The inspection took place on 10 May 2018 and was unannounced.

Southernwood House 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. Southernwood House accommodates up to 28 people in one adapted building. It provides care for older people some of who may be living with dementia. It also provides care for younger people who need support and people who may have a physical disability. The service is also registered to provide personal care to the same groups of people living in their own houses and flats in the community. However, at the time of the inspection the provider was not proving this service to anyone.

There had been no registered manager at the home for over six months. 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 previous manager had deregistered on 1 November 2017. The deputy manager was running the home with support from the area manager.

This is the first inspection where the service has been rated Requires Improvement.

The provider’s recruitment processes ensured that staff were safe to work with vulnerable people and for most of the time there were enough staff to meet people’s needs. However, at busy times people had to wait for care. Staff received training and support which enabled them to provide safe care for people. However, at times systems in the home did not fully support safe care. For example, there were no protocols in place to support staff to administer medicines prescribed to be taken as required in a consistent manner. In addition, records of people’s nutritional intake did not record their food and fluid intake in a way which would support clinicians to assess people’s dietary needs.

The home had been pleasantly decorated and there were signs to support people to find their way around the home. However, more could be done to support people living with dementia to be independent and we recommend that the provider takes account of best practice in providing a dementia friendly environment. Furthermore, we found some of the furniture was old and worn and in need of replacement.

The provider had purchased a computer system to record the care that people needed. However, staff were still learning how to use the systems and we found that the care plans did not fully support people’s needs. In addition, the deputy manager and area manager had not utilised audits in the system. The deputy manager was aware of these concerns and further training on the system was planned.

Despite the lack of information in the care plans staff knew people’s needs well and people were happy with the level of care they received. Risks to people while receiving care were accurately recorded and care was planned to keep people safe. When people neared the end of their lives care was planned to help them have a dignified death and they and their relatives were offered comfort and support.

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. People were asked for consent before any care was provided and were offered choices around food, clothing and where people liked to spend time. Staff respected people’s privacy and dignity. People were supported to engage in a variety of activities to enhance their wellbeing.

The provider had systems in place to monitor the quality of care needed and action was taken to resolve concerns. The area manager had reviewed the care and environment and had a

Southernwood House is located in the market town of Spalding. The service is registered to provide residential care for to up to 24 people including older people, people living with dementia and people with physical disabilities. The service is also registered to provide personal care to people living in their own home although this aspect of the service is is not operated currently. The service provides day care support but this activity is not regulated by the Care Quality Commission (CQC).

We inspected the service on 8 September 2015. The inspection was unannounced. There were 20 people living at the service and two people attending for day care on the day of our inspection.

The service did not have a registered manager. Although the registered provider had appointed a new manager in October 2014, at the time of our inspection an application to register this person had not yet been submitted to CQC. A registered manager is a person who has registered with the 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.

CQC is required by law to monitor the operation of the Mental Capacity Act, 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves. At the time of the inspection one person who used the service had their freedom restricted in order to keep them safe and the provider had acted in accordance with the MCA and DoLS.

People were cared for safely and they were treated with dignity and respect. They were able to access a range of healthcare professionals when they required specialist support and their medicines were managed safely. Food and drink were provided to a very high standard.

People and their relatives were closely involved in planning the care and support provided by the service. Staff listened to people and understood and respected their needs. Staff reflected people’s wishes and preferences in the way they delivered care. Staff understood how to identify, report and manage any concerns related to people’s safety and welfare.

People were supported to enjoy a range of activities and pursue their personal interests. The manager told us that further work was in hand to improve the therapeutic activities offered to people living with dementia.

People and their relatives could voice their views and opinions to the manager and staff. The registered provider, the manager and staff listened to what people had to say and took action to resolve any issues as soon as they were raised with them. The manager reviewed untoward incidents and concerns carefully to look for opportunities to improve policies and practices for the future.

Staff were appropriately recruited to ensure they were suitable to work with vulnerable people. They had received training and support to deliver a good quality of care to people and an active training programme was in place to address identified training needs.

Staff delivered the care that had been planned to meet people’s needs and had a high degree of knowledge about their individual choices, decisions and preferences. Staff cared for people in a kind, warm and friendly way.

There were systems in place for handling and resolving complaints. People and their relatives knew how to raise a concern. The service was run in an open and inclusive way that encouraged staff to speak out if they had any concerns. The manager and the registered provider regularly assessed and monitored the quality of the service provided for people.

Below is a summary of what we found when we inspected Southernwood House on 30 April 2014. During our inspection we spoke with five people who used the service, two relatives who were visiting, the deputy manager and four members of staff. We looked at three people’s care records and other documentation.

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

During our inspection we focused on our five questions:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Is the service safe?

Systems were in place to make sure the manager and staff learnt from events such as complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

People were treated with respect and dignity by the staff. People we spoke with told us they felt safe. Safeguarding procedures were in place. Staff we spoke with and records we looked at confirmed that staff were trained and understood how to safeguard the people they supported.

The home had proper policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards. The Mental Capacity Act (2005) and Deprivation of Liberty Safeguards is law which protects people who are unable to make decisions for themselves.

