About the service: Southlands is a care home which provides residential care for up to 48 people. At this inspection there were 40 people living at the service.

People’s experience of using this service: People and their relatives told us the service was safe but did not feel there was enough staff to meet their needs. People spent long periods of time sat in communal areas with no staff presence or interactions. Care plans contained appropriate assessments of risk and instructed staff how to reduce the likelihood of harm. Appropriate recruitment checks were completed.

The home environment was clean and tidy which reduced the risk of infection and staff knew how to report any concerns if required. People were supported to receive their medicines at the right time.

People were supported by staff who had induction training and on-going training to ensure staff had the skills, knowledge and support they needed to perform their roles. People and relatives spoke positively about staff. People were provided with food and drink they enjoyed and it was presented in a way to meet people's individual needs.

We observed staff were kind and caring and people were observed to be content and happy in staff presence. People told us they were encouraged to be as independent as possible and staff respected their privacy and dignity.

Care plans were person centred and reviewed on a regular basis. A variety of activities were available to people everyday and people were encouraged to take part. A complaints procedure was in place in an accessible format.

There were ongoing quality checking arrangements in place where action plans were developed to support the continuation of improvements for the benefit of people who lived at the home. Staff told us they felt supported by the management team.

Rating at last inspection: Requires Improvement (Report published January 2018).

Why we inspected: This was a planned inspection based on the rating at last inspection.

Follow up: We will to 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 comprehensive inspection took place on 30 January 2018 and was unannounced.

At the inspection on 8, 12, 13 July 2017 we had found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in Regulation 9 Person centred Care; Regulation 11 Need for Consent; Regulation 12 Safe Care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 17 Good Governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The rating was Inadequate overall and the service was placed into special measures. Following that inspection we requested an urgent action plan from the provider which they provided immediately. They have provided regular action plans since that inspection.

We then inspected on 24 October 2017 and found that improvements had been made although there was a continued breach of Regulation 11 of the Health and Social Care Act Regulations (Regulated Activities) 2014 because the service was not consistently making decisions in people’s best interests. The service was rated Requires Improvement overall and the service was removed from special measures.

In addition there is a current police investigation relating to historic events. CQC have not reported on these matters at this inspection.

At this inspection we found further improvements at the service with no breaches of regulations.

Southlands 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 accommodates up to 48 older people who may be living with dementia in one building.

There was a manager employed at the service. They were not yet registered with CQC although their application had been accepted and was being processed. 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 recent changes at the service, in relation to the staffing and management, had positively impacted on the quality of the service. Quality assurance systems, although effective in identifying areas for improvement had not allowed sufficient time for actions to be completed and checked. This was discussed with the manager.

Most staff were recruited safely and appropriate checks were completed prior to people commencing work, to ensure they were suitable to work with vulnerable people. We identified that one person started work with only preliminary checks in place but they were supervised during their induction period until full checks were completed. There were sufficient staff to meet people’s care needs safely. Staff received an induction, appropriate training and supervision. We made a recommendation about staff recruitment.

Staff were knowledgeable about people’s needs and we found that people were receiving the care they required. There was up to date information in care files which meant that staff had all the information they needed to ensure that people received consistent and responsive care in line with their preferences. Some records were not fully completed although the relevant issues had been identified. Food and fluid charts did not have sufficient space allowed for all records of what people had to eat and drink. The provider was aware that improvements were needed to some records and had them under review.

People’s wishes at the end of their life had been identified. Where appropriate anticipatory medicines had been prescribed.

Staff had been trained in safeguarding adults and were aware of what action to take if they saw or suspected abuse. There wer

This comprehensive inspection took place on 24 October 2017. The inspection was unannounced. At the last inspection in July 2017 we had found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These were in Regulation 9 Person centred Care; Regulation 11 Need for Consent; Regulation 12 Safe Care and treatment; Regulation 13 Safeguarding service users from abuse and improper treatment; Regulation 17 Good Governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following that inspection we requested an urgent action plan from the provider which they provided immediately.

At this inspection we found that improvements had been made although there was a continued breach of Regulation 11 of the Health and Social Care Act regulations (Regulated Activities) 2014 because the service was not consistently making decision’s in people’s best interests.

