About the service: Southport Rest Home is a residential care home which is registered to provide accommodation and personal care for 25 older people. Accommodation is provided over three floors. The home provides specialised care and facilities to meet the needs of people practicing the Jewish faith, but also caters for the needs of people from other faiths and cultures. At the time of the inspection 17 people were living at the home.

People’s experience of using this service:

People’s experience of living at the home was positive. We were told repeatedly that people enjoyed living at Southport Rest Home and that their needs were consistently met.

People were cared for by staff who knew them well, understood their needs and provided effective care to keep them safe. Risk was subject to regular review and was effectively managed. People received their medicines as prescribed from trained staff. The home was clean and measures were in place to reduce the risk of cross-infection.

Staff received regular training and support and were equipped to provide effective care. Care was provided in-line with best-practice guidance and legislation. People had access to a good choice of food and drink and maintained a healthy diet. 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. When people were unable to make decisions about their care and support, the principles of the Mental Capacity Act (2005) were followed.

People and their relatives spoke positively about the staff and the way in which care was provided. Staff treated people with kindness and respect and supported their dignity in a sensitive manner. People were encouraged and supported to maintain their independence. They were actively involved in decision-making regarding their own care and developments within the wider home.

Care was personalised and met the needs of each individual. Care records captured important information regarding people’s histories, families and preferences. This information was used to tailor the provision of care to meet each person’s needs. There were a very low number of complaints recorded. People told us this was because any concerns were addressed as soon as they were raised. End of life care was provided in accordance with people’s faith and wishes.

The registered manager, provider and staff promoted an open, positive culture with a focus on high-quality, person-centred care. The registered manager made effective use of audits and other sources of information to review and improve practice. The home had forged links with other providers and resources in the local community to support further development.

More information is provided in the full report.

Rating at last inspection: Good (report published 19 July 2018)

Why we inspected: This was a scheduled inspection based on the previous rating from the last comprehensive 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 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

The inspection of Southport Rest Home took place on 2 July 2018 and was unannounced. The last inspection of the service took place on 20 & 21 February 2018 and we identified a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Safe care and treatment and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Good governance. We found a lack of assessment and care planning around risks to people's safety and well-being and systems were not sufficiently robust to assure the safety and quality of the service.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the key questions we asked around providing a safe and well led service to at least good. We also asked the provider to complete an action plan which told us how they would achieve this.

We undertook an unannounced focused inspection of Southport Rest Home on 2 July 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our February 2018 inspection had been made. The inspector inspected the service against two of the five questions we ask about services: is the service safe? is the service well led? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining key questions through our ongoing monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these key questions were included in calculating the overall rating in this inspection.

Southport Rest Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Southport Rest Home is owned and managed by Southport Rest Home Ltd and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. It is located close to the amenities provided by the town.

A registered manager was 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.

At this inspection we found improvements had been made.

People had a care needs assessment and risk assessments were completed to identify risks to people’s health and well-being. This information helped formulate a plan of care which contained the required amount of detail to demonstrate the care and support people required. This breach had been met.

The service’s systems to assure the quality of the service were now more robust. This included audits which identified key areas of practice. Standards were being maintained and we saw evidence of how the registered manager was driving forward improvements. This breach had been met.

Sufficient numbers of staff were available to provide support to people in accordance with individual need. Agency staff were used in an emergency and the same agency staff were asked to work in the home. This ensured there was a staff team who knew people and were familiar with their care and support needs.

Measures were in place to ensure the environment and equipment was safe and well maintained. This included the completion of health and safety checks and ‘general’ maintenance of the home.

Medicines were managed safely and people received their medicines as prescribed.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff receiv

An unannounced inspection took place of Southport Rest Home on 20 & 21 February 2018. Where we receive information of risk or concern about a service, or information that indicates a service has improved, we may carry out a comprehensive inspection sooner than originally scheduled. The comprehensive inspection for this service was carried out sooner as we received information of concern and risk which we needed to explore.

We carried out an unannounced comprehensive inspection of this service in July 2017 when a breach of Regulations under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 was found. This was in respect of Regulation 12 - Safe care and treatment. We found people were not adequately protected from the risk of unsafe administration of medicines because medicine errors remained at a high level over a prolonged period. We found concerns around the auditing system to reduce the number of medicine errors.

