Southwater is a ‘care home’ which offers accommodation with care and support to up to seven older people. Nursing care is not provided by the service. This service is provided by community nurses. At the time of the inspection there were six people living at the 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.

When we last inspected the service in March 2018 we found eight breaches of the Health and Social Care Act 2008 and associated regulations. The overall rating for the service was ‘Inadequate ‘. It was rated Inadequate in two domains; ‘Is it safe?’ and ‘Is it well led?’ It was rated ‘Requires Improvement’ for ‘Is it effective?’ and ‘Is it responsive?’ It was rated Good for ‘Is it caring?’ The Care Quality Commission (CQC) issued requirements for breaches of the regulations related to consent and the employment of fit and proper persons. We took enforcement action against Southwater regarding breaches of the regulations related to safe care and treatment, staffing and governance. We imposed a condition on the provider’s registration, requiring the provider to send a monthly progress report on the areas of greatest concern and risk. The provider also changed their registration to reduce the number of people living at the service from up to 18, to seven. The service was put 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.

The provider sent an improvement plan outlining the immediate steps being taken to protect people and improve the service, and continued to send monthly progress reports to CQC which showed ongoing improvements. This comprehensive inspection in November 2018 was carried out to check whether the improvements made had been sustained and the service was now providing safe and effective care to people. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is now out of special measures.

Prior to the inspection in March 2018 Southwater had developed a joint action plan with the local authority under their ‘Provider of Concern’ process. The majority of the actions in the plan had been completed when it was reviewed in October 2018, and the service continues to be monitored by the community nurse team and local care trust.

At this inspection in November 2018 we found action had been taken to address all areas of concern, but improvements were still needed. Some care plans contained inaccurate information, and were not person centred. People had not been consulted when their care plans were reviewed or their end of life wishes documented. In addition, the systems in place for assessing and monitoring the quality of the service, had not identified these issues, which meant they were not yet fully effective.

When we last inspected in March 2018, the registered manager had needed to take an unplanned leave of absence from the service and there was nobody with the knowledge and training to manage, monitor and carry out the day to day running of the service in their absence. At this inspection we found there was now a management team at Southwater who were able to carry out the day to day running of the service in the registered managers absence. The registered manager and management team acknowledged the areas in which the service needed to develop and improve, and were working with the local authority to make this happen. “One person living at Southwater told us, “I thin

This inspection was unannounced and took place on 6, 13 and 28 March 2018. We carried out this inspection to check the safety and quality of the service, following concerns which were shared with us about the care and support people received at the home. These concerns had triggered a local authority ‘Provider of Concern’ process, and a joint action plan had been developed with the local authority which was due to be formally reviewed three weeks after the inspection.

Southwater is a family run ‘care home’ which offers accommodation with care and support to up to 18 older people. Nursing care is not provided by the service. This service is provided by community nurses. At the beginning of the inspection there were 12 people living at the home. However, during the inspection more appropriate accommodation was being sought for two people with complex needs. 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.

The home was managed by a person who was registered with the Care Quality Commission as the provider and registered manager for the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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 had needed to take leave of absence for personal reasons. However no contingency plans were in place for this eventuality, and there was nobody with the knowledge and training to manage, monitor and carry out the day to day running of the service. In their absence wider concerns were raised about the leadership and management of the service. A family member stepped in to support the service in the role of ‘business manager’, although they had no previous experience of working in the care sector. An interim deputy manager was working at the service for three mornings a week. On the final day of the inspection the registered manager commenced a phased return to work.

During this inspection we identified a number of issues which impacted on the quality and safety of the support provided. This included issues around medicines administration, the assessment of risk, care planning, staffing levels and deployment, training, management and leadership and protecting people’s rights under the Mental Capacity Act 2005.

People were not always being protected from the risks associated with medicines. The registered manager had previously taken sole responsibility for this task. In their absence there were no other staff able to administer medicines because they did not have the skills or training. By the time of the inspection three members of staff had been trained and further training was planned. Despite this there were not always trained staff available to administer people’s medicines. On one occasion three people did not receive their medicines as prescribed and pain relief was not offered.

Risk assessments were not always completed or accurate, or had not been reviewed when people’s needs changed. This impacted on the monitoring and management of risks related to people’s food and fluid intake, tissue viability and moving and handling needs. Care plans did not consistently provide the guidance staff needed to understand and meet people’s needs in line with their preferences. They did not consistently document people’s end of life wishes. Formal reviews had not been completed or documented which meant some of the information on the care planning system was out of date, for example related to moving and handling needs.

Staff did not have the training required to enable them to meet people’s needs and keep them safe. There was no evidence that mandatory training had been updated. Staff had not been trained to

This unannounced inspection took place on 29th April and 3rd May 2016.

Southwater residential home offers accommodation with care and support to up to 18 older people. Nursing care is not provided by the service. This service is provided by community nurses. At the time of our inspection there were 10 people living at Southwater. The home is a large converted 1930’s house, with many original features and has an attractive, well maintained and secluded garden.

At the time of our inspection the provider was also the registered manager, and is referred to as the registered manager throughout the report. 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.

The service provided excellent and innovative person centred care. People were supported to maintain their interests by a staff and management team that not only respected the persons adult status, but treated them as individuals. Activities were varied and tailored to their preferences, interests and wishes. People were able to make suggestions and discuss improvements and changes at any time. They felt listened to and put at the centre of their care. The whole ethos of Southwater is centred around making sure that people feel at home and part of an extended family creating a home from home environment. Southwater constantly strives to listen to people and does everything possible to ensure that everyone living and visiting the home feels comfortable and at ease. Comments from visitors include "we've hit the jackpot! It's a wonderful place" and "delighted to have found such a lovely home".

