Southfield Care Home has a total of 54 beds and provides personal care to older people and people living with dementia. The home is situated in Great Horton on the outskirts of Bradford. A total of 36 people were living at Southfield Care Home at the time of inspection, including one person admitted for respite care.

Southfield Care 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.

Since the last inspection the registered manager had resigned and the deputy manager had been appointed to the post of manager and was in the process of being registered with the Commission (CQC). 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.

This inspection took place on 19 December 2018 and the 11 January 2019 and was unannounced. Our last inspection took place on 24 October 2017 and at that time the service was rated ‘Requires Improvement’ overall with no breaches or regulations. This rating was made because although the service was on a journey of improvement, it was too early for the provider to be able to demonstrate the improvements made could be sustained over time. At this inspection we found the provider had succeeded in ensuring the new policies and procedures were now fully embedded and they had a clear vision about the future direction of the service.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff had regular safeguarding training and were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the manager’s attention, they had taken appropriate action to make sure people were protected.

The manager and staff were observed to have positive relationships with people living in the home. People were relaxed in the company of staff and there were no restrictions placed on visiting times for friends and relatives.

Staff were respectful to people, attentive to their needs and treated people with kindness and respect. The atmosphere in the home was calm and relaxed. Staff knew individual people well and were knowledgeable about their needs, preferences and personalities.

People were supported to have 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.

Care plans were person centred and sufficiently detailed to ensure staff provided appropriate care and treatment. People’s care and support was kept under review and wherever possible people were involved in decisions about their care and treatment. Risks to people’s health and safety had been identified, assessed and managed safely. Relevant health and social care professionals provided advice and support when people’s needs changed.

There were enough staff to support people when they needed assistance and people received support in a timely and calm manner. There was a robust recruitment procedure to ensure new staff were suitable to care for vulnerable people and arrangements were in place to make sure staff were trained and supervised.

Medicines were managed safely and people had their medicines when they needed them. Adequate aids and adaptations had been provided to help maintain people’s safety, independence and comfort. People had arranged their bedrooms as they wished and had brought personal possessions with them to maintain a feeling of homeliness.

There were a range of leisure activities for people including events in the home and in the local community and it was apparent people e

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Our last inspection took place on 7 and 8 March 2017 and at that time we found the service was not meeting four of the regulations we looked at. These related to safe care and treatment, fit and proper person employed, staffing and good governance. The service was rated ‘Inadequate’ and was placed in special measures.

Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. This inspection was therefore carried out to see if any improvements had been made since the last inspection and whether or not the service should be taken out of ‘Special measures.’

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the five key questions. Therefore, this service is now out of Special Measures. However, while we concluded improvements had been made they needed to be fully embedded and sustained to make sure people consistently received safe, effective and responsive care and treatment. This is reflected in the overall rating for the service which is now ‘Requires Improvement.’

There was a registered manager in post. 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.

Policies and procedures ensured people were protected from the risk of abuse and avoidable harm. Staff told us they had regular safeguarding training, and they were confident they knew how to recognise and report potential abuse. Where concerns had been brought to the registered manager’s attention, they had worked in partnership with the relevant authorities to make sure issues were fully investigated and appropriate action taken to make sure people were protected.

Comprehensive risk assessments identified individual risks to people’s health and safety and there was information in each person’s care plan showing how they should be supported to manage these risks. Systems were in place to ensure people received their prescribed medicines safely.

There were enough staff on duty to meet people’s needs and staff had undertaken training relevant to their roles. Staff told us there were clear lines of communication and accountability within the home and they were kept informed of any changes in policies and procedures or anything that might affect people’s care and treatment.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS) and acting within the legal framework of the Mental Capacity Act 2005 (MCA).

People told us they enjoyed the food and we staff were proactive in supporting people to maintain their fluid and food intake, especially people identified as being at risk of malnutrition.

We saw the complaints policy had been made available to everyone who used the service. The policy detailed the arrangements for raising complaints, responding to complaints and the expected timescales within which a response would be received.

The care plans in place were person centred and identified specific risks to people health and general well-being, such as falls, mobility, nutrition and skin integrity.

We saw arrangements were in place that made sure people's health needs were met. For example, people had access to the full range of NHS services. This included GPs, hospital con

Our last inspection of this service took place on 2 June 2015. At that time we identified no breaches of legal requirements. However, we recommended that the registered provider and registered manager make improvements to some aspects of the service.

This inspection took place on 7 and 8 March 2017 and was unannounced.

Southfield Care Home provides accommodation and personal care for older people. Most people who live at the home live with dementia. The service is registered to accommodate up to 54 people. On the day of our inspection there were 42 people living at the home. The service is situated in Great Horton on the outskirts of Bradford.

The service had a registered manager who had worked at the home for many years. 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 the home was poorly maintained and not always cleaned effectively which put people’s health and safety at risk. In December 2016 the registered provider had been served a fire enforcement notice due to poor fire safety at the home. There was no action plan in place to address these concerns. Window restrictors did not comply with current health and safety guidance.

