This inspection took place on 9 and 11 January 2019 and was unannounced.

At our previous inspection on 13 December 2017 we found the provider was in breach of the regulation in relation to good governance. The provider did not always act on concerns in a timely manner and some people told us there was not an open and transparent culture. We also found the service required improvement in several areas including medicines management, staffing, following best practice guidance in providing a suitable environment for people living with dementia, and person-centred care planning. At this inspection, we found the provider had made improvements in all of these areas but was still in breach of the regulation in relation to good governance because the provider’s systems for identifying shortfalls in the quality and safety of the service were not robust enough.

Southdown 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 25 people in one adapted building. It provides personal care and nursing to older people, some of whom may be living with dementia. At the time of our inspection there were 21 people using the service. Because the service is operated by a sole provider who takes responsibility as the registered person for issues relating to the management of the home, Southdown Nursing Home is not currently required to have a registered manager.

Although the provider had made improvements to the safety of the service since our last inspection, we found at this inspection that the service was not always safe because there were no formal systems to ensure good hygiene and control the spread of infection, other than in the kitchen. The provider had not addressed a safety issue involving a broken floor tile and chemicals were not always stored securely. The provider did not obtain all of the information they are required to use when checking the staff they recruited were suitable to work at the home.

We found the provider was in breach of the regulation in relation to safe care and treatment. You can see what action we told the provider to take at the back of the full version of the report. We are considering what action to take in regards to the continued breach of the regulation in relation to good governance and will report on this when it is complete.

The provider assessed risks to people on an individual basis. People had detailed risk management plans so staff knew how to keep them safe. These were designed to allow people as much freedom and choice as possible while ensuring they were safe from avoidable harm.

The provider had systems to ensure there were enough staff to care for people safely. People and their relatives felt the service was safe and there were robust procedures to safeguard people from abuse. Medicines were managed safely.

The provider could not always produce evidence that they complied with legal requirements about obtaining consent from people before providing care to them. Where people lacked capacity to consent, the provider could not always demonstrate that they had followed appropriate procedures to determine decisions were made in people’s best interests.

People received care and support in line with national guidance. Staff received the training and support they needed to do their jobs effectively. People had access to healthcare services when they needed them and people’s nutritional needs were met. The environment was adapted to meet people’s needs, although some areas were in need of refurbishment.

People received care and support from staff who were friendly, respectful and caring. Staff made an effort to build good relationships with people and help them feel at home. Staff considered people’s individual needs when providing information to them, so people un

Southdown 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.

Southdown Nursing Home accommodates up to 29 older people in one adapted building. At the time of inspection 20 people were using the service, many of whom were living with dementia and some had a learning disability.

Southdown Nursing Home is not required to have a CQC 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.

At our last comprehensive inspection on 28 and 29 November 2017 we identified a breach of regulation relating to good governance. At a focused inspection on 10 March 2017 we found the provider remained in breach of the regulation relating to good governance. In addition, we found they were in breach of regulation relating to safe care and treatment. At a focused inspection on 23 May 2017 we found the provider had taken sufficient action to address both breaches of regulation.

We undertook an unannounced comprehensive inspection of this service on 13 December 2017. We found that whilst the provider had embedded their governance framework this did not ensure that actions identified as requiring improvement at our previous comprehensive inspection were implemented. This included in regards to the medicines management, complaints escalation process and recording actions taken following incidents. There were also insufficient systems in place to ensure good practice guidance was sought and embedded. We recommend the provider implements good practice guidance regarding safe management of medicines and providing a dementia-friendly environment.

An open and transparent culture had not been established and some staff, people and relatives felt the management team were not open to receive feedback.

Care records on the whole provided accurate information about people’s needs. However, we identified for some people care records were not in place in regards to individual’s specific care needs and did not always contain information regarding people’s preferences. Information was not always made available to people in an easily accessible manner, particularly for people living with dementia and/or those who had a learning disability.

A formal tool was not used to review people’s dependency levels in order to establish staffing levels. Our observations showed people received prompt support, however, feedback from staff was that at times this was more difficult particularly at night and at weekends. The provider had not implemented the Care Certificate to ensure staff new to care understood their roles and duties. Nevertheless, a training programme was in place and staff received regular supervision and appraisal.

Staff worked with other health and social care professionals in order to meet people’s needs. This included in regards to people’s healthcare needs, their dietary requirements and in regards to care decisions for people who lacked capacity. Staff adhered to the Mental Capacity Act 2005. 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 were aware of people’s needs, including the level of support they required to manage and mitigate any risks to their safety. An activities programme had been embedded at the service and people were observed as being engaged and enjoying the activities on offer.