Recruitment practice was safe and thorough. All the required checks had been carried out before staff commenced their employment.

The registered manager set the staff rotas. We found that they took people’s care needs into account when they made decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people’s needs were met.

Is the service effective?

People’s health and care needs were assessed. People and where appropriate, their relatives, were involved in reviewing their care plans. Specialist dietary requirements, mobility and equipment needs had been identified in care plans where required.

We looked at people’s records and saw that care plans set out people’s individual care needs. Care plans had been reviewed on a regular basis and adjustments made when a person’s care needs changed.

During our inspection we observed members of staff knew people's individual health and wellbeing needs. We saw that people responded well to the support they received from staff members.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person told us: “I have just moved in. It’s been fine so far. It’s nice to have some company.”

People who used the service, their relatives and friends completed a satisfaction survey every three months. Where concerns or comments were raised these had been addressed.

People’s preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Records showed people had access to a range of healthcare professionals some of whom visited people at the home. This included GPs, district nurses, palliative care nurses and a chiropodist.

Is the service responsive?

The provider had a complaints policy in place and information was displayed in the home. There was written information in people’s bedrooms, should people or their relative wish to raise a concern.

Staff had received training in how to manage complaints during their induction. They were able to tell us how they would escalate any concerns raised.

People completed a range of activities in and outside the home on a regular basis. The home had its own minibus, which helped to keep people involved with their local community. There were good links with the local secondary school and pupils were involved in volunteering.

Is the service well led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly. As a result the quality of the service was improving.

Staff we spoke with were positive about the management skills of the registered manger. One member of staff told us they felt supported: " They really care about the people that live here and makes sure we have what we need to look after people."

When we visited the home we spoke with five people about their experiences. Everyone told us they were being well cared for and were treated with dignity and respect. One person told us, "I came here for two weeks respite and didn't want to go home." They also said, "We get lots of choice, that's the enjoyment of it. If you want to stay up and watch the football you can."

Another person told us, "It is my home, the staff look after me well. We get on well." Someone else said, "The food is really good, you get a good choice and it's nice and fresh and home cooked."

One person told us they had been unwell at Christmas, they told us, "They really looked after me and helped me to get better."

We saw people received dignified and sensitive care by a well trained team of staff. People were offered a range of activities to participate in. A trip to a local church was planned which people told us they were looking forward to.

We didn't manage to speak with any visitors or relatives during our visit, however we saw some compliments were left in the comments book. One person said, "I'm so glad Nana has a great place to live with lovely staff." Another person had said, "X had a wonderful stay with you all and came home full of life and fun."

When we visited Southernwood House we found that people’s individual needs were being met within a homely, relaxed environment.

We spoke with four people who live in the home to gain their views. One person told us, “I’m getting on alright, the carers are nice and I’m happy.” Another person said, “It’s quite nice, it’s lovely. The staff treat me well, you never get offended by any of them. I feel safe here, I have a lovely room upstairs where I can look out of the window. I have no complaints, I’m being very well looked after.”

Another person told us, “Generally, I’m being well looked after, they do their best and the care staff are nice. I have no complaints or concerns.”

We spoke with a relative who was visiting the home. They told us, “Mum is being very well looked after. The communication is good. It’s nice that people can get a choice. They go out for ice creams and to the flower festival. There’s lots of variety of things to do. It’s peace of mind for someone who needs more care than you can give. She’s safe when I leave here.”

People we spoke with said they were satisfied with the service they received.

One person said “the staff are good, they know how to look after you.” And “I enjoy the food, there is a good choice, we had a Spanish day where we ate paella.”

Another person said “the carers are excellent, my needs are met.”

A relative said “it’s wonderful.”

On our follow up visit people told us that their hearing aids had now been serviced and were working. One person wanted a better fitting hearing aid so that it was more comfortable to use.

Two people told us that they really liked the views in their rooms facing onto the garden and one person whose room faced the courtyard liked watching the movements of people passing outside from her room.

People told us that the quality of the food was good although they were bored with the lack of choice they were given. They said they were offered the same options every week.

Many people told us that they liked going out into the garden whenever staff had time to take them, but on the day we visited it was very hot and they all said that it would be too exposed in the garden.

We were told by several people that staff in general were good workers who tried to meet their care needs as best as they could.

Some people who use the services described not receiving care and support in a planned and timely way. One person spoke of not receiving the encouragement to keep moving to help with her skin integrity. Other people spoke of difficulty in hearing, as their hearing aids are not kept in good working order. One person told us that someone had visited about a month ago and “done something to it and it was lovely for a while but it has gone again”.

Other people spoke positively about the care and support they receive. One person told us she was very happy at the home and said, “I can’t fault it, I picked the right one”.

We received only positive comments about the food, and people were seen enjoying their lunch.

People who use the service told us that they feel perfectly safe in the home, but one person said they had seen staff “lose it a bit” by shouting at another person who uses the service, but they also referred to the person aggravating staff.

People who use the service spoke positively about staff competence, one person told us, “I can not fault the staff”.

Residents meetings are held where people who use the service can make suggestions and comments on the running of the home. One person said, “I have been to a residents’ meeting, a couple of them I think. There’s not been one for some time, maybe I missed it”.