This inspection was unannounced and took place on 24 October 2017. The service is registered to provide accommodation and support for up to 25 people. At the time of our inspection, 12 people with learning disabilities were using the service.

At our last comprehensive inspection on 4 May 2017, the provider continued to be in special measures following a second inadequate rating. The overall rating for this service remains inadequate, and therefore remains in special measures. This inspection found that there were not enough improvements to take the provider out of special measures. CQC is pursuing the appropriate regulatory response.

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 timescale.

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 is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There was 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.

At our last comprehensive inspection in May 2017, the provider was in breach of eight Regulations. Risks to people had not been assessed, monitored or reviewed; incidents were not reported as potential safeguarding concerns; the provider had not followed guidance when people were unable to make decisions for themselves; people’s independence was not promoted; and people still did not receive care that was individual to them. In addition, the provider still did not have effective systems in place to ensure they met the standards required in the home. The provider had not met the requirements needed when things had gone wrong, and did not display their rating on the web site that was in place at the time.

We took enforcement action against the provider. On 7 August 2017, the provider informed the local authority that an action plan had been completed and submitted to the CQC. We had not received this. We asked the provider to send this to us, which they did on 11 August 2017. We saw that this action plan did not address two of the breaches in Regulations. We had also found that improvements were needed to ensure that people’s choices were listened to and that they were actively involved in making decisions about their care. At this inspection, we found that the actions had not been completed, and the provider had not made the improvements they were told to.

Risks to people were still not effectively managed, and the p

This inspection was unannounced and took place on 4 May 2017. The service was registered to provide accommodation for up to 25 people. At the time of our inspection, 13 people with learning disabilities were using the service.

At our last comprehensive inspection on 1 December 2016, the provider was placed into special measures by CQC following an inadequate rating. The overall rating for the service remains ‘Inadequate’ and therefore remains in ‘special ‘measures.’ This inspection found that there were not enough improvements to take the provider out of special measures. CQC is now considering the appropriate regulatory response.

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.

There was 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.

At our last comprehensive inspection, the provider was in breach of seven regulations. Fire safety procedures were not followed; people were living in an environment that had unpleasant odours; people’s health care needs were not responded to in a timely manner; their dignity was not promoted; care was not individual to people; the management was ineffective and they had not notified us about incidents when needed. We took enforcement action against the provider and they sent us an action plan on 4 January 2017 telling us how they would make improvements in these areas.

At this inspection, we found that the provider had completed some of these actions, but others were still outstanding. For example, few improvements had been made in relation to the individual and person centred nature of the support people received. In addition, whilst the audit system in place had been effective in relation to fire safety and the environment, and policies had been updated, the provider did not know what some of the policies were, and was not analysing the information gathered.

At our previous inspection, we also found that improvements were needed in various other aspects of the service. We were not confident that there were enough staff available for people during the night; staff did not have personal protective equipment readily available to them; the provider had not responded to safeguarding concerns as they should have done

This inspection was unannounced and took place on 1 December 2016. This comprehensive inspection was brought forward as a result of information received from the police and local authority about the way people were receiving care and support. The inspection did not look at the specific incident being investigated by the police but did look at whether people were being supported safely. The service was registered to provide accommodation for up to 25 people. At the time of our inspection, 13 people with learning disabilities were using 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.

There was 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.

Our last comprehensive inspection took place on 21 March 2016 and we found that actions were required to improve the care that people received. We told the provider to make improvements to ensure that they were acting lawfully when providing care and support to people who were not able to consent to this themselves. The provider should have sent us a report explaining the actions they would take to improve. However, they did not do this. At this inspection, we found insufficient improvements had been made. The provider had considered how they made decisions for people that were in their best interests, but they had not followed the guidance available.

People were not safe. The provider had not ensured that fire safety procedures were followed. We were not confident that there were enough staff to meet people’s needs and keep them safe at all times. Risks to people were not managed effectively and some people were at risk of not having their medicines as prescribed. People were living in an environment that was not free from unpleasant odours and staff did not have easy access to protective equipment such as gloves when needed. Even though staff were aware of how to protect people from harm, we did not have assurance that the provider acted upon concerns that were raised.