The management team had built working relationships with the local authority and the clinical co

We carried out an unannounced comprehensive inspection of this service on 28 and 29 November 2016. At which a breach of legal requirement was found in regards to good governance. After the comprehensive inspection, we undertook a focused inspection on 10 March 2017 to follow up on the breach of regulation. At the focused inspection we found the provider was in breach of legal requirements relating to safe care and treatment and good governance. We issued a warning notice in regards to the continued breach of good governance and gave the provider until 16 April 2017 to make the required changes. In addition, the provider wrote to us and said they would take the necessary action to address the breach of regulation relating to safe care and treatment by 7 April 2017.

We undertook this focused inspection on 23 May 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk

Southdown Nursing Home provides accommodation, personal and nursing care to up to 28 older adults. At the time of our inspection 20 people were using the service, some of whom were living with dementia.

At this inspection we found improvements had been made to address the concerns identified at our inspection on 10 March 2017. Pressure ulcer care had improved with risk assessments being regularly reviewed and preventative measures being carried out. People with wounds received appropriate treatment and staff regularly reviewed wounds to ensure they were healing.

New processes had been introduced to review the quality of service delivery and ensure accurate and complete recording of the care delivered. We saw additional audits had been introduced to review key aspects of care, including care records. Accurate daily support records were maintained, including repositioning charts and food and fluid charts.

The provider had worked with health and social care professionals from the local authority and clinical commissioning group (CCG) to improve the quality of the service. The provider had met the breaches identified at our previous inspection.

We carried out an unannounced comprehensive inspection of this service on 28 and 29 November 2016 at which a breach of legal requirement was found in relation to good governance. We found the provider did not have sufficient processes in place to review the quality of all care records and ensure learning from key service data. Following our inspection, the provider told us they would make the necessary improvements by 31 January 2017.

We undertook a focused inspection on the 10 March 2017 to check they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

Southdown Nursing Home provides accommodation, nursing and personal care to up to 28 older people, some of whom have dementia. At the time of our inspection 24 people were using the service.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. 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.

At this inspection we found the provider had not taken sufficient action to address the breach of regulation identified at our comprehensive inspection on 28 and 29 November 2016 and there remained ineffective processes in place to review and monitor the quality of care records. In addition to the continued breach of legal requirement relating to good governance, we identified people were not protected from the risk of unsafe care and treatment because sufficient processes were not in place to help prevent and manage pressure ulcers.

We found the provider was now in breach of two legal requirements relating to good governance and safe care and treatment. You can see what action we have asked the provider to take in regards to the breach of safe care and treatment at the back of this report. We are considering what action to take in regards to the continued breach of good governance and will report on this when it is complete.

After our comprehensive inspection in November 2016 the service was rated ‘good’ overall and for four of the key questions, with only the key question ‘is the service well-led?’ rated ‘requires improvement’. However, due to the concerns identified at this inspection the service is now rated ‘requires improvement’ overall and for the two questions ‘is the service safe?’ and ‘is the service well-led?’.

We undertook an unannounced inspection on 28 and 29 November 2016. At our previous comprehensive inspection on 24 and 25 November 2015 the service was rated ‘requires improvement’ and was in breach of six regulations of the Health and Social Care Act. These related to person-centred care, dignity and respect, safe care and treatment, good governance, displaying their rating and submission of statutory notifications. We undertook focussed inspections on 5 May 2016 and 30 August 2016 to check on the breaches and by our August 2016 inspection the service had taken the necessary action to meet the regulations.

Southdown Nursing Home is registered to accommodate up to 29 older people who require personal and nursing care. At the time of our inspection 19 people were using the service.

The service is owned by an individual provider who also fulfils the manager’s role. It does not therefore require 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.

Accurate and complete care records were not maintained in regards to food and fluid intake for those at risk of malnutrition, dehydration or recurrent urinary tract infections, and accurate records were not maintained for those who required regular repositioning to reduce the risk of pressure ulcers. The current care record audits did not include a review the quality of daily monitoring forms and therefore there were not robust systems in place to review the quality of all care records.

The management team had plans to analyse key performance data to identify any learning to prevent incidents and complaints from recurring but this was not embedded at the time of our inspection.

Governance processes were not strong enough to ensure all areas of service delivery were reviewed and to ensure accurate and complete recording. The provider was in breach of the legal requirements relating to good governance. You can see what action we have asked the provider to take at the back of this report.

Staff were knowledgeable about the people they cared for. They were aware of the level of support they required and how this was to be provided. Nursing staff had developed clear and detailed support plans for each person and these were regularly reviewed to ensure they reflected people’s current needs.