We saw some good practices in relation to how medicines were managed and administered in the home. However, we identified concerns in relation to the management of medicines prescribed to be given on an ‘as required’ basis.

We saw evidence that action was being taken to reduce risks in relation to people’s health and wellbeing. However, what was happening in practice was not reflected within risk assessments and care plans. This risked that staff would not take consistent and effective action to reduce risks.

People told us they felt safe living at the home and there were sufficient staff to ensure their needs were met. The registered provider did not use a formal method to continually assure levels of staff were sufficient to meet people’s needs.

Recruitment systems were not sufficiently robust to ensure only staff suitable to work with vulnerable people and in the caring profession were employed.

Safeguarding procedures were in place and staff had attended training and were able to explain their responsibilities with regard to keeping people safe

People told us the food was good quality and they received a healthy and varied diet. Where people were nutritionally at risk we saw they were closely monitored and staff ensured they consumed a fortified diet. We found information within care records was often duplicated or not up to date in relation to people’s nutritional needs. This put people at risk of receiving inconsistent and inappropriate care.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). Staff had completed Deprivation of Liberty Safeguards (DoLS) applications where they needed to deprive people of their liberty. However, we could not be assured that staff consistently worked in accordance with the principals of MCA. Where staff had made decisions on behalf of people who did not have capacity, they were not always able to evidence these decisions were in the person’s best interest.

Staff received regular training, however, the training provided was not effective. We saw examples where staff would have benefitted from additional training and were concerned that staff had to complete training on seven key topics in one day. We were unable to see evidence that new staff had received induction training or that staff had received effective supervisions.

Staff worked closely with a range of health and social care professionals to ensure people maintained good h

We completed an unannounced inspection on 2 June 2015. This meant the provider and registered manager did not have notice that we would be inspecting the service on this date.

During our last inspection on 30 October 2014 we identified six breaches of legal requirements and made a recommendation that the provider and registered manager ensure they were fully aware of their requirements to notify the Commission of certain incidents which occurred at the home.

We found improvements had been made to meet all legal requirements and recommendations made by the Commission. However, there was still further work to be done to ensure these improvements could be sustained and to demonstrate that the new processes were fully embedded.

Southfield Care Home provides accommodation and personal care for older people living with dementia. The service is registered to accommodate up to 54 people. On the day of this inspection 40 people lived at the home; 30 people were accommodated in the old side of the building and 10 people were accommodated in the newly built extension which opened in early October 2014. Accommodation is provided in single bedrooms, most with en-suite bathrooms. There is the ability for double rooms to be provided should there be a request for this. The service is situated in Great Horton on the outskirts of Bradford.

The service had a registered manager in post. 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.

Improvements had been made to the premises to help protect people from potential risks and the provider had an improvement plan in place which showed the refurbishment of the older part of the building would be completed by the end of 2015.

New systems had been introduced to manage safeguarding incidents and accidents. Staff had been trained and were confident in identifying and responding to safeguarding which helped ensure people were better protected from the risk of abuse.

Improvements had been made to the management of medicines so that people were protected against the risks associated with the administration, handling and recording of medicines.

Our observations and discussions with people concluded there were sufficient numbers of staff on duty to ensure people were safe and provided with personalised interaction. Recruitment procedures were in place to ensure only staff suitable to work in the caring profession were employed. These procedures were not always being consistently followed, however the registered manager provided assurance they would address this as an immediate priority.

Improvements had been made to ensure staff received appropriate training to enable them to deliver safe and effective care. However, at the time of our inspection not all staff had regular supervision meetings, although this was something the registered manager planned to address.

Risk assessments were in place where areas of potential risk to people's general health and welfare had been identified. People were supported to access a range of health and social care professionals to assist with care, treatment and support where appropriate.

Staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and their role in protecting the rights of people with limited mental capacity.

We observed a calm and relaxed atmosphere in the home with lots of laughter and fun between people and staff. People appeared comfortable, well dressed and clean. Staff had a good knowledge of the people they supported. This included an understanding of potential triggers and effective strategies to help reduce the risk of behaviour that challenged. Care staff spent time interacting with people and encouraging them to join in a range of meaningful activities.

Improvements had been made to the way complaints were managed, monitored and responded to. People’s feedback was obtained in a variety of ways such as surveys, meetings and questionnaires. This information was then used this to help adapt and improve the service. The feedback from people and relatives about the service, staff and standard of care provided was consistently positive. People told us the food was good and they confirmed there was always plenty of choice and variety of food on the menu.

Processes and systems to assess and monitor the quality of care provided had been introduced, such as audits of care plans and the environment. The feedback about the registered manager and senior care team was positive. We also saw evidence that they promoted and encouraged an open and honest culture.

The registered manager told us without a deputy manager and with only limited administrative hours they were having difficulty ensuring that all the policies, records and audits were up to date. The provider had plans in place to provide the registered manager with additional support as they recognised this was important to ensure improvements continued.

