors which are accessed by stairs or a passenger lift. People have access to the communal areas on each floor and to the garden area.

A registered manager was in post 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. Although the registered manager was not present for this inspection we received assistance and support from the deputy manager.

At the last inspection on 5 August 2015, the service was rated Good overall with the key question in ‘safe’ rated as Requires improvement. This was because staff’s medicine administration practices did not consistently show people's medicines were managed safely. The registered manager and her team had made the required improvements identified at our last inspection to ensure people had their medicines administered safely to meet their health needs

At this inspection we found the service remained Good overall. However, the rating in the key question of ‘safe’ remains as Requires improvement. This was because the preventive practices to ensure avoidable risks of potential cross infections and environmental trip hazards were not consistently reduced. Other risks associated with people's care were identified and staff were knowledgeable about those risks and how to manage them. People were consistently protected from the risk of harm by staff who understood their responsibility to report any concerns about people’s welfare.

People had various reasons for feeling safe while they lived at the home which included staff who had knowledge of their care needs and being available to support their requests. The differences in the staff teams skills had been assessed alongside the numbers of staff required so people’s care and safety was not compromised. Where staff vacancies existed the registered manager showed they were taking action by methods of the on-going recruitment of staff to decrease the need for agency staff. This would be an aid to strengthen people’s opportunities to build relationships with staff and receive care from staff they were familiar with.

People were confident their care and health needs were effectively responded to and met by staff who had the knowledge to do this. Staff had been provided with the training and support they required to support people's specific needs. Staff also worked closely with doctors and where required dieticians and speech and language therapists to ensure they knew about people's nutritional preferences, allergies and special dietary requirements. People enjoyed their meals and were able to choose what they wanted to eat.

People were supported to have maximum choice and control of their lives and staff assisted them in the least restrictive way possible; the provider’s policies and systems supported this practice. Staff respected people's right to consent and make their own decisions about their care and treatment. Where people did not have capacity to make their own decisions, systems were in place to support the ethos of people’s decisions being made in their best interests.

People were complimentary about how staff supported them with kindness and thoughtfulness by staff who knew them well. People were confident staff practices were inclusive so people were supported to be involved in making their own choices in all areas of their daily life. Staff supported people to keep their dignity and encouraged people to remain as independent as

This inspection took place on 13 August 2015 and was unannounced.

The provider of Southcrest Nursing Home is registered to provide accommodation and nursing care for up to 43 people who have nursing needs. At the time of this inspection 31 people lived at the home.

The manager was appointed in October 2014 and has made an application to be registered with us. 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.

We carried out an unannounced comprehensive inspection of this service on 2 October 2014 at which a breach of a legal requirement was found that had an impact on people who lived at the home. The provider did not work within the guidelines of the Mental Capacity Act 2005 (MCA) as this had not been applied consistently when people were unable to make their own specific decisions about their care. After our comprehensive inspection the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. At this inspection we saw that improvements had been made.

People were asked for their permission before staff provided care and support so that people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests and staff provided care in the least restrictive way in order to effectively meet people’s needs.

People’s medicines were kept safely and made available to them. However, we saw the administration of people’s medicines was not consistently managed in a safe way so that avoidable risks to people receiving their medicines as prescribed were sufficiently reduced.

We saw conversations between staff and people who lived at the home were positive in that staff were kind, polite and helpful to people. All the people we spoke with told us they felt their privacy was respected and they felt safe as staff helped them to meet their needs, such as, to move safely around the home environment.

People were kept safe by staff who understood how to identify and report potential harm and abuse. There were procedures and processes in place to make sure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how the risks to people were reduced.

Staff were trained and supported to meet the needs of people who lived at the home. Staff were available when people needed assistance, care and support. This included making sure people were supported in doing fun and interesting things so that they were not at risk of social isolation.

People enjoyed the food they received and their nutritional needs were being assessed and met. When they needed it people were supported to see health and social care professionals to make sure they received appropriate care and treatment.

People received care which was right for them as staff knew what their individual preferences and needs were. People told us that staff helped them to have things to do that were interesting and they received support at times they needed it.

People knew how to raise complaints and where this had happened action had been taken to resolve the issues so that improvements were made. The manager had created an open and honest approach to where improvements were needed and shared this with people, their relatives and staff.

The manager felt supported by the provider and was developing the staff team who enjoyed working at the home. Staff felt able to share issues and ideas to make improvements for the benefit of people who lived at the home. Staff were clear about their roles and spoke about people who they supported with warmth and fondness.

The manager had set up and developed responsive systems to monitor and review people’s experiences to ensure improvements were made where necessary. The provider visited the home and provided their impressions of the home which included the standard of care people received. The manager used this information alongside their quality checks to plan and enable improvements to be sought. As a result the quality of the service people received continued to improve.

This inspection took place on 2 October 2014 and was unannounced.

Southcrest Nursing Home is registered to provide accommodation and nursing care for up to 40 people who have nursing needs. At the time of this inspection there were 33 people living at the home.

The provider is required to have a registered manager in post. The registered manager had left their post on 19 August 2014. The provider had taken action and an interim manager was recruited but they left their post on 14 September 2014. The provider had recruited a deputy manager to start at the home on 6 October 2014 and the provider is taking further action to recruit another 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.

Staff told us they had not received training to support them to understand the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). This law sets out to support the rights of people who do not have the capacity to make their own decisions or whose activities have been restricted in some way in order to keep them safe. We found there was an inconsistent approach in applying the MCA in order to support people’s rights when specific decisions needed to be made so that the right people were involved.

A DoLS application had been made to the local authority for an assessment to be carried out. This is done by professionals who are trained to assess whether the restriction is needed to meet the person’s needs effectively and keep them safe. This showed that this person’s rights were protected by the proper authorisations when this was required.

