About the service:

Southminster Residential Home is residential service providing accommodation and personal care for up to 34 people. At the time of our inspection there were 28 people using the service. The service supported adults, including people living with dementia. People lived in their own bedrooms which had their own toilets and sinks. There were also communal bathroom facilities, lounges and dining rooms.

People’s experience of using this service:

The service benefited from a longstanding registered manager who was passionate and committed to providing good quality care to people. The recent introduction of a new deputy manager and support of an area manager had helped the registered manager to make and sustain required improvements which were identified at previous inspections.

Staff felt valued and well supported. Consequently, people received support from a well trained consistent staff team who were motivated to provide good quality care.

People were supported to take their medicines in a safe way by staff who had been assessed and trained as competent. Risks to people had been identified and staff had a good knowledge of how to keep people safe from harm. We made a recommendation about risk recording.

Staff had access to up to date information about how to support people safely and to promote their independence. Good infection control practices were used by staff to prevent infection. The premises looked fresh and clean with no unpleasant smells.

Staff received support to be competent in their role and had the necessary knowledge and skills to provide effective support. People were supported to access healthcare services and treatment when required.

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 were kind and caring and respected people’s privacy. People were spoken to politely and treated with dignity and respect. End of life care arrangements were explored and documented if appropriate.

People received care and support which reflected their needs and preferences. We made a recommendation about person-centred care planning. People had access to activities they enjoyed. Complaints were responded to appropriately and feedback from people, relatives and staff was invited to drive improvements.

Rating at last inspection:

Requires Improvement (report published February 2018)

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

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 we receive any information of concern, we may inspect sooner.

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

We inspected Southminster Residential Home on 23 & 24 January 2017 and this was an unannounced inspection. At our last inspection which took place on 04 September 2017, the Commission highlighted a number of concerns and found multiple breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated inadequate following this inspection and was placed in special measures. Positive conditions were imposed on the registration for Southminster Residential Home to drive improvement in the service.

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. We met with the provider and asked them to complete an action plan to show what they would do and by when to improve the key questions; is the service Safe, Effective, Caring, Responsive and Well-led to at least good. The provider wrote to us with actions they had taken to improve the service.

During the inspection in January 2018 the service demonstrated to us that improvements had been made and we no longer rated them as inadequate overall or in any of the key questions. Therefore, this service was no longer in special measures. The service was rated as requires improvement as the provider would need to show they can sustain the improvements and continue to provide good care.

We continue to investigate an incident that occurred in 2017, This incident is subject to an investigation and as a result this inspection did not examine the circumstances of the incident.

We found that risk assessments were in place. Information recorded within people’s care records identified risks associated with individual’s care and support needs, with detailed information on how to manage the risks.

Medicines were managed safely and people received their medicine as intended and all documentation had been completed to evidence this. Medicine policies and processes were in place to give clear guidance to staff on handling and monitoring medicines in a safe way.

People had care plans in place that detailed their individual needs and provided staff with information about people's preferences, what was important to them and how staff could support them.

People’s dignity was respected at all times during the inspection and staff had good knowledge and understanding of people’s needs and preferences. There were enough staff on each shift to meet people’s needs safely and in a timely way.

Staff had received support and training to ensure they had the knowledge and skills to enable them to carry out their roles. We found staff to be caring and compassionate towards people they cared for.

We found the provider had implemented processes to show that they were open and transparent about mistakes made in line with their legal obligations of duty of candour. Investigations into incidents showed that lessons had been learnt and this helped to drive improvement in the service.

Although the service had a number of quality monitoring processes in place to ensure the service maintained its standards, these were new systems and not completely embedded in practice.

Southminster Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Southminster Residential home is registered to accommodate up to 40 people in one adapted building, which is set over two levels. The care home is situated within its own private grounds. At the time of our inspection there were 20 people using the service.

A registered manager was in post at the time of our inspection. 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 r

We carried out a responsive focused inspection at Southminster Residential home on the 4 September 2017 as a result of safeguarding concerns received by the Commission that peoples medications were not being managed safely.

We reviewed the outcome from this inspection and due to concerns found we expanded this inspection across all the key areas. We have not reviewed all the key lines of enquiry but we will be returning to the service within three months of this reports publication and provide a comprehensive overview of each key question at this time.

The home had previously been inspected in July 2016 following Inadequate and Requires Improvement’s ratings in 2015. At this time the service had been found to have made improvements achieving an overall rating of Good, with Requires Improvement in the safe domain.

Southminster residential home can provide accommodation for to up to 40 older people who may or may not be living with dementia. At the time of inspection 33 people were living at the service.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

A long standing registered manager was in place 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.

Medicines were not managed safely and when errors had occurred they had not investigated these transparently. In most cases they had not identified errors or discrepancies through the services own quality assurance audits.

When lessons from errors had been identified, the service did not ensure that these actions were implemented in a timely way to mitigate future risk of the error reoccurring.

Entries in people’s daily records by care workers demonstrated that they did not have the skills or knowledge to support people safely. Discussions we had with the provider and registered manager also reflected their inability to manage complex risks appropriately with a person centred approach.

Language used to describe people presenting with behaviours that challenged was disrespectful and uncaring.

People who had complex mental and physical health care needs did not have care plans that reflected how these needs im

The unannounced comprehensive inspection of this service took place on the 22 July 2016. Southminster residential home provides accommodation and personal care for to up to 40 people. Some people at the service are living with dementia. At the time of the inspection, Southminster was home to 32 people.

A long-standing registered manager was in place. 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.

During this inspection, the service was rated as Good overall with requires improvement in the Safe domain.

