Southlands Residential Home is a large detached property, registered to provide accommodation for up to 27 people; this is provided in either single or shared rooms. The home has large, well maintained gardens and a large car park for visitors. It is situated close to local amenities and bus routes into Bolton.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

At this inspection we found the service remained Good.

There was a registered manager at the home. 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 they felt safe living at the home and 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.

There were sufficient staff available to ensure people's wellbeing, safety and security was protected. An appropriate recruitment and selection process was in place which ensured new staff had the right skills and were suitable to work with people living in the home.

Staff had a good understanding of systems in place to manage medicines, safeguarding matters and behaviours that are challenging to others. People's medicines were managed so they received them safely.

Accidents and incidents were recorded and audited monthly to identify any trends or re-occurrences. The home had been responsive in referring people to other services when there were concerns about their health.

Relatives we spoke with said they felt welcome to visit at any time; they felt involved in care planning and were confident that their comments and concerns would be acted upon. The provider learned from complaints and comments and used them to improve the service.

Risk assessments were in place for a number of areas and were regularly updated. Staff had a good knowledge and understanding of people’s health conditions.

The service worked in partnership with other professionals and agencies to meet people's care needs.

Feedback received from people who used the service and their relatives was overwhelmingly positive and people were encouraged to contribute their views. People were positive about the staff who supported them and told us they liked the staff and were treated with dignity and kindness. People told us they felt safe living at the home.

People were satisfied with the food provided at the home and the support they received in relation to nutrition and hydration. There was an open and transparent culture and encouragement for people to provide feedback.

People told us they were aware of how to make a complaint and were confident they could express any concerns and these would be addressed.

Staff told us they enjoyed working for the organisation and spoke positively about the culture and management of the service. They also told us that they were encouraged to openly discuss any issues.

Further improvements had been made to the design and decoration of the environment and a large, secure sun terrace provided an easily accessible and peaceful external space for people to enjoy. There was a homely atmosphere and due consideration was given to the needs of people with dementia.

Audit and governance systems were in place and operated effectively and statutory notifications were sent to CQC appropriately.

There was an up to date certificate of registration with CQC and insu

The unannounced inspection took place on 01 March 2016. We had previously carried out an inspection in November 2013 when we found the service was meeting all the regulations reviewed at that time.

Southlands Residential Home is a large detached property, registered to provide accommodation for up to 27 people. This is provided in either single or shared rooms. The home has large, well maintained gardens and a large car park for visitors. It is situated close to local amenities and bus routes into Bolton. At the time of the inspection there were 22 people residing at the home.

There was a registered manager at the 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. On the day of the inspection the registered manager was unavailable. However, the administration manager and the care manager facilitated the inspection.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities)

Regulations 2014. This breach related to staff support. You can see what action we told the provider to take at the back of the full version of the report.

We looked at rotas and saw that staffing levels were good. Staff we spoke with confirmed this. We saw that there was a robust recruitment procedure, which helped ensure employees were suitable to work with vulnerable people.

Appropriate risk assessments were held in care files. The environment and equipment were maintained and checked regularly.

Staff had undertaken training in safeguarding adults and were aware of the procedures to follow if they had a concern. Staff had also undertaken appropriate medication training and safe systems were in place for the ordering, dispensing, storage and disposal of medicines.

We observed the lunchtime meal and saw that the food was of a good standard and people’s nutritional needs and requirements were catered for. Monitoring charts were completed to ensure people’s health and well-being was being overseen.

Care plans included a range of health and personal information and were regularly reviewed and updated.

Staff had undertaken a robust induction programme on commencement of their employment and training was on-going within the service.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

People told us staff were kind and caring. We observed interactions between staff and people who used the service and saw that they were friendly and courteous. People’s privacy and dignity was respected.

Information was given to people who used the service and their relatives and communication was good.

A number of staff had undertaken training in end of life care and people’s wishes for the end of their life were documented.

People’s choices with regard to times to get up and go to bed, the clothes they wished to wear, what food they wanted and how they wanted to pass the day were respected. These choices and preferences were recorded within the care files.

There was a range of activities on offer at the home and people were encouraged to follow their own hobbies and interests.

There was an appropriate complaints policy but there had been no recent complaints. We saw a number of compliments received recently by the home.

People who used the service, relatives and staff said the management were approachable at all times.

Policies and procedures were in need of updating and some contact details were out of date.

Staff supervisions and appraisals had not been undertaken for some time and staff meetings had not been held for a significant length of time, though one was arranged for the near future.

There were a number of audits and checks in place but monitoring and

We observed staff engaging well with people who used the service. It was clear staff knew each individual well.

We sampled five care files and found assessments of care needs had been undertaken. Risk assessments were in place and had been updated as required.

We spoke with five people who used the service. All comments were positive. These included: "I am happy here", "I am looked after very well", "Nothing is too much trouble, everyone is kind", "This is the next best thing to home, what more can I say" and "I love it here, the food is good and the staff are very friendly".

Southlands had appropriate systems in place that ensured medicines were safely and effectively managed.

We had received some information with regards to the lift within the home not functioning for sometime. We discussed this with the senior carer on duty during the inspection and were satisfied appropriate action had been taken. We found equipment throughout the home was maintained in good condition and working order.

We sampled five staff personal files and found staff had received appropriate training for their roles and responsibilities.

Staff had appropriate guidance in place on how to handle any complaints received about the service.

During the inspection we sampled five care files. We found that each had comprehensive initial assessments of care needs. Personal and social history of people who lived at Southlands had been documented and this made care files person centered. Likes, dislikes and preferences were also noted.

We saw nutritional assessments were completed when required. People who used the service were weighed at least monthly or more frequently if any weight loss was noted. We found referrals to GP and dieticians were made when appropriate.

People who used the service told us: “The food is very good, I had second helpings”, "You always get an alternative, if you don't fancy what's on the menu, mind you, I never refuse, the food is excellent", "I always say that I won't have a second helping, but its so good the food here" and "You cant fault the food here, it's first class and its always presented nicely".

Southlands participated in Preventing Infection Together in Care Homes (PITCH), an infection control initiative implemented by the local authority. Staff had received infection control training and regular audits of the environment, individual bedrooms, mattresses and hand hygiene had been undertaken.

We saw that furniture and fittings were in good condition. People who used the service were able to have their own furniture and personal possessions in bedrooms if they chose. We observed all areas and found that there were no trip or slip hazards.

We spoke with three relatives during our visit.

They told us:

“We are more than happy with how the staff look after my X. I am always told what’s going on”.

“I come at various times and I have never had any cause for concern. Staff treat everyone the same and are always respectful”.

“I feel the staff speak to everyone respectfully, they are wonderful. I have no complaints at all”.

“I am looked after very well. I only came for a month and decided that I would like to live here permanently”.

“Everyone is so kind, I had a fall before I came but here they make sure I am safe”.

“I am so pleased how everyone looks after my X: X always looks cared for and happy”.

People told us, "We get looked after smashing" and "We'd come back again". One person said "I've no complaints up to now and I've been here a while". People told us that staff were very obliging and they only had to ask if they needed anything. Regarding activities, people told us that there wasn't much to do. One person said, "We sit here in the chair talking" and another person told us that they watched television or had a sleep.