Following the last inspection, we asked the provider to complete an improvement action plan to show what they would do and by when to improve the key question is the service ‘safe’ and is the service ‘well led’ to at least ‘good’. The breach regarding the safe management of medicines was met, however we identified a further breach relating to safe care and treatment and this domain remains ‘requires improvement’. The rating for ‘well led’ also remains as ‘requires improvement’ due to concerns around the governance of the service.

Southport Rest Home Ltd is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Southport Rest Home Ltd is owned and managed by Southport Rest Home and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. It is located close to the amenities provided by the town and is adjacent to a local park.

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.

There was a clear organisational management structure in place. The registered manager was able to evidence a series of quality assurance processes/systems and audits carried out internally. These were not sufficiently robust to identify issues to help maintain standards and support the development of the service.

We found for one person, risks to their health were not assessed and a plan of care formulated to

ensure consistent outcomes for their safety and wellbeing.

We found improvements in the way medicines were administered to ensure people received their medicine safely. Monitoring of medicine management was robust and there was a reduction in medicine errors. Improvements had been made to meet the relevant requirement. This breach had been met.

Staff administered medicine safely and people were able to manage their own medicines with staff support.

Prior to this inspection we received information of concern that staff were not trained in the use of equipment to transfer people safely, for example, a hoist and there was a lack of moving and handling equipment to support people. We saw staff were supported with a training programme which included moving and handling training. The registered manager however made arrangements for further moving and handling training to take place later this month to support staff’s learning. We spoke with the registered manager who told us the home had sufficient moving and handling equipment to support people sa

This inspection took place on 10 July 2017 and was unannounced.

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 23 people were living at the service. The service is a charitable trust which describes itself as a Jewish care home. Facilities at the service include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was in post. However they were not available on the day of the 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 responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

During an inspection in August 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, meeting nutritional and hydration needs, good governance, protecting people from abuse and improper treatment and receiving and acting on complaints. We inspected the service again in December 2016 and found that the necessary improvements had been made and the service was no longer in breach of regulations. During this comprehensive inspection we checked to see whether the improvements had been sustained and if the service met all regulatory requirements.

When we carried out the last unannounced comprehensive inspection in August 2016, we identified concerns in relation to the management of medicines and safeguarding service users. We issued a warning notice and told the provider to improve. At the next inspection in December 2016 we saw that practice had improved and that medicines were being administered safely. The PIR submitted prior to the inspection demonstrated that recent medicines audits had identified a high volume of errors including; missed medicines, missed signatures and stock control discrepancies. None of these errors had resulted in actual harm to people’s health, but the numbers were sufficiently high to cause concern. As part of this inspection we checked to see what action had been taken to ensure that medicines were administered safely.

A comprehensive medication policy was in place to support staff with the safe management of medicines. Staff who administered medicines had received medicines training. An audit of medicines was completed on a regular basis.

The audits we reviewed indicated that the number of errors had reduced over the previous six months. However, 400 errors were recorded in the previous 12 months.

Care records clearly evidenced that risk was appropriately assessed and reviewed on a regular basis. Accidents and incidents were recorded in sufficient detail to allow for analysis. They were audited by senior members of staff on a regular basis to look for patterns or trends. There were no significant findings from the audits viewed during this inspection.

The provider regularly completed a number of safety checks and made use of external contractors where required. Checks included; moving and handling equipment, gas safety, electrical safety, water temperatures and fire safety. Each of the checks had been completed in accordance with the relevant schedule.

Staff were safely recruited and deployed in sufficient numbers to meet the needs of people living at the service. Staffing levels were based on the number of residents rather the completion of a dependency tool. People’s dependency and care needs were reviewed regularly and people were supported to move to alternative accommodation if their needs could no longer be safely met.

Staff told us that they felt well-supported by the service and were given access to good quality training and regular supervision. The majority of training had been refreshed in accordance with the p

This inspection took place on 13 December 2016 and was unannounced.

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 19 people were living at the home. The home is a charitable trust which describes itself as a Jewish care home. Facilities at the home include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was 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.