Staff assessed the risks to people’s safety and developed plans to manage and mitigate those risks. Staff had communicated with people the risks to their safety and what processes were in place to support them to remain safe, this included reminding people of what equipment was used to promote their independence whilst keeping them safe. Staff were aware of their responsibilities to safeguard people from harm and worked with the local authority safeguarding team if there were any safeguarding concerns.

Staff provided people with prompt support when needed and regularly asked if they needed any assistance. They cared for people in a polite and friendly manner. Staff adjusted their style of working to meet people’s individual needs including their method of communication. Staff respected people’s privacy and dignity.

Staff adhered to the principles of the Mental Capacity Act 2005. The management team organised for ‘best interests’ meetings to be held if they felt people were unable to consent to decisions about their care. The management team liaised with the local authority to ensure people were only deprived of their liberty when required to maintain their safety.

Staff provided people with the level of support they required at mealtimes to ensure they received adequate nutrition and remained hydrated. Staff liaised with other healthcare professionals to meet people’s health needs and ther

We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2015 at which breaches of six legal requirements were found. We undertook a focussed inspection on the 5 May 2016 to check whether sufficient action was taken to address these concerns. We identified that the provider still remained in breach of three legal requirements. These related to providing safe care and treatment specifically in relation to medicines management, good governance and submission of notifications. Warning notices were issued in regards to the breaches of safe care and treatment and submission of notifications. The provider had until 13 June 2016 to make the necessary improvements to meet the warning notices, and they worked to the same deadline to make the improvements relating to good governance.

We undertook a focused inspection on the 30 August 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our previous comprehensive and focussed inspections, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

Southdown Nursing Home provides accommodation, nursing and personal care to up to 28 older people, some of whom have dementia. At the time of our inspection 20 people were using the service.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. 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.

The provider had made the necessary improvements and was now meeting the regulations inspected. Medicines management processes had been strengthened to ensure they were safe and people received their medicines as prescribed. Accurate stock checks were maintained and medicines administration records were completed accurately. Protocols had been developed for ‘when required’ medicines.

Processes to review the quality of service provision had improved, particularly in regards to medicines management. Arrangements were in place with the local pharmacy for full medicines audits to be carried out. The provider was also in the process of embedding and improving the quality of care record audits.

The provider was now adhering to the requirements of their registration with the Care Quality Commission and submitting statutory notifications as required.

We carried out an unannounced comprehensive inspection of this service on 24 and 25 November 2015 at which breaches of legal requirements were found. We found that safe medicines management processes were not followed, people’s social and recreational needs were not met, people were not consistently treated with dignity and respect and their independence was not encouraged. We also found that governance processes were not robust and the registered manager did not adhere to requirements of their registrations including submitting statutory notifications and displaying their rating. After the comprehensive inspection, the provider wrote to us to say what they would do to meet the legal requirements. They said they would make the necessary improvements by 19 February 2016.

We undertook a focused inspection on the 5 May 2016 to check that they now met legal requirements. This report only covers our findings in relation to this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Southdown Nursing Home’ on our website at www.cqc.org.uk.

The service did not require a registered manager, as the provider was an individual provider who also managed the service. 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.

We saw that whilst some improvements had been made the service was still in breach of some regulations. Safe medicines management processes were not consistently followed. We found medicine administration records were not complete and there were some stock discrepancies indicating medicines had been administered, but this had not been recorded. There were no written protocols for people who were prescribed ‘when required’ medicines and there was a risk that people would not receive their pain relief when they needed it.

Systems to monitor the quality of service delivery had been improved and the service had liaised with other healthcare professionals to develop these systems. However, at the time of our inspection sufficient action had not been taken to fully implement these systems and these were not effective enough to identify and address the concerns we identified, particularly for medicines management practices.

The provider had not adhered to all the requirements of their registration with the CQC. They had received authorisation from the local authority to deprive some people of their liberty, but they had not submitted the associated statutory notifications. They had met the requirement to display their rating and we saw that a copy of their previous CQC inspection report was available in the communal hallway.

Improvements had been made in regards to providing person centred care. Staff had consulted with people about what activities they would like to participate in and the service had developed an activities programme, which was in the process of being embedded at the service. We observed that arrangements had been made to have local performers come to the service to entertain people. People’s social and recreational needs were now being met.

We observed that staff spoke to people politely and respected their privacy. Staff supported people to maintain their dignity and we observed that people were well-presented. At lunchtime we observed that staff encouraged and enabled people to eat independently.

