About the service:

Southfield House is a residential care home that was providing 24-hour personal care and accommodation to 22 older people, aged 65 and above at the time of the inspection.

People’s experience of using this service:

The service had an open and supportive culture. Systems were in place to monitor the quality and safety of care delivered. There was evidence of improvement and learning from any actions identified.

There were sufficient numbers of trained staff to support people safely. Recruitment processes were robust and helped to ensure staff were appropriate to work with vulnerable people.

People’s needs were thoroughly assessed before starting with the service. People and their relatives, where appropriate, had been involved in the care planning process.

Staff were competent and had the skills and knowledge to enable them to support people safely and effectively. Staff received the training and support they needed to carry out their roles effectively. Staff received regular supervisions and annual appraisals were planned.

Staff had awareness of safeguarding and knew how to raise concerns. Steps were taken to minimise risk where possible.

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 supported people to access other healthcare professionals when required. Staff supported people to manage their medicines safely.

People’s outcomes were consistently good, and people’s feedback confirmed this.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.

We observed positive interactions between staff and people. Staff had good relationships with people and were seen to be caring and respectful towards people and their wishes.

People were supported to express their views. People we spoke with told us they had choices and were involved in making day to day decisions.

The provider and registered manager followed governance systems which provided effective oversight and monitoring of the service.

The premises were homely and well maintained. We observed a relaxed atmosphere throughout the home.

The service met the characteristics of Good in all areas.

Rating at last inspection:

At the last inspection of the service (published 25 May 2018) the home was rated Requires Improvement overall and there were two breaches of regulations in relation to safe care and treatment and good governance. At this inspection the overall rating has improved to Good.

Why we inspected:

This was a planned inspection based on the previous rating.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as

per our re-inspection programme. If any concerning information is received, we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on 28 and 29 March and 03 April 2018 and was unannounced on the first day.

We last inspected the service 13 and 15 July 2016 when we rated the service as Requires Improvement and there was a breach of regulation 18 in relation to staff training. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe and Well-Led to at least good.

At this inspection we found the provider had taken remedial action to meet staff training requirements, however we found two new breaches of regulations in respect of safeguarding people from abuse and improper treatment and good governance. You can see what action we told the provider to take at the back of the full version of this report.

Southfield 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.

The service consisted of a main building and an adjoining extension called Norwood. People who were more independent and required less support lived in Norwood. Staff referred to this part of the building as the 'assisted community.' At the time of our inspection there were 21 people living at the service with 15 people residing in the main building and six in Norwood.

We looked at records relating to people who were currently subject to DoLS and found timely applications for DoLS had not always been made appropriately when the indication was this was required, for example if the person had been assessed as lacking capacity.

Regular audits were carried out in a number of areas but had not always been effective in identifying and resolving some of the issues we found during the inspection in regards to timely applications for DoLS. These had not always been made appropriately when the indication was this was required, which meant some people were potentially being deprived of their liberty without authorisation.

These issues meant there had been a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding, because people must not be deprived of their liberty without lawful authority.

Because auditing systems had not identified this issue this meant there was also a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to good governance, as systems were not in place to assess, monitor and improve the quality of service delivery. You can see what action we told the provider to take at the back of the full version of this report regarding these regulatory breaches.

There was a registered manager in post, who was also the owner. 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.

People living at Southfield House told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur.

There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff received appropriate induction, training, supervision and appraisal and there was a staff training matrix in place.

We saw there were individualised risk assessments in place to identify specific areas of concern. Care plans were person-centred and covered essential elements of people’s needs and preferences. Staff sought consent from pe

This unannounced inspection took place on 13 July 2016 and was followed by an announced visit on the 15 July 2016. We last inspected the service in January 2014. At that inspection we found the service was meeting all the regulations that we inspected.

The Southfield House provides residential care for up to 23 people, some of whom are living with early onset dementia.

The service consisted of a main building and an adjourning extension called Norwood. People who were more independent and required less support lived in Norwood. Staff referred to this part of the building as the 'assisted community.' At the time of our inspection there were 21 people living at the service, 15 people lived in the main building and six in Norwood.

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. The registered manager also owned the service with their partner who was appointed as a director.

People said Southfield House was a comfortable place to live with well cultivated gardens surrounding the home. Thought and attention had been given to the homely feel of the service, including fresh flowers in communal areas and the service was kept clean and tidy. Staff kept the home free from obstacles and trip hazards so people could move around safely. Risks to personal safety had been assessed and steps were taken to prevent avoidable harm. The premises and equipment were checked and maintained to ensure they were safe.

We found that staff training was out of date in some cases and needed to be improved.

There were safeguarding procedures in place. Staff knew what action to take if abuse was suspected. There were measures in place for supporting people to take their prescribed medicines safely.

There were enough staff to support people in the service and to meet their needs. The provider had carried out appropriate checks to ensure staff were suitable and fit to support people. Staff received appropriate support. They had a good understanding of people's needs and how these should be met.

Care Quality Commission (CQC) is required by law to monitor the operations of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. MCA is a law that protects and supports people who do not have the ability to make their own decisions and to ensure decisions are made in their ‘best interests’. It also ensures unlawful restrictions are not placed on people in care homes and hospitals. In England, the local authority authorises applications to deprive people of their liberty. We found the provider was complying with their legal requirements.

