About the service:

Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 32 people living in the service when we visited. People who lived at Southlands Place were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, and could show behaviours which may challenge. Most people needed some support with their personal care, eating, drinking or mobility.

People’s experience of using this service:

People told us and we observed that they were safe and well cared for and their independence was encouraged and maintained. Comments included, “This is a good place to live, I feel safe,” “I am well looked after” and “Staff are pretty marvellous”

• The service had made improvements since our last inspection. This meant people’s outcomes had improved and the breach of regulations met. However, whilst the provider had progressed quality assurance systems to review the support and care provided, there was a need to further embed and develop some areas of practice that the existing quality assurance systems had missed. For example, the monitoring of completed behavioural charts that showed aggression towards staff and other people since December 2018 had not been followed up or escalated to the management team for action. This meant that the provider had not had a full oversight of incidents that occurred in the home. We also found shortfalls in the management of some peoples’ pain control and that not all peoples’ social and well-being needs were reflected in peoples’ care plans.

• These required further improvement, however we acknowledge that the shortfalls in respect of incidents were addressed immediately.

We have made a recommendation about seeking expert guidance regarding oral hygiene practices.

• There were sufficient staff to meet people’s individual needs: all of whom had passed robust recruitment procedures that ensured they were suitable for their role.

• There were systems in place to monitor people's safety and promote their health and wellbeing, these included health and social risk assessments and care plans. The provider ensured that when things went wrong, accidents were recorded and lessons were learned.

• Staff received appropriate training and support to enable them to perform their roles effectively. Visitors told us, “Staff seem knowledgeable, look after my relative really well,” and “The staff team seems to have really improved.”

• People’s nutritional needs were monitored and reviewed. People had a choice of meals provided and staff knew people’s likes and dislikes. People gave very positive feedback about the food. Comments included, “The food is good,” “Very generous with the rations” and “Good food”

• The environment was comfortable, clean and well maintained.

• People and relatives told us staff were ‘kind’ and ‘caring’. They could express their views about the service and provide feedback. One person said, “We are looked after.”

• People were supported to keep in contact with their families. One person told us, “I text every day, I think I could skype if I needed to, I think there is a laptop I could use.”

• The care was designed to ensure people's independence was encouraged and maintained.

• People and families were involved in their care planning as much as possible. End of life care was planned for and staff received training and

• There was now a happy workplace culture and staff we spoke with provided positive feedback about the management style.

• Referrals were made appropriately to outside agencies when required. For example, GP visits, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

The service met the characteristics for a rating of ‘Good’ in three of the five key questions we inspected, with the responsive and well-led question being

This inspection took place on 3, 5 and 10 December 2018. The first day was unannounced. Southlands Place is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 38 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, some of these people could show behaviours which may challenge. Most people needed some support with their personal care, eating, drinking or mobility.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

The service was first rated as Inadequate, with five breaches in Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and placed in ‘Special Measures,’ after the inspection of 9, 17 and 18 October 2017. Following that inspection, we followed our enforcement procedures and added a formal condition to the provider's certificate of registration that they must draw up an action plan and submit it to us every month to show what they would do and by when to improve all five key questions to at least Good.

The service was next inspected on 4, 5 and 11 June 2018. The service was again rated as Inadequate and we identified five continued breaches and two new breaches in regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, consent to care, safety, safeguarding people from abuse, complaints, good governance and staffing. As a result of the 'inadequate' rating, Southlands Place remained in 'Special Measures.'

Following that inspection, we again met with the provider and also followed our enforcement procedures. We performed this inspection to review progress towards addressing areas identified in the last inspection. The provider had continued to send us a monthly action plan as required since the last two inspections. After the last inspection, we also continued to receive a range of comments from both people and external professionals about the service. We took both matters into account when planning this inspection.

Separate to this inspection, CQC are also reviewing a serious incident for a person in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this review related to the October 2017 inspection.

At this inspection we found the provider had made some improvements and the service was now rated as Requires Improvement, but remained rated as Inadequate under the key question, Well-Led. This was because the provider had still not met three of the five breaches in regulation, which have been identified for the past two inspections. However, due to improvements made, the service is no longer in ‘Special Measures.’

This service has had no registered manager for over 18 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. Since October 2017 there have been three management changes. The provider appointed a new manager; they started in post in June 2018. Their application to become registered manager is being progressed by our registration department. The provider is Caring Homes Healthcare Group Limited, a nat

This inspection took place on 4, 5 and 11 June 2018. The first day was unannounced. Southlands Place 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. Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 44 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, some of these people could show behaviours which may challenge others. Most people needed some support with their personal care, eating, drinking or mobility.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

The service was last inspected on 9, 17 and 18 October 2017. The service was rated as inadequate at that inspection and we identified five breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to person centred care, consent to care, safety, safeguarding people from abuse and good governance. As a result of the ‘inadequate’ rating, Southlands Place was placed into ‘Special Measures.’

Following that inspection, we met with the provider and also followed our enforcement procedures. We added a formal condition to the provider’s certificate of registration that they must draw up an action plan and submit it to us every month to show what they would do and by when to improve all five key questions to at least good. The provider sent us a monthly action plan as required. After the last inspection, we also continued to receive a range of comments from both people and external professionals about service provision, which we took into account when planning this inspection.

Separate to this inspection, CQC are also reviewing a serious incident for a person in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, this review related to the previous inspection.

At this inspection we found the provider had not made the necessary improvements and the service remained rated as inadequate over all. The provider had not ensured they had met any of the five breaches identified at the last inspection and additionally two further breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were identified.