People told us that they were supported by staff that were kind and caring. Relatives of the people who lived at the home felt welcomed and supported by all of the staff. Staff had time for people and treated them with respect. People received care in a dignified manner that protected their privacy. Staff encouraged people to be as independent as possible and offered them choices in their day to day living.

People told us they felt safe, and we found that the registered manager had a number of systems and processes in place to promote safety. Staff received training in and understood their responsibilities in relation to safeguarding of vulnerable adults. We found risks to individuals were well assessed and clear plans were in place to minimise these risks. People had been involved in planning the care and support they received from the service. Their needs had been identified, assessed and reviewed on a regular basis.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. Care plans contained assessments of people's capacity to make decisions in line with the Mental Capacity Act 2005. We found that people’s consent had been obtained for care and treatment provided to them by the home. We found that none of the people living at the home lacked capacity to make a decision. While no applications to deprive people of their liberty had needed to be submitted, policies and procedures were in place. The registered manager and care staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and understood the principles of the MCA and when an application should be made.

People received personalised care and staff treated them as individuals and with respect. Staff knew peoples' likes and dislikes. We saw staff offering people choices. People who lived in the home told us how they made choices in relation to their care and support. For example when they wanted to get up, what they wanted to eat and where they wanted to spend their day.

People were protected from the risk of abu

A single inspector carried out this inspection. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

One person we spoke with described living at the home as “I don’t think anything here could be improved. Anything you ask for you get".

The service was safe because people had been protected against the risks associated with medicines because the provider had appropriate arrangements in place to safely manage medicines.

Care staff received regular training and supervision to ensure that they could meet people’s health care needs.

Systems were in place to make sure that the Registered Manager and care staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The Care Quality Commission [CQC] monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, policies and procedures were in place. The Registered Manager and care staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The service was effective because we found that people's consent had been obtained for care and treatment provided to them by the service.

People's health and care needs had been assessed with them or their representative and they had been involved in writing their plans of care

Is the service caring?

The service was caring. We spoke with five people who lived at the home. We asked them for their opinions about the staff that supported them. Feedback from people was positive, for example; “Staff are never too busy to help you. I haven’t got to ask for anything".

When speaking with and observing care staff during this inspection it was clear they genuinely cared for the people they supported. They told us about people's individual health and social care needs and how these needs had been met in an individual way.

People's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Is the service responsive?

The service was responsive. We spoke with five people who lived at the home. We saw from records that planned care and treatment had been provided in line with people's individual care plans. Aspects of people's needs or care had been linked to risk assessments. Specialist health needs had been identified where required and appropriate health care professionals had been consulted and involved in providing care.

Is the service well-led?

The service is well led. The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better had been addressed promptly. As a result the quality of the service was continuously improving.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure people received a good quality service at all times.

We saw there was an effective system in operation which had been designed to enable the provider to regularly assess and monitor the quality of the services provided. For example during 2014 the Registered Manager had sought feedback from health care professionals who had visited the home. The Registered Manager told us and people who lived at the home confirmed that their opinions about the running of the home are sought on a daily basis.

On the day of our inspection nine people were living at the home and were receiving care from the service. We, the CQC, spoke with eight people who lived there, the owner/ manager, two care workers and the chef. We looked at three care plans.

One person described the home as a "the best place I could be". Another person said "It is absolutely marvellous here, we are spoiled rotten.”

We saw that care workers interacted with people in a relaxed, friendly and respectful manner. Care workers worked with and supported each individual at their own pace.Their independence was respected and encouraged. People appeared well cared for and said they were happy.

We saw people had a choice of suitable and nutritious food and drink available in sufficient quantities. People said the food was good. One person said “the food is always good.”

Care workers were skilled and experienced and most had worked at the home for many years. Care workers had received training in safeguarding vulnerable adults and recognising abuse and knew how to report any concerns.

We looked at the quality assurance methods used to monitor the quality of care delivered. We saw that there were numerous systems in place to assess the risks and ensure safe delivery of care.

At the last inspection in January 2012 concerns were identified in a number of outcomes. We (the Care Quality Commission) followed up on the action that the provider had taken at this planned inspection. It was evident that the provider had made improvements.

We spoke with six of the eight people living at the home and three staff. We also spent time observing care and looked at three care plans. One person said “My life has completely changed since moving here, I am really happy.” One member of staff described the home as a “Real family”. All the staff we spoke with were positive about the support they received.

People told us that they were involved in discussions and decisions about care. One person said “We are always being asked for our opinions”.

People enjoyed their social lives and could choose how to spend their days. Staff demonstrated a good understanding of how to protect people from abuse. People’s health and welfare needs were well met. Risks to people’s health and wellbeing were identified and plans were in place to manage these risks.

Staff at the home were positive about their work and the rewards it brought. They felt well supported by the management at the home and confident that they could get advice and support. People's needs were met by staff who were skilled, trained and who received supervision.

We (the Care Quality Commission) spoke to eight people using this service. They all spoke highly of the staff and the service they received at Southwater. People said they were really well cared for and all complimented the staff. Some comments made were “they are so good and kind”, another said “they are really lovely, I can’t speak highly enough”.

People said they had plenty of choice and were able to make day to day decisions about what time they get up and go to bed, where they eat and how they wish to spend their day themselves.

People told us that staff were always polite, kind and never rude. People who were more dependent said that staff knew how to carry out their caring duties, including careful use of moving and handling equipment. People said that staff came quickly if they rang their call bell.

People we saw in their rooms were happy with the room and furniture.

People told us that they were asked what they would like to eat, that they were well looked after, and that lunch was brought to them in their room if they were not feeling well.