During the last inspection in August 2016, we found the provider was not meeting legal requirements in relation to safe care and treatment, meeting nutritional and hydration needs and good governance and we issued warning notices in relation to these areas. The provider was also not meeting legal requirements in relation to protecting people from abuse and improper treatment and receiving and acting on complaints and we issued a requirement notice regarding this. During this focused inspection we checked to see whether improvements had been made in these areas and to ensure legal requirements were being met. 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 Southport Rest Home on our website at www.cqc.org.uk.

When we had previously visited this home in August 2016 and found the home to be in breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in respect of the management of medicines. We issued a warning notice.

At this inspection we saw medicines were now being managed safely. A medication policy was in place to support staff with the safe management of medicines in a care home. Staff who administered medicines had received medicine training. A senior member of staff member confirmed the medicine training they had received and that they checked to make sure staff administered medicines safely to people.

We found that the provider had made improvements regarding the safe administration of medicines and legal requirements were met.

During the last inspection we found that people were not adequately safeguarded against the risk of abuse and neglect because the provider had not acted on information of concern. We also found that safe disciplinary procedures had not been followed because a member of staff remained in work following serious allegations.

During this inspection we spoke with people living at the service, the head of care and the registered manager to see what changes had been made and what impact they had on the safety of the service. The head of care confirmed that staff conduct and practice were monitored and regularly observed and that staff had been briefed on the importance of reporting concerns. They also told us that between themselves and the registered manager, cover was provided over seven days. No concerns had been identified by the head of care or the registered manager since the last inspection.

People living at Southport Rest Home had access to a number of ways of raising concerns, but each person that we spoke with said that staff treated them with respect at all times.

We found that the provider had made improvements regarding safeguarding service users from abuse and neglect and legal requirements were met.

During the last inspection in August 2016, we identified concerns regarding restrictions placed on the provision of food and drinks for people who were not Jewish. The decision to provide only Kosher food meant that some foods were not available to

This unannounced inspection was conducted on 9 and 10 August 2016.

Situated in a residential area of Southport, Southport Rest Home provides accommodation and personal care for up to 25 people. At the time of the inspection 19 people were living at the home. The home is a charitable trust which describes itself as a Jewish care home. Facilities at the home include lounge areas, a dining room, car parking and gardens. A passenger lift is available for access to the bedrooms located over three floors.

A registered manager was not 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 manager had been recently appointed and was in the process of applying to become registered. The manager was not available on either day of the inspection. The manager was represented by trustees and administrative staff.

We looked at the medicines, medication administration records (MARs) and other records for nine people living in the home. We found there were still concerns with medicine management and the service was in breach of regulation.

Some people living at the home told us that they did not always feel safe. We were told by staff that concerns had been reported prior to the appointment of the current manager that did not appear to have been acted on.

People told us that they were concerned by the lack of choice of food and the restrictions imposed by the need to store, prepare and serve Kosher food.

We saw evidence that the processing of complaints had improved recently. We were told that each person had a copy of the complaints procedure in their room. Records from May 2016 onwards were detailed and recorded outcomes. However, a number of people living at the home told us about making complaints that did not appear in the records that we were shown and had not been resolved to their satisfaction.

The manager told us that audit systems were in place for some important activities, for example, administration of medicines. But it was clear that audits were not extensive or robust enough to ensure that safety and quality were effectively monitored. This meant that the issues and concerns identified on this inspection such as those relating to medicines, staff conduct and food had not been identified and effectively monitored.

Accidents and incidents were recorded, but there was no evidence that they had been assessed to identify patterns and triggers. The documents that we saw contained limited information presented in different formats. There was no consolidated record of accidents and incidents available during the inspection.

All of the staff that we spoke with confirmed that they felt better supported following the appointment of the new manager. However, records indicated that the majority of staff had not received a supervision or appraisal in 2016.

We made a recommendation regarding this.

The records that we saw showed that the home was operating in accordance with the principles of the MCA. Applications to deprive people of their liberty had been submitted appropriately.

We received mixed views regarding the attitude, approach and conduct of the staff. However, throughout the inspection we saw staff engaging with people in a positive and caring manner.