People were supported to have enough to eat and drink and able to make choices about what they wanted. Each mealtime consisted of a number of alternative dishes to meet people's preferences. Where people required changes to their diets, the consistency of their food, or required support from staff, this was provided. People who required closer scrutiny of their food and fluid intake because of identified risks, were monitored and people were referred to specialist healthcare professionals where required.

People had developed good relationships with staff who were caring, compassionate and sensitive. People were treated with respect and their dignity was promoted. When upset or anxious, people were reassured by staff who understood them. People were helped to retain their independence whether eating, drinking, walking around or helping with the housework. People's feedback was sought on a day-to-day basis so that any changes to their activities or meal choices could be made quickly.

There was a complaints procedure and feed

During our inspection of Southfield House we spoke with three people who used the service and one family member. All of them told us that they were happy with the care and support provided. One person told us “I don’t think we could be better looked after in any care home in the country”. They also said “I knew I could live here after three weeks of being admitted”.

The family member we spoke with told us “We have had fantastic support from the staff at the home; all the girls are excellent with the residents”.

We also spoke with the provider/manager, the deputy manager and senior care worker. Both the deputy manager and the senior care worker told us that they were well supported and received training which ensured that they were up to date with current practice.

Both the people who used the service and the care workers told us that they felt comfortable in talking to the provider/manager if they had any concerns.

We looked at four care files, two staff files and the supervision records of six staff. All the records were up to date. The care files contained information to assist care workers in carrying out their duties. The training the staff received also ensured that the people who lived at Southfield House were provided with care and support that met their needs.

We spoke with an officer of the Stockport Social Services Quality Assurance team who told us that they had received no concerns regarding this service.

We spoke with five people who used the service as well as a relative. All the people spoken with told us they were happy living in the home and that the staff were helpful. One person told us, "Staff are very kind and patient".

We reviewed the care files of three people using the service and found evidence that there was a procedure in place to ensure that consent was gained from the person for staff to administer their medication where necessary.

We saw that care plans identified the needs of the person and had been reviewed on a regular basis. One person told us, "Staff know me well. I chose to come here on the basis of the standard of care".

People spoken with told us they received appropriate support with their medication. We found evidence that there were systems in place for the safe administration of medicines.

We saw evidence that there were effective recruitment procedures in place to ensure that people who used the service were protected from inappropriate staff.

We found that there were sufficient numbers of staff on duty to meet the needs of people who used the service.

We found that there were effective systems in place for the completion and storage of records relating to the care of people using the service and the maintenance of the premises

Our visit took place on the 6 January 2012 between the hours of 4pm and 8pm. We conducted the inspection with the Deputy Manager. We also spoke with two members of staff and a number of people who used the service.

People who used the service told us that it was a set menu at lunch time but that they had a choice of meal at tea time. However everyone said “if they did not like what was on the menu an alternative meal would be offered”. A cook worked six days a week and a member of the care staff cooked the meals on a Sunday. Comments we received from the people we spoke with were “No squabbles about the food”; “Get enough to eat”; “Food ok, if I don’t like something I can ask for something else”.

Other comments from the people who lived at Southfield were “Staff are really, really good, always pleasant and willing to help”; “Never felt awkward when being helped with personal care”; “Can’t praise them enough”. Everyone said that their privacy and dignity were respected.

The deputy manager and the two care workers we spoke with during our visit said that they were well supported and that the provider was very approachable. They also said that they received regular training. One person said “Do lots of courses”.

No one we spoke with had any complaints and said that if they did they felt able to speak with the provider, deputy manager or a member of staff. Two people said that they had complained in the past but said that their complaint had been dealt with to their satisfaction.

There had been no safeguarding of adult referrals or investigations.

On the 19 January 2012 we spoke by telephone to five family members all of whom were generally happy with the care that their relative was receiving. We received comments to our questions such as; “We are kept informed by the staff team”; “Feel able to make a complaint if we had one to make;” “We are given a questionnaire to complete asking about our views and opinions;” “We have never seen anything untoward, staff so patient and kind with others, which is quite noticeable”; “I think the food is generally good – not always brilliant;” “Respect privacy and dignity, staff don’t talk across X, feel X is safe.”

We also contacted Stockport MBC Contracts and Performance department and the District Nursing Service who visit Southfield House.

Stockport MBC told us that they did not have many people who were being funded living at Southfield but that they had received no complaints or concerns.

We were told by one of the district nurses that they had no concerns about the home and that people were well cared for. The also said that the staff were cooperative and referred people to them in a timely manner.

A pharmacist from Stockport NHS pharmacists visited the home in October of 2011. The pharmacist told the provider that the place in which the medication was stored was not satisfactory due to room temperature. The provider told us that this would change once the renovations to the home were completed. In the mean time a thermometer was being used to make sure that the room stayed within the temperature guidelines.

The home had recently been extended into the detached house to the side of the property. A ground floor corridor now linked the two properties. The new wing had seven beds all of which had an en-suite facility. We found on the day of our visit that one of the rooms was being used which meant that the home had 16 people rather than the 15 they were registered for. Shortly after our visit the number of people living at the home returned to 15. When we spoke with the provider on the 25 January 2012 the application form to register had been completed. The provider also told us that they had received confirmation of receipt and that the application was being processed. The provider also assured us that no one else would be admitted until the registration was granted.