The provider remained in breach of the legal requirements relating to safe care and treatment, good governance and notifications. We are taking further action against the provider in relation to notifications and will report on this when our action is completed. You can see what action we have asked the provider to take to address the breach of regulation in rel

We carried out an unannounced comprehensive inspection of this service on 1 and 9 April 2015. Several breaches of legal requirements were found and the Care Quality Commission issued a warning notice for a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they have met the requirements of the warning notice. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southdown Nursing Home on our website at www.cqc.org.uk.

Southdown Nursing Home provides accommodation and nursing care for up to 23 older people. There were 16 people living at the home when we visited. The service is owned by an individual provider who also fulfils the manager’s role. It does not therefore require a registered manager. 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.

People were protected from the risks of inappropriate or unsafe care because the provider had taken steps to protect people. We found that individual risk assessments for people had been reviewed and up dated since the last inspection. Risk management plans had been integrated with care plan objectives. Effective reviewing mechanisms had been implemented so care plans met people’s needs. Care plans and risk assessments were person centred and people were involved in their care.

Staff explained to us that they were clear about how they would help and support people safely and effectively.

People we spoke with thought there were enough staff on duty to meet their needs. A new activities co-ordinator post had been implemented and people were pleased with the new energy this had provided in the home.

Plans were now in place to monitor accidents and falls and evaluate why they had occurred and put in place measures to mitigate further risk.

All building work was completed in April 2015 and on inspection we found the premises to be clean, tidy and free from dust. There was no clutter in any part of the home and all the facilities were of a high standard and available for use.

All the staff team had received fire awareness training and knew what to do in the event of a fire. A pattern of regular fire drills had been established. A fire risk assessment had been carried out for the building.

The provider had implemented a new six monthly audit of the building to ensure the necessary standards are maintained. An action plan will be in place to ensure the outcomes are monitored and evidence compiled which is signed off when completed.

The provider had made the necessary improvements to protect people.

On the day of our inspection there were seventeen people living at Southdown nursing home. Due to people’s complex needs some people were unable to share their views in a meaningful way. However, we spoke to two people who use the service and they told us, “the staff here are really nice”, “they look after me well”, “I don’t have any complaints” and “I would speak to the owner if I need to complain”. We also spoke to a visitor who told us “the staff are good here, the home is cosy and clean”.

We used SOFI as a method to help us understand the experiences of people using the service. We observed that people's experience of the service was overall positive.

We found improvements had been made since the last inspection in the way the home managed care plans. People's care plans were comprehensive and staff had very good knowledge of individual needs and the ways that people like being supported.

It was evident from the practices we saw during our visit that the people using the service were well supported by the staff that worked there and treated with respect.

At our last inspection of the service we had judged that people’s physical healthcare needs were being met. However, there was limited mental stimulation being provided for them. At this visit we saw that an extra member of staff was now providing structured activities every day and people were very engaged with her. We had also found that there was limited evidence available to show that people had been able to make choices with regard to the food they ate. This had now been addressed and people were being provided with alternative options.

At this visit we saw that there was not always an assessment of peoples care needs and information about how they should be supported, in place. Changes in peoples assessed needs were not always being identified and addressed. This meant that staff did not always have access to up to date information and there was a possibility of people receiving unsafe or inappropriate care.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of care service.

We used the Short Observational Framework for Inspections (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. Through the use of SOFI we were able to observe that people’s experience of the service was a positive one. We saw staff support being provided in a way that protected the dignity of people and that the service was meeting the nutritional needs of people using the service.

Comments that people made included "she (the manager) works very hard, they all do”, and “they (the staff) are all very good, very kind to us”.

However, when we asked people about how they made choices, with regard to the meals that they were given, all of them told us that they were never given a choice, telling us “the food’s alright but there’s never a choice” and “ we don’t know what’s coming until its in front of you”.

The residents we spoke with in the home were generally very happy with the care and support that they were receiving. Although, for most of them, the home is chosen on their behalf by a relative or care manager, they told us that they were comfortable and that staff were very kind and caring. Feedback included comments such as “they are a really good crowd here” “they are so lovely” and “they are always so helpful”.

We asked whether they had been consulted by staff when their care plans were being compiled and they couldn’t remember that happening. We were assured that this took place so we have suggested that residents if they are able, or their relatives, sign the care plans to indicate that they have been involved and that they agree with the way that staff decide that care and support should be provided.