Southlands is a care home that provides accommodation and personal care for up to 48 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors. There were 32 people resident at the service when we inspected.

There was no registered manager employed at this service. 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. There was an interim manager in post at the time of our inspection who was in the process of applying for registration.

Risks to people had been identified although the risks relating to specific medical conditions people might have had not always been identified.

Staff recruitment was robust. There were sufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner except for the servicing of one lift.

Most training was completed but the learning from training was not yet embedded and therefore not yet just routine practice for staff.

People were not always supported to have maximum choice and control of their lives and staff had not supported them in the least restrictive way possible; the policies and systems in the service were clear and did not support this practice. Staff had not followed the correct process for making best interest decisions in line with company policy.

People’s nutritional needs were met.

Staff were described by people as being caring and we saw positive interactions between people and staff.

Activities took place but were not always meaningful to people living with dementia. Activities at the service were being developed.

The environment was not dementia friendly, particularly outdoors and did not reflect current good practice guidance.

People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.

There had been a lack of effective leadership and management at the service which had led to a significant deterioration in the quality of the service at the last inspection. This was now being addressed by the provider.

The quality assurance system was effective.

This service has been 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. During this inspection the service demonstrated to us that improvements had been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This inspection took place on 8, 12 and 13 July 2017. Days one and two were unannounced and we informed the manager that we would return on day three. At the last inspection in July 2015 the provider had no breaches of regulation.

We moved our planned comprehensive inspection to an earlier date because we had received concerns about some people who had lived or still lived at the service from a member of the public and from East Riding of Yorkshire Council. When we carried out our inspection we identified breaches of Regulation 9 Person Centred Care, Regulation 11 Need for consent, Regulation 12 Safe Care and Treatment, Regulation 13 Safeguarding service users from abuse and improper treatment, Regulation 17 Good Governance and Regulation 18 Staffing of the Health and Social Care Act 2008 (Regulated Activities) 2014. CQC requested an urgent action plan which was sent by the provider.

Southlands is a care home that provides accommodation and personal care for up to 48 older people who have physical disabilities and/or are living with a dementia related condition. It is a detached property set out over two floors. There were 41 people resident at the service when we inspected.

There was no registered manager employed at this service. 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. There was an interim manager in post at the time of our inspection, who had worked at the service for seven weeks, but they left shortly after the inspection. The regional manager was overseeing the service.

Risks to people had been identified but the written assessments did not reflect the practice of staff. Accidents and incidents had not always been managed in a timely fashion which had resulted in some people waiting for medical assistance, causing them distress.

Staff recruitment had not always been safe but was now more robust. There were insufficient numbers of staff on duty to meet people’s needs effectively.

Servicing and maintenance of the environment had been carried out in a timely manner in most cases but one passenger lift was not working. This had been the case for a prolonged period of time and the provider confirmed this lift had been decommissioned.

Most training was completed but the learning from training had not been embedded over time into staff practice. Staff had not always been supported appropriately but since the interim manager had started in post supervisions had been reintroduced.

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. However, staff had not followed the correct process for giving covert medicines after implementing the correct procedures in making the best interest decision.

The chef was knowledgeable about people’s dietary needs and the food we saw was nutritious. They were aware of how to fortify diets and provide fortified drinks and finger foods for people living with dementia but these were not always nutritious with people eating a lot of sandwiches and biscuits. Staff were not effectively monitoring people’s food and fluid intake and taking action, as required.

Staff were described by some people as being caring and we saw staff speaking politely to people in a friendly manner. However, other people told us that not all staff were caring and did not promote people's dignity or meet people's basic care needs through the care they provided. Staff practice did not always reflect what was written in in the care plans.

Activities took place but were mainly in groups and they were not meaningful to people living with dementia.

The environment was not dementia fr

This inspection took place on 9 July 2015 and was unannounced. We previously visited the service on 19 September 2013 and we found that the registered provider did not meet one of the regulations we assessed. This was in respect of the management of medicines. We carried out a further inspection on 13 December 2013 and found that the provider had taken appropriate action and the regulation had been met.