This service has had no registered manager for over one year. Since October 2017 there have been three management changes, including a newly appointed manager who had started their post on the same day as our first day of inspection. This manager told us it was their intention to make an application to register with the Commission. 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 provider is Caring Homes Healthcare Group Limited, a national provider of care.

At this inspection we continued to find a wide a range of areas which needed action to ensure the safety and well being of people. People's safety was not ensured in areas such as medicines management, infection risk, wound care, diabetes and prevention of pressure damage. The service also continued not to consistently follow national guidelines to reduce such risks. Additionally, at this inspection we found the provider had not ensured all relevant actions had been taken in relation to fire safety.

The provider’s systems

This inspection took place on 9, 17 and 18 October 2017. The first two days were unannounced. Southlands Place is registered to provide nursing, care and accommodation to 71 people. There were 60 people living in the service when we visited. People cared for were mainly older people who were living with a range of care needs, including arthritis, diabetes and heart conditions. Some people were living with dementia, some of these people could show behaviours which may challenge others. The service also provided care for people who were at the end of their lives. Most people needed some support with their personal care, eating, drinking or mobility.

Accommodation was provided over three floors of a purpose-built building. There were multiple communal areas throughout the building, and accessible gardens. The service was situated in a quiet residential street in Bexhill-on-Sea.

There was no 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. A home manager had been appointed in July 2017. She had applied to be registered with us as manager for the service. The provider is Caring Homes Healthcare Group Limited, a national provider of care.

The last inspection of the service was on 17 and 20 March 2017. The service was rated as good, although come aspects of the well-led question required improvement. At that time there were 36 people living at the service and the upper floor had not yet been opened.

We performed this responsive comprehensive inspection because a wide range of issues had been raised with us, including from people’s relatives, staff, external professionals and the local authority. Separate to this inspection, CQC are also reviewing a serious incident for a person, in accordance with Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection we found there were a range of areas which needed action to ensure the safety and well-being of people. People’s safety was not ensured in areas such as management of wounds, prevention of pressure damage, diabetes and infection risk. The service was also not consistently following national guidelines to reduce such risks. Staff had not received training in all relevant areas to meet all of the needs of people living in the service to ensure they knew how to reduce people’s risk.

Procedures for safeguarding people were not always effective. This was because timely referrals had not been made to the Local Authority in accordance with policies to ensure risk of abuse was appropriately considered.

The service was not consistently following the requirements of the Mental Capacity Act (2005) by ensuring all relevant people had an assessment of their mental capacity. There was a lack of documentation in relation to best interest decisions for some people and some Deprivation of Liberty Safeguards (DoLS) applications did not include all relevant matters.

People were not consistently involved in developing their own care plans. Some people were not always receiving the care they needed in relation to areas such end of life care, mobility and dementia care needs. Some people’s care plans were not clear, to ensure all staff knew how to provide people with the care they needed. Some staff did not follow people’s care plans when providing care.

The provider and home manager’s systems for audit had not identified a range of areas, so had not taken necessary action to address issues before the inspection. This included areas such as confidentiality of people’s records, some aspects of medicines management and certain aspects of management of people’s urinary catheters. They had not identified that some records had not been ma

Southlands Place is a care home that was first registered in February 2016.

The service was purpose built to accommodate 71 people with a wide range of varying needs: ranging from minimal support, to those who have nursing needs and for those who live with dementia. The accommodation for people is situated over three floors but at present only two floors are being used. The residential and nursing floor is on the ground floor with those who live with dementia on the first floor. There are multiple communal areas situated throughout the home with a cinema room, a hairdressing salon and a self-service café. There are accessible gardens in the centre of the service and large safe baloneys on the upper floors.

There were 36 people in Southlands at the time of our inspection, 15 of whom lived with dementia and 21 who required nursing care and support. Not all of the people living in the service were able to express themselves verbally and communicate with us.

This inspection was carried out on 17 and 20 March 2016 by three inspectors. It was an unannounced inspection. Due to a number of complaints received in respect of staffing concerns the comprehensive inspection was brought forward.

The registered manager is currently on long term leave and had previously made a decision to retire giving six months’ notice. The deputy manager was being supported by the area manager until a newly recruited manager comes in to post in April 2017. 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.

People, relatives and staff told us there were insufficient staff deployed to consistently meet people’s needs. We found that the staffing levels had been an issue and this had been discussed at a recent resident and staff meeting. The area manager confirmed that there had been problems but with the recruitment of new staff the problem was in the process of being resolved. We found during the inspection that the staffing levels were sufficient to meet people’s needs and keep them safe.

People’s individual preferences for meaningful activities were currently not being fully met and this had been acknowledged by the provider and actions were being taken to address this.

Whilst complaints were logged and responded to they were not always responded to in a timely manner. We saw also that whilst complaints were either substantiated or not substantiated there were no actions recorded by the registered manager and therefore the provider could not be assured that appropriate action had been taken or that they had an overview of the investigation.

There was a system of monitoring checks and audits to identify the improvements that needed to be made. There were improvements needed to the completion of the audits to ensure that the provider had an overview of the service provided and be enabled to drive improvement.

People’s individual assessments and care plans were reviewed monthly or when their needs changed. There were plans for to involve people at monthly reviews and invite their relatives or legal representatives to participate in reviews that were scheduled. Families told us that they had mixed messages and had not been involved in these reviews as yet. One family had a review however during the inspection which assured us that these were in the process of being arranged. People were promptly referred to health care professionals when needed. Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.

Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effecti