We did raise some concerns relating to choice for residents when we visited the service. The first was in relation to the way that people spend their days. They told us that the television is always on, although they are not consulted about what they would like to watch and several people just sleep in front of it. When we visited, a cookery programme was on and the one person who was awake told us “I don’t want to watch this, I don’t need learn how to cook”

There were some organised activities arranged for those who wished to join in but several residents told us that they would like more to do. We have asked the Registered Provider to consult with them about this and to explore ways in which more activities might be introduced.

We also noted that there was a lack of choice in relation to the meals served in the home. Although residents said that they usually enjoyed the food they had not been consulted about what was going to be served on that day and offered an alternative if it did not suit them. One resident told us “I just wait and see what turns up”.

We have suggested that the Registered Provider should look at ways to introduce more choice into the menu.

All of the residents that we spoke with said that the home was comfortable and always clean. They told us that they liked their rooms and had been able to bring in possessions from home in order to personalise them. We saw many of them had photographs and pictures and small items of furniture.

Residents are able to access a full range of healthcare services in the home; they told us that doctor visits regularly as does the chiropodist and optician. They all knew who was in charge of the home and they told us that if they had any concerns at all they were sure that they would be sorted out very quickly.

This inspection took place on 24 and 25 November 2015 and was unannounced. At our last comprehensive inspection on 1 and 9 April 2015 we found breaches of six legal requirements relating to safe care and treatment, person-centred care, the need for consent, safeguarding people, meeting nutritional and hydration needs, employing fit and proper persons and submission of statutory notifications. We issued a warning notice for the breach relating to safe care and treatment. We undertook a focussed inspection on 15 July 2015 to follow up on the warning notice and found that the necessary action had been taken to address our concerns. During this inspection we looked at the other five breaches to check whether the provider had taken the necessary action to meet legal requirements.

Southdown Nursing Home provides accommodation, nursing care and support to up to 29 older people. At the time of our inspection 20 people were using the service, some of whom were living with dementia.

The service is owned by an individual provider who also fulfils the manager’s role. It does not therefore require 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.

We found that the previous concerns and breaches identified at our comprehensive inspection on 1 and 9 April 2015 had been addressed. However, we found additional breaches relating to safe care and treatment in regards to medicines management, maintaining people’s privacy and dignity, good governance and in relation to the service’s CQC registration requirements. You can see what action we have asked the provider to take at the back of the main body of the report.

Staff were knowledgeable about the risks to people’s safety. Risks assessments had been undertaken and management plans were in place. Staff were knowledgeable about recognising signs of potential abuse and how to report these concerns. However, medicines management processes were not robust enough to ensure adequate stocks of medicines were kept at the service to enable people to receive their medicines as prescribed.

People’s privacy and dignity was not always maintained. People were not always supported to wear clean clothes. People’s independence was not always encouraged and supported.

People’s care records had been updated. Support plans provided information about people’s needs and information was included about people’s hobbies, interests and preferences, however, we were unsure about how this information was used to provide an individually tailored service. There was a lack of activities at the service, and a reliance on relatives to enable people to access the local community.

The manager undertook checks on the quality of the service, however these were not robust enough and sufficient systems were not in place to check the quality of all areas of service delivery.

The provider was not adhering to the requirements of their registration. They had not submitted statutory notifications in regards to DoLS assessments and had not displayed ratings previously awarded, both within the home or on their website.

Staff recruitment processes had improved to ensure staff were suitable to work. Staff had relevant experience and the manager undertook checks of their suitability. There was a rolling training programme in place. However, some of the newer staff had missed some of this training. The manager informed us staff had received the required training at their previous jobs but we saw no evidence to support this. Induction processes were not robust and we made a recommendation to the provider about following national guidelines in relation to the induction of new staff.

Assessments had been undertaken to establish people’s capacity to make decisions about their care and the support they received. People were supported in line with the Mental Capacity Act 2005 and best interests meetings had been held for people who did not have the capacity to consent to their care. The manager had arranged for people to be assessed to establish whether they required a Deprivation of Liberty Safeguard (DoLS). DoLS ensures that people are only deprived of their liberty to receive care and treatment when this is in their best interests.

People’s nutritional needs had been assessed and those at risk of malnutrition received the support they required. Staff were aware of who had specific dietary requirements and how they were to be supported. Staff supported people to access health services and weekly GP rounds were held.

The service was taking part in the ‘Vanguard’ initiative to aid smoother transitions and continuity of care when people moved between health and social care services.

There were processes in place to ensure complaints and concerns raised were dealt with. The manager reviewed all complaints and incidents to ensure appropriate action was taken to support people.

Staff felt supported by their manager, and their views and opinions were listened to. There were regular staff meetings and staff received individual supervision and appraisals.