The service had been inspected previously in March 2015 and rated as Inadequate, followed by a requires improvement rating in October 2015. During this inspection, we saw that the provider and registered manager had made significant, continued, and on-going improvements at the service.

People told us that the manager and care staff were approachable, helpful, and caring. They told us that they were very happy with the care they received, their relatives told us the registered manager, and staff team provided people with the support they needed in a dignified and compassionate way.

The service ensured that staffing levels were adequate and enough staff were employed to meet people’s individual needs. The service had retained a strong core team of staff who knew people at the service well. Staff told us that they enjoyed working at the service. The registered manager did not use agency staff but increased staffing when they needed to, filling vacant shifts with existing staff, internal bank staff. The registered manager also worked occasional shifts. The service had safe and robust recruitment procedures.

People received freshly prepared meals that considered their individual likes, dislikes and health needs. If they did not like the choices available, we saw that they could request something else. Relatives were able to join their loved ones for meals if they requested to. A variety of hot and cold drinks, biscuits and fresh fruit were available throughout the day if people wanted these.

Staff had received mandatory training and training updates. The registered manager also provided additional training to staff to meet the needs of people at the service.

The service worked collaboratively with health and social care professionals to meet people’s health needs. The registered manager carried out regular staff competency checks and medicine audits to ensure that medicines were being administered correctly.

Care plans, and risk assessments were individualised and updated regularly or when people’s needs changed. The registered manager had devised a person centred and comprehensive dementia risk assessment.

The registered manager had good links with outside organisations to ensure that the service kept up to date with best practice.

We carried out an unannounced comprehensive inspection on 24 and 26 March 2015 at which six breaches of the legal requirements were found. These related to staffing levels, premises and equipment, person-centred care, safe care and treatment and governance. After this inspection, the provider wrote to us to say what they would do to meet the legal requirements in relation to the breaches.

We then received further concerns in relation to manual handling, staffing levels and attitudes, person-centred care and how poor practice is managed. As a result we undertook a focussed inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southminster Residential Home on our website at www.cqc.org.uk.

Southminster provides care and accommodation for up to 40 people. It does not provide nursing. There were a total of 31 people living in the service at the time of our inspection.

The service has a registered manager. 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 supported staff to provide care that was based on individual needs, however the systems in place to review the care being provided were not effective.

The provider and manager had a detailed action plan in place; however it was too soon to measure whether the changes were sustainable and effective.

Whilst the manager supported staff to develop their skills and meet people’s needs, there were not effective measures in place to deal with poor practice.

There were sufficient staff to provide people with the care and support they required to meet their needs and keep them safe.

The provider and manager had implemented new measures to identify and minimise risk, however it was not yet clear whether these changes were sustainable and effective.

People were treated with kindness and respect by staff who knew them well.

Staff treated people with respect and dignity.

We did not speak to people using the service on this occasion. This was a desktop based review.

We found that the provider had systems in place to help safeguard vulnerable people using the service.

We did not speak to people living at the home at this follow up inspection.

People living in the home said that the care provided was good, it was friendly and that they felt safe. Propeller said that they would like more social stimulation.

People told us that they were happy living at Southminster Residential Home. They generally felt that they had choice in their day to day lives and that the staff team were caring and friendly. They said that they felt safe. People also spoke highly of the manager. On occasions both people living in the home and their relatives felt that the social activities were limited.

This was an unannounced inspection carried out on 24 and 26 March 2015. Southminster provides care and accommodation for up to 40 people. It does not provide nursing. There were a total of 37 people living in the service at the time of our inspection.

The service has a registered manager. 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.

Arrangements were insufficient for managing risks appropriately in relation to premises and equipment to keep people safe. Staff did not always understand the purpose and type of lifting equipment and how it should be used safely and people did not have the appropriate equipment for individual use. At times incorrect techniques were used by staff for assisting people to move.

There was not always enough staff and the delegation and organisation of their duties did not always mean people received the support they needed to meet their individual needs. People were not provided with regular access to meaningful activities and stimulation, appropriate to their needs, to protect them from social isolation, and promote their wellbeing.

People were not always treated with respect and their dignity, privacy, choice and independence were not always promoted. Staff had received some element of training in dementia care but not all staff demonstrated an understanding of dementia and how this affected people in their day to day living. Staff training, development and support was not effective to ensure staff had the right knowledge and skills to carry out their roles and responsibilities.

The provider had suitable arrangements in place to safeguard people against the risk of abuse. As a result the staff could demonstrate they had the knowledge to ensure that concerns were identified and reported in a timely and appropriate manner.

The provider had suitable arrangements in place for the management of medicines and people received their medicines safely.

Deprivation of Liberty safeguards (DoLs) had been appropriately applied. These safeguards protect the rights of adults using services who do not have capacity to make their own decisions and require some element of supervision. Applications had been made for appropriate assessment and authorisation by professionals for a best interest decision on any restriction on their freedom and liberty.

A lack of review of records in some areas including some relevant individual risk assessments and care plans meant that people may not always be supported consistently and in the correct way.

Some areas of the home required redecoration and repair. The environment had not been adapted to suit everyone’s needs and did not promote a dementia friendly environment. The service lacked dining facilities and people were not provided with the opportunity to sit at a dining table to eat. This did not promote a social and stimulating mealtime experience and impacted on their health and welfare.

The registered provider and management were unable to demonstrate how they identified where improvements to the quality of the service were needed and quality assurance systems in place were not effective. As a consequence there were no systems in place to drive improvement to the quality of the service being delivered. Improvement was needed to the governance and leadership of the service to ensure the care and support provided to people was appropriate and in keeping with best practice.

We found that there were a number of breaches in the Regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014 and you can see what action we have told the provider to take at the back of the full version of the report.