We observed that care was not provided routinely or according to a strict timetable. For the majority of the day staff were able to respond to people’s needs and provided care as it was required.

We saw evidence in care records that people had been involved in the review of their care. Some of the care records that we saw were signed by the person themselves indicating their involvement and consent to the provision of care. However, evidence of people’s involvement and consent was not

We carried out an unannounced comprehensive inspection of this service on 9 & 10 December 2014 when a breach of legal requirements was found. This was because we had some concerns about the way medicines were managed and administered within the home. We asked the provider to take swift action to address these concerns.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on the 2 April 2015 to check that they had followed their plan and to confirm that they now met legal requirements.

This report only covers our findings in relation to this topic within the safe domain. The domains effective, caring, responsive and well-led were not assessed at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Southport Rest Home Limited’ on our website at www.cqc.org.uk’

Southport Rest Home is owned and managed by Southport Rest Home Limited and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. It is located close to the amenities provided by the town and is adjacent to a local park.

The home’s registered manager has worked in this role since January 2014. 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 and associated Regulations about how the service is run.

A pharmacist inspector carried out this focused inspection 2 April 2015. At this visit we found that whilst improvements had been made, there remained some areas where further improvements were still necessary. We therefore recommend that the provider seeks further guidance, e.g. the current ‘NICE Guidelines –Managing medicines in care homes’, to ensure that medicines are safely recorded and accounted for.

We spoke with six people during our visit to the home. People told us that they were happy with the care that they received.

A person told us "It's a lovely place,I feel very secure here". Staff told us "People are looked after here".

People who lived at the home told us that they were looking forward to the new activities programme. The manager of the home told us that this was as a result of a recent meeting with people who lived at the home who felt they would like more activities in the day.

We found that people's nutritional needs where being met and there was a choice of meals available. When we spoke with people who lived at the home they told us that they felt that they would like to know what choices were available in advance. The manager told us that menu's will now be displayed outside the dining room.

We found that people's health needs were being met. We reviewed documentation and spoke with staff who had a good knowledge of people's health needss and were able to demonstrate how to escalate any concern's appropriately. We saw that people were seen appropriately by a wide variety of health professionals.

We found that there was enough staff to provide care at the home. We reviewed staff records and found that they were appropriately trained. We spoke with staff who said they felt supported.

We reviewed cleanliness in the home and found it to be of a high standard.

People spoke positively to us about the care and attention they received. One person told us, “I am very happy here. The food is good and if I want something else, I just let the staff know and they get it for me.” Relatives we spoke with told us that staff were attentive when they visited and kept them up to date with any changes to care needs.

We looked at the care records and daily notes for three people living in the home. These were generally well organised and included detailed assessments of need, risk assessments and strategies to manage those risks. We spoke with six people in some depth. They said that staff supported them well. We saw there was good communication when staff carried out care. One person told us, “The staff are really kind and know how to help me.”

Staff we spoke with were knowledgeable about managing medication. We checked a number of medication administration records (MAR charts) and they were accurate, signed and dated appropriately.

Staff we spoke with told us they had good access to training to help them carry out their work. The manager told us that she would be putting more regular supervision meetings in place to support staff. The home held staff meetings every three months to ensure staff were up to date with information related to how the home was run.

The home had systems in place to record, and securely retain, information regarding the care delivered to people and to the running of the home.

All people spoken with confirmed that they were encouraged to express their views openly. They were of the opinion that these views were being taken into account by staff in the decision making for the care and treatment they received at the home.

One person told us that staff were very good at keeping them informed about their care and this was regularly discussed. One person said, '‘Staff are always available and they are very good.'' Many expressed the view that they felt like they were treated with respect and dignity.

The level of dependency of people in the home varies but those needing some degree of personal care said they felt comfortable with staff who were, ''Very patient and kind.’’ All spoken with said that the staff were both competent and respectful in terms of promoting their privacy and dignity.

We spent some time observing the care and talking to people living in the home. We saw staff attending to people and providing ongoing support. Generally people were relaxed and talked freely. We spoke with one person who said, ‘’The staff look after me very well. There’s plenty of staff about, I only have to call them.’’