We found that the provider needed to make improvements to ensure people’s needs were always met and they were safe. We observed one member of staff used inappropriate moving and handling methods and staff practices did not reduce the risk of cross contamination when handling food.

Staffing levels were sufficient to meet people’s needs but the way in which staff practices were checked needed to be improved. Despite the provider having induction and training procedures in place there was a lack of consistency in identifying staff practices that needed to be improved.

People’s health care needs were assessed, planned and delivered to meet their needs. People had access to healthcare professionals such as doctors and dieticians who provided treatment, advice and guidance to support their health needs.

We received varied comments about the standard of meals people received. However, the provider had recruited an agency cook to assist in raising the standard of meals. People were supported to eat and drink enough to keep them healthy. Where people had special dietary requirements we saw that these were provided for.

Relatives and people who lived at the home told us that staff were caring towards them. We saw staff respected people’s privacy and dignity whilst they provided and supported people with their care. Staff chatted with people who lived at the home in a kind and caring manner.

We received mixed views from some relatives about how responsive staff were in meeting people’s individual needs. Although we saw staff responded to some people’s individual needs as planned for, there were some improvements needed so that people’s needs and preferences were consistently met. This included supporting people to have opportunities to take part in fun and interesting things to meet their social wellbeing.

People and their relatives were not fully involved in giving their views about the services they received. This was because they had not had opportunities to attend regular meetings to express their views about the home. Work had had begun in addressing the issues we had raised and a meeting had been arranged for people to attend.

There had been a lack of consistent effective leadership in the home and there had been significant changes in the staff team. The quality of some aspects of care was checked and improvements made. However, we could not evidence a consistent approach to the monitoring and management of the home on a day to day basis. This was an area where further improvements were needed to show good standards of care were always maintained and the services were well led on a daily basis.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 as the requirments of the MCA were not being met to promote people’s rights and best interests. You can see what action we told the provider to take at the back of the full version of the report.

On 29 November 2012 we carried out an inspection at Southcrest Nursing Home. This inspection was to assess whether compliance actions we set following our previous inspection during July 2012 had been met. At the time of our inspection 31 people were using the service.

We spent time with the manager who at the time of our inspection had not applied to become registered as manager with the Care Quality Commission (CQC).

We saw two visitors who told us that they were happy with the care and support that their relative had received. Throughout the inspection we observed examples of staff supporting people and offering reassurance while carrying out care tasks. Staff were aware of how they were able to maintain and promote people’s privacy and dignity.

We saw that care plans, risk assessments and other records were in place to give staff guidance and direction about the level of care required to meet individual needs.

We found that improvements had taken place to make sure that appropriate checks happened before new members of staff started to work at the home.

Staffing levels remained as highlighted within the previous inspection report. Although no overall dependency assessment was available the manager assured us that care needs had reduced. This was not however the belief of some members of staff.

Since our last inspection the manager had introduced effective systems to assess the quality of service provided for people.

While at Southcrest we observed people’s care and support to help us understand the experiences of people who used the service. We spent time observing the care provided in the communal lounge. During our observations we saw staff speak to people who used the service in a respectful way when they were sat in communal areas.

However we saw a number of staff entering the bedrooms of people who used the service without knocking or checking out that they were happy for staff to enter. This showed a lack of regard for people’s privacy and dignity.

We spoke with three relatives during our inspection who were happy with the level of care provided. Comments included “they look after her well” and “I have peace of mind.”

Care plans, risk assessments and other records were available for each person who used the service. However these did not always cover all areas of identified need and were not always up to date to give staff guidance and direction.

Information on safeguarding was available for members of staff. Staff training records

were available although it was evident that some staff had not received training. Staff on duty at the time of our inspection did however have sufficient knowledge of their

responsibilities upon safeguarding people who used the service.

Safeguards to ensure that new employees are qualified and suitable to work with vulnerable people were in place but not always sufficiently robust.

Staffing levels at the time of our inspection were insufficient to meet the dependency levels of people who used the service.

Systems to seek the views of people who used the service needed to be developed to ensure that they were fully involved with the quality of the service.

We spent time observing the care carried out at Southcrest nursing home. Due to their frailty many people living at the home were unable to comment in detail about the care they receive. One person did tell us that “the staff work extremely hard”. A relative had told us that they “had no regrets” placing someone at Southcrest and that they “would recommend” because they “walk out the door knowing they are well cared for”.

We looked at two people’s care records; these included their care plans, risk assessments and records completed by the care workers. Care plans made reference to people needing certain equipment to be in place such as pressure reliving cushions and mattresses.

We viewed medication records and found that these were completed as needed. A record was maintained on each of the Medication Administration Record (MAR) charts of the number of tables remaining. We checked the balances of a sample number of medicines and found that they balanced with the records held.

We saw evidence of regular audits being undertaken. This means that checks were done on certain aspects of service delivery such as medication, health and safety, hoists, bedrails and accidents.

When we carried out this inspection 25 people were using the service. We spoke with the manager, a registered nurse, the non-clinical lead and some of the care workers and a domestic. The non-clinical lead was a member of staff who held delegated responsibilities for area of practice not including ‘nursing tasks’. We also spoke with eight people who used the service and three people who visited relatives. Comments made by people who used the service included: “I like it here”. A visitor told us: “It’s really good”.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. Some improvement in how staff involved people was identified. Staff knew about the needs of the people they were caring for. We looked at care records and found that these contained guidance for staff on how to meet their needs.

People told us that they enjoyed the meals provided and that they were offered regular drinks. This meant that the risk of people becoming dehydrated was reduced.

We found that infection control procedures were in place to ensure that the home was clean.

We found that medicines were kept safe and given to people as prescribed.

The registered manager was aware of shortfalls in some staff training and supervision.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.