This inspection took place on the 07 April 2017and was unannounced.

Southdowns Nursing Home provides accommodation, personal and nursing care for up to forty eight people living with dementia and mental health problems. There were 47 people living at the home at the time of our inspection. Accommodation is arranged over two floors and each person had their own bedroom. Access to the each floor is gained by a lift, making all areas of the home accessible to people. Southdowns Nursing Home is a large detached house in a residential area of St Leonards on Sea, close to local amenities.

A registered manager was responsible for the day to day management of the home. 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 an inspection in July 2015, Southdowns Nursing Home was rated as inadequate with breaches of regulation. At that time we took appropriate enforcement action. The provider sent us an action plan stating the breaches of regulation would be addressed by 30 December 2015. At our inspection in February 2016, we found our concerns had been addressed, although improvements were required. This inspection was to see if the improvements had been made and sustained. We found that improvements had been made and sustained.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s mental capacity was assessed and reviewed regularly to ensure that decisions made were still valid and in their best interest.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans had been developed and they were still looking to improve them by introducing a computer based system, which would include risk assessments and graphs to monitor falls and weight loss. Nurses wrote the care plans and all staff recorded the care and support provided and any changes in people’s needs. The registered manager said care staff were being supported to do this and additional training had been arranged for those who required it. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there were always sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs. All new staff received an induction and told us that it was a good introduction to the service and felt supported by the care and management team. All staff received regular supervision from senior staff and felt that this gave them the opportunity to discuss any learning needs.

Pre-employment checks for staff were completed, which meant on

This inspection took place on the 02 and 08 February 2016 and was unannounced

At the last inspection on 07 and 09 July 2015 they were rated as inadequate. The Care Quality Commission (CQC) issued Warning Notices after the inspection in respect of the safety and welfare of people, meeting peoples nutritional needs, staffing and treating people with respect and dignity. We found the provider had met the Warning Notices.

We also asked the provider to make improvements to the monitoring and assessing of the quality of the care and support provided. The provider sent us an action plan stating they would be addressed by 30 December 2015. We found our concerns had been addressed, although additional improvements were required.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However we found that the DoLS applications were not all completed properly, for example they lacked the reason that the application had been made. We also found that the conditions of the standard authorisation granted for some people were not followed or reflected within the care plan. We have recommended that further expert advice is sought to underpin the training received.

We also found that whilst there was an organisational induction process in place, not all staff had been signed off as competent and there were no competency assessments for staff that deemed them competent to undertake care delivery. This is an area that requires improvement.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans were still being developed and they were still looking to improve. Nurses wrote the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The manager said care staff were being supported to do this and additional training had been arranged. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people were able to move into the home. The manager told us it had been difficult to recruit nurses with the right knowledge and understanding of supporting people with dementia, a deputy manager had been appointed and the provider continued to advertise for full time nurses. However, they had to rely on staff doing overtime and on agency staff at times.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met. There were systems in place for the management of medicines and we observed staff completing

We spoke to seven people during our inspection visit. Not all the people we met were able to tell us their experiences due to their complex needs. Therefore we also used a number of different methods such as observation of care and reviewing of records to help us understand the experiences of people who used the service.

People we were able to speak with who lived in the service told us they liked living at ‘Southdowns Nursing Home.’ We were told, "I am very lucky to live here, sometimes I grumble but the staff understand me so well,” and, "It is nice here.” We also spoke with relatives/visitors. One visitor told us, “Wonderful place, the staff are very committed.”

People’s views and experiences were taken into account in the way the service was provided and delivered in relation to their care. When individuals were unable to personally be involved in decisions about their care, families and next of kin were approached and consulted. We found that care and treatment was planned and delivered in a way that ensured people’s safety and welfare. There were effective recruitment and selection processes in place and staff records and other records relevant to the management of the service were accurate and fit for purpose.

We used a number of different methods to help us understand the experiences of people using the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. People who could, told us that the staff were kind, and that the food was good and tasty.

Relatives told us that they were kept informed of what was happening, that the staff were good and they had no concerns about the care delivered. They also told us that staff would always listen to any little grumble and take notice of what was said.

Not all of the people using the service were able to tell us about their experiences in the home. However for those who were they told us that the home was warm and comfortable, that there was sufficient good food provided in the home and the home was clean and tidy.

People spoke well of the staff and told us that they respected their privacy and dignity. However some raised concerns about how the staff were always busy and one visitor said she came in at meal times to ensure her relative ate properly.

We were told by some people that they had opportunities to join in activities in the home and were supported to keep in contact with families and friends.

We undertook an unannounced inspection of this service on the 07 July and 09 July 2015.

Southdowns Nursing Home provides accommodation, personal and nursing care for up to forty eight people living with dementia and mental health problems. There were 48 people living at the home at the time of our inspection. Accommodation is arranged over two floors and each person had their own bedroom. Access to the each floor is gained by a lift, making all areas of the home accessible to people.

Southdowns Nursing Home is a large detached house in a residential area of St Leonards on Sea, close to public transport, local amenities and some shops.

This service did not have a registered manager in post. The registered manager resigned at the end of March 2015. A registered manager is a person who is 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. During this inspection we met the manager who had been in post for three weeks and was in the process of submitting their application to become the registered manager.

We last inspected the home 16 May 2013 and no concerns were identified.

People and visitors spoke positively of the home and commented they felt safe. Our own observations and the records we looked at did not always reflect the positive comments some people had made.

People’s safety was being compromised in a number of areas.

Staffing levels were not sufficient and staff were under pressure to deliver care in a timely fashion. The delegation of staff placed people at risk from accidents and incidents due to lack of supervision in communal areas.

The delivery of care suited staff routine rather than individual choice. Care plans contained information on people’s likes, dislikes, what time they wanted to get up in the morning or go to bed. However these were not followed. We saw staff make decisions about where people spent their day without consulting the individual. For example, remaining in bed because staff didn’t have time to get them up. The lack of meaningful activities for people in their rooms impacted negatively on people’s well-being.

Whilst people were mostly complimentary about the food at Southdowns Nursing Home, the dining experience was not a social and enjoyable experience for people. People were not always supported to eat and drink in a safe and dignified manner. The meal delivery was not efficient and we were told by people that they didn’t often get a hot meal at lunchtime. We also observed food left in front of people without being offered the support they needed to eat. We also could not be assured that people had sufficient amount of fluids to drink.

Whilst quality assurance systems were in place, We found that shortfalls had not been acted on. Quality assurance systems had not identified the shortfalls we found in the care delivery.

Arrangements for the supervision and appraisal of staff were in place. Although staff supervision took place to discuss specific concerns, regular supervision and appraisals, intended to monitor the training, ongoing development and the competence of staff had lapsed slightly due to a change of management structure.

The deputy manager understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Relevant guidelines were available within the service for all staff to reference. Staff at all levels had an understanding of consent and caring for people without imposing any restrictions. However the staffing levels on the first day of the inspection had impacted on people not being got up as usual and being restricted to their room.

People we spoke with were very complimentary about the caring nature of the staff. People told us care staff were kind and compassionate. Staff interactions demonstrated they had built a rapport with people and people responded to staff with smiles. However we also saw that many people were supported with little verbal interaction and many people spent time isolated in their room.

People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health.

People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Southdowns Nursing Home all had registration with the nursing midwifery council (NMC) which was up to date.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

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