The service is registered to provide personal care and accommodation for up to 48 older people, some of whom may be living with dementia. On the day of the inspection there were 44 people living at the home. The home is located in Hutton Cranswick, a village close to Driffield, in the Riding of Yorkshire. It is close to village amenities and on good transport routes.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 3 June 2014. However, just prior to the inspection we were informed that the registered manager was due to retire during the week of our inspection. A new manager had been appointed and was due to start at the home on 13 July 2015. 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 told us that they felt safe living at Southlands and we saw that the premises were being maintained in a safe condition. Staff had completed training on safeguarding adults from abuse and were able to describe to us the action they would take if they had concerns about someone’s safety. They said that they would not hesitate to use the home’s whistle blowing policy if needed. However, we saw some poor practice on the day of the inspection. For example, one person was seated in a wheelchair throughout the day that did not belong to them and did not support their posture correctly. This was not recognised by staff and had to be pointed out by the inspection team.

People were supported to make their own decisions and when they were not able to do so, meetings were held to ensure that decisions were made in the person’s best interests. If it was considered that people were being deprived of their liberty, the correct authorisations had been applied for.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The training record evidenced that most staff, including ancillary staff, had completed training that was considered to be essential by the home.

Some concerns were raised by people who lived at the home and staff about staffing levels. This had been acknowledged by the registered provider and the home was in the process of recruiting additional staff to cover for staff absences. We observed there were occasions when people had to wait too long for assistance and this caused them distress.

New staff had been employed following the home’s recruitment and selection policies to ensure that only people considered suitable to work with older people had been employed, although there needed to be clearer evidence that all safety checks had been received prior to people commencing work.

Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust. Staff who had responsibility for the administration of medication had completed appropriate training.

People’s nutritional needs had been assessed and people told us that their special diets were catered for. We saw there was a choice available at each mealtime. Most people were satisfied with the meals provided, although some people commented that menus were ‘repetitive’.

People told us that staff were caring and this was supported by the relatives and health care professionals who we spoke with. There were systems in place to seek feedback from people who lived at the home, relatives and staff. We saw that people’s comments and complaints were responded to appropriately.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by managers were designed to identify any areas of improvement in respect of care planning, medication and accidents / incidents. We saw that, on occasions, the outcome of surveys, audits and complaints were used as a learning opportunity for staff.

People who used the service were satisfied with the care they received and their homely environment. We chatted briefly with people during this visit and their responses to us were positive about the service and staff. One person told us how they managed some of their medication themselves and said “I like to be as independent as possible and the staff respect this. Staff check that I am taking my medication okay, and they order my repeat prescriptions for me.”

We found that improvements had been made to medication practices and record keeping within the service. The provider had sent the Care Quality Commission an action plan following our visit in September 2013 and the actions within it had been completed by the time of this inspection.

People told us that they were consulted about their care and were able to make their own decisions about life in the home. People felt staff respected their privacy and dignity. One visitor said “My parent has a care plan and it has been discussed with both of us”. We found people were being looked after by friendly, supportive staff within a warm and homely environment. Care was personalised and reflected people’s choices and decisions. Care records were up to date.

There were clear processes in place for what should happen when a person moved to another service, such as a hospital, which ensured that the person’s rights were protected and that their needs were met.

People told us “We get our medicine on time and when we need it”, but we found that appropriate arrangements were not in place in relation to recording, handling and safely administering medicines to people who used the service.

The provider had an effective quality assurance system in place and people’s views and opinions of the service were listened to and acted on where necessary. There was also a complaints system available, which people understood and were confident of using if needed.

Records about people who used the service enabled staff to plan appropriate care, treatment and support. The information needed for this was systematically recorded and kept behind locked doors to keep it safe and confidential.

We found the service offered people a warm, comfortable and safe environment in which to live. The provider, manager and staff worked together to improve care practices wherever possible and acted on recommendations from outside agencies who were involved in people’s care.

People who used the service told us that they enjoyed living in the home. People said “The care we receive is very good. We can talk to the staff about our care and treatment and they listen to our opinions and respect our wishes.”

People told us that they enjoyed the food in the home. Three people said “There is a good choice of meals with alternatives offered to us if we do not like what is on the menu.”

People told us they were able to come and go as they pleased and could spend the day doing what ever they chose to. People told us they could choose to get up and go to bed when they wanted.

People told us they enjoyed the food and there was plenty of choice. One person told us that mince was on the menu far too often. Another person told us they were a vegetarian and the cook ensured they had a good varied diet.