We recommend the provider ensures all window restrictors in the home conform to the most up to date health and safety guidance. We also recommend that a formal process be introduced to ensure all policies and procedures are consistently reviewed, updated to reflect current guidance on best practice.

The service was on a journey of improvement. However there was still further work to be done to ensure the improvements made since our last inspection could be sustained and to demonstrate that the new processes were fully embedded.

We inspected the service on 30 October 2014. This was an unannounced inspection.

Southfield Care Home provides accommodation and personal care for older people living with dementia. In the weeks prior to our visit a new ground floor extension with 12 additional bedrooms opened. The service can now accommodate up to 54 people. Accommodation is provided in single bedrooms, most with en-suite bathrooms. There is the ability for double rooms to be provided should there be a request for this. The service is situated in Great Horton on the outskirts of Bradford.

The home has a registered manager in post. 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 and associated Regulations about how the service is run.

We had previously inspected the service on 12 February 2013 and identified that the systems in place to assess and monitor the quality of care were ineffective. We asked the provider to make improvements and returned to the service on 7 June 2013. We found that improvements had been made to the auditing and quality assurance systems.

During this visit we found the provider had not ensured that these improvements were sustained. We found the service was not well led and the systems in place to assess and monitor the quality of care were inadequate. This meant issues and areas for improvement were not identified and acted upon. Incidents and accidents were not appropriately reported, managed and analysed. There were not effective systems in place to ensure people were regularly asked for their feedback about the quality of care provided and how the service should be run.

People we spoke with told us they felt safe living at the service. However, we found the provider had not taken appropriate action to ensure the care people received was safe. They had not appropriately protected people from the risks associated with unsafe or unsuitable premises. They had also not taken appropriate steps to ensure people were protected from the risk of abuse. The systems in place to manage people’s medicines did not ensure people received their medicines in a safe way.

The service was not always responsive. There was a complaints procedure in place. However, the records kept could not always demonstrate that appropriate action had been taken to resolve issues.

Care records were clearly written and regularly reviewed. They also incorporated advice and recommendations given by healthcare professionals. However, there was no formal and structured care review process to ensure the support delivered met people’s current needs.

There were adequate numbers of staff to care for people. Care staff had a good working knowledge about the people they cared for. They were caring and treated people with respect and showed an awareness of the importance of maintaining people’s privacy and dignity. However, staff did not receive sufficient training and support to ensure they provided safe and effective care.

We saw staff took time to engage people in social activities. However, the activities programme was not formalised and staff were not given dedicated time to engage people in activities.

Systems were in place to monitor and manage situations where people’s freedom may have been restricted in order to keep them safe. However, care staff would have benefitted from additional training on the Deprivation of Liberty Safeguards (DoLS) and the Mental Capacity Act 2005 (MCA) to ensure they were fully aware of their duties in protecting the rights of people with limited mental capacity.

We identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take to address these issues at the back of the full version of the report.

We also found evidence that the CQC was not being notified of some incidents which had occurred at the service, such as safeguarding incidents. We wrote to the provider and the registered manager and reminded them of their duty to ensure they notified the CQC of certain incidents. We explained that if we found evidence they had failed to notify the CQC of these incidents in the future this could result in enforcement action being taken against them.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people had complex needs which meant they were not able to tell us their experiences. We observed how people spent their time and how staff interacted with people.

We saw people were provided with choices about how they spent their day. We saw people were engaged in activities of their choice. For example a fish and chip lunch outside in the garden.

The staff we spoke with demonstrated a good knowledge of people's needs and were able to explain how individuals preferred their care and support to be delivered. We found the atmosphere within the home was warm and friendly and we saw staff approached individual people in a way which showed they knew the person well and knew how best to assist them.

We found people had care plans and risk assessments in place. The care plans and risk assessments were accessible to staff and/or the people who used the service. Two people who used the service told us they were “very happy” with the care and treatment they had received at Southfield Care Home.

At the inspection in February 2013 we had concerns the provider did not have an effective system to regularly assess and monitor the quality of service people received. At this inspection we found improvements had been made and there were now systems in place to monitor the quality of the service they provided.

Three people who used the service told us they liked the home. One told us they were “thankful when they had to give up their home and that there were places like this to go to”. Four relatives told us they were satisfied with the care and treatment their relatives received. One commented “cannot speak highly enough of the home” and another said “marvellous the staff could not do more for their relative”.

During our inspection some people were not able to tell us their full experience of living at the home. So we observed how staff talked with people and provided their care and support. We saw staff being warm and accepting of people.

One person told us they “would have to go a long way to find staff better than this”. Four relatives told us the staff was kind and respectful. One commented the staff were like an “extended family”.

Although we found people had experienced care, treatment and support that met their needs. We found the formal systems in place which monitored and assessed the quality of the service provided needed to be improved upon.

Everyone we spoke with told us that they are involved as appropriate in the planning and review of their care and welfare. Staff kept them fully informed on their care and staff were always available, encouraging and helpful in assisting people with daily living activities.