Another person told us about recent treatment for an infection. Staff had been quick to call the doctor and had followed through the care prescribed. One person also told about how staff had made referrals to the dentist and later a dietician had visited to give advice about dietary needs. This shows that the home were responsive to people’s care needs and have liaised when necessary to support peoples health care needs.

Other comments received were also very positive:

‘’The staff and manager are very good and everything is well organised.’’

‘’Staff are marvellous and are always cheerful.’’

People spoken with were very relaxed around staff and said that they were listened to so that any concerns could be addressed. We observed staff interacting with people living in the home in a positive and supportive manner. Residents, when asked, said that they felt ‘safe’ and they were confident that any concerns would be listened to and addressed.

An unannounced inspection took place on the 9 and 10 December 2014.

Southport Rest Home is owned and managed by Southport Rest Home Ltd and is a registered charity. The home provides personal care and support for up to 25 older people. Nursing care is provided by the local district nursing care services when needed. The care home is located close to the amenities provided by the town and is adjacent to a local park. At the time of our inspection 17 people were living at the home.

A registered manager was 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.

Throughout our inspection we observed staff supporting people in a discreet and sensitive way to maintain people’s safety and dignity. People told us the staff were polite at all times. During our inspection we saw positive interaction between the staff and the people they supported. People’s comments included, “The staff are wonderful” and “The staff are beyond good.”

People said they felt safe living at the home and their support was given in a way that made them feel safe. People’s comments included, “Yes, I feel safe living here, the staff are always around to help me”, and “The staff take good care of me always.”

Staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported.

Recruitment checks had been carried out to confirm staff were suitable to work with vulnerable people.

People informed us there were sufficient consistent numbers of staff to provide assistance when needed. People said they felt well looked after.

Risk assessments were centred around people’s individual needs and aimed at promoting people’s independence with staff support where needed. These included whether people were at risk of falls and also the use of bed rails to reduce the risk of falls from the bed.

Environmental risks assessments and health and safety checks had been undertaken of the premises to ensure people’s safety.

Staff had a good knowledge about people’s needs and how they supported them to keep well and active. People living at the home told us the care they received was provided in a way they liked and that met their needs.

Health professionals we spoke with were complimentary regarding the care and support people received. We saw that people were supported by external health and social care professionals to maintain their health and wellbeing. One person living at the home said, “You only have to ask and it is arranged. I get excellent help when I need it.”

We observed the lunch time meal. This we found to be a very pleasant experience. People told us they enjoyed the meals and were provided with a varied menu. People had been consulted about the meals and their feedback listened to and changes made in accordance with people’s requests. One person told us, “The chef is really good and makes sure we are happy with the food, the staff do the same.”

Staff were skilled and trained to provide care to people at the home. A new training programme was being introduced and also supervision meetings with staff as part of staff development and learning. Staff told us they received good support from the registered manager. An induction was available for new staff.

The registered manger had a good knowledge of the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Staff supported people in a caring and sensitive manner. People and their family members told us the staff were approachable, helpful and considerate. Family members told us the staff communicated well with them about their relative’s care and support. One relative said, “They (the staff) always keep in touch.”

People could see their family members and friends when they wanted. There were no restrictions on when people could visit the home.

Staff, people who lived at the home and family members we spoke with were complimentary regarding the registered manager and the management of the home. People told us they had daily contact with the registered manager and had plenty of opportunities to talk with them. This we observed during the inspection. People informed us the service ran well and the registered manager was supportive and approachable.

Staff told us they felt they could speak up if they had concerns and they would be listened to. They told us they received the information they needed to support people in the home and also around how the home was operating. Staff had access to a whistle blowing policy thus ensuring an open culture existed.

A process was in place for managing complaints and people who lived at the home told us they would speak up if they had a concern. The quality of the service was subject to review and people were able to share their views about the home. Feedback was sought from people and their family members though this tended to be on an informal basis rather than by attending meetings or completion of satisfaction questionnaires.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 in relation to the care home not consistently following safe practice around administering medicines to people. This placed people’s health and wellbeing at unnecessary risk.

You can see what action we told the provider to take at the back of the full version of this report.