We inspected the service on 27 and 28 April 2016. Southwell Court Care Home is registered to provide accommodation and personal care for up to 82 older people, some of whom are living with dementia, over three floors. At the time of our inspection, 67 people were using the service.

The service had a registered manager in place 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 responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection on 22 and 23 April 2014 we asked the provider to take action to ensure that suitable arrangements were in place to obtain the consent of people in relation to the care and treatment provided for them. During this inspection, we found that the provider had taken appropriate action and improvements had been made. People were encouraged to make independent decisions and legislation to protect people who lacked capacity was being adhered to.

At our last inspection we also asked the provider to take action to ensure that they acted upon information which would improve the service people received. During this inspection, we found that the provider had taken appropriate action and improvements had been made. We found that quality monitoring systems were being used effectively to monitor the service and respond to any issues.

People were protected from the risk of abuse and staff had a good understanding of their roles and responsibilities if they suspected abuse was happening and appropriate action had been taken when required.

Staff were knowledgeable about how risks to people’s safety could be reduced and potential risks were identified and responded to.

People were supported by sufficient numbers of staff and they received their medicines as prescribed and these were managed safely.

People were supported by staff who received an induction and training relevant to their role. Staff felt improvements were being made to how they were supported by the management team.

People were protected from the risks of inadequate nutrition and specialist diets were provided if needed. Referrals were made to health care professionals for additional support or guidance if people’s health changed and their advice was acted upon.

People were treated with dignity and respect and had their choices acted on. We saw staff were kind and caring when supporting people.

People were supported to maintain their interests and were mostly either proactively or responsively engaged with by staff. A wide range of activities took place within the service which was well staffed and resourced.

People, relatives and staff were given opportunities to feedback their views on the running of the service and there was evidence that action had been taken in response to people’s views.

Prior to our visit we reviewed all the information we had received from the provider. During the inspection we spoke with eight people who used the service and two relatives and asked them for their views. We also spoke with five care workers, four senior care workers the maintenance officer and the registered manager. We looked at some of the records held in the service including the care files for eight people. During the inspection we completed a Short Observational Frameworks for Inspection (SOFI) on the top floor. We observed the support people who used the service received from staff and carried out a brief tour of the building.

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

Is the service safe?

Staff knew how to respond to any allegation of abuse and we found they were effective at ensuring people were safeguarded. A relative told us, “I do not worry about their safety.” A person who used the service told us, “I have an emergency button if anything goes wrong. I have had to use it several times, someone comes to see me quickly.”

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. One application had been made and the correct documentation was available for this. Proper policies and procedures were in place. The manager told us the management team have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

We found the provider did not have effective systems to involve people in planning their care and obtaining people’s consent for this to be provided. A staff member told us they did not involve people when they reviewed their care plans.

We found the provider could be more effective at assessing and monitoring the quality of the services provided. Audits were not completed as frequently as expected and they did not contain the information needed to show their outcomes.

We found the provider could be more effective at identifying, assessing and managing risks related to the health, welfare and safety of people who used the service. Information in audits was not used to manage risks related to people who used the service. Concerns about the temperature in part of the home had not been risk assessed. A staff member told us, “It can be very, very hot on the top floor.” A person who used the service told us, “It gets hot, it can get very hot.”

We found the provider did not have an effective system designed to have regard to the complaints and comments made by people who used the service and those acting on their behalf.

Is the service caring?

We found the care and welfare needs of people who used the service were met in a sensitive and caring manner. One person told us, “We enjoy a bit of banter.”

During the SOFI observations we saw positive changes in people’s mood when staff interacted with them. We saw staff interacted positively with each person on a regular basis throughout the observation. We did not see any interactions we viewed as poor.

Is the service responsive?

We found care workers responded appropriately when people had the capacity to make decisions about their care and welfare. A person who used the service told us, “I feel able to make choices.”

There were sufficient staff to respond to people’s health and welfare needs and we saw staff respond appropriately to these. During the SOFI observations we saw staff were able to respond to people in a timely manner.

We found there was some reluctance amongst staff to work on floors other than the one they normally worked upon.

Is the service well-led?

We found the provider did not protect the rights of people who did not have the capacity to consent, because they did not act in accordance with the legal requirements of the Mental Capacity Act (2005).

We found people’s care and support was planned and delivered in a way that ensured their safety and welfare. The manager said they had put in an “incredible effort” to ensure all the care plans were reviewed and up to date.

Staff support and supervision did not take place as intended. A senior care worker said, “I like to think I am doing a good job, but it would be nice to be told so in supervision.” Some staff said they did not feel comfortable to raise things with the management team.