Referrals to healthcare professionals were not always made in a timely manner and the provider did not consistently respond to peop

This inspection was unannounced and took place on 21 March 2016. Southwinds is registered to provide accommodation for up to 25 people. At the time of our inspection, 13 people with learning disabilities were using the service.

There was 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.

At our last inspection on 31 December 2015, a warning notice was issued in relation to the need for consent. The provider sent us a report on 6 March 2016 explaining the actions they would take to improve. At this inspection, we found the issues resulting in the warning notice were no longer applicable. However, further improvements were required.

Even though people had capacity assessments in place, they were not decision specific and did not show how decisions made were in people’s best interests. We saw some people might have had restrictions placed upon them as they were not able to go out on their own and may not have had the capacity to make decisions about their safety. Applications to ensure these restrictions were lawful had not been made.

People received a varied and nutritious diet, however the changes we had previously been told about which would increase people’s choices had not yet happened. People did not have easy access to drinks. This meant that people were potentially at risk of not having enough to drink during the day.

We found that improvements were required to ensure the audits that were in place were effective in identifying any shortfalls and driving continuous improvement. Improvements were also needed to ensure all the records relating to people’s care reflected each individual and were reviewed regularly. The provider needed to improve the recruitment process so this was safe. We found the overall culture at Southwinds did not empower the people who used the service.

People were able to maintain relationships that were important to them. They had the opportunity to take part in various activities that interested them and knew how to make complaints or raise concerns. Work was in progress to enable people to contribute to the planning of their and staff treated people kindly and their privacy was respected.

People told us they felt safe and staff knew how to protect people from harm. Risks were assessed and staff knew how to manage these safely. Medicines were managed accordance with good practice and people’s health was maintained.

We found there were enough staff to meet people’s needs and staff told us they had received training to develop their knowledge and skills.

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

This unannounced inspection took place on 31 December 2015. At our last inspection on 13 August 2015 we found there were breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in respect of the way records were written and maintained, and the care and welfare of people who used the service.

Southwinds provides accommodation and personal care for up to 25 people with a learning disability. There were 13 people living in the home on the day of our inspection.

There was 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.

At the inspection in August 2015 a warning notice was issued as the provider was breaching legal requirements in the way people’s records and those relating to the management of the home were monitored and managed. At this inspection we found that some improvements had been made, however no action had been taken to protect the rights of people who lacked the capacity to make choices for themselves. When people were unable to consent, mental capacity assessments and best interest decisions were not completed. The provider had not considered that some people were being restricted and that deprivation of liberty safeguards referrals were needed.

There were no audits in place to monitor the quality of the service or incident trends to identify where improvements could be made.

Systems were in place to support staff and give them opportunities to discuss their performance and development. There were whistleblowing arrangements in place which staff could use anonymously if they preferred. Staff could use this to raise concerns about the care people received and the way the home was managed.

People received a varied and nutritious diet but were not provided with a choice of meals. People had access to health care professionals when specialist support was required.

People told us they felt safe. Risks associated with their care had been assessed in response to our previous concerns. Staff had received training to use equipment correctly and safely. Staff understood how to report concerns about people’s safety and how to protect them from harm and abuse. People told us they were happy with their care and we saw that the staff were kind. People were supported to maintain relationships with family and friends who were important to them.

People enjoyed socialising together and spending time alone if they preferred. If people were unhappy or wanted to raise concerns or complaints they knew who to speak with and felt their concerns would be listened to.

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

We carried out an unannounced comprehensive inspection of this service on 17 March 2015. Breaches of the legal requirements for the management of medicines, consent to care, arrangements for people’s care and welfare and the management of the home were found. After the comprehensive inspection the provider wrote to us to say what they would do to meet the breach of the legal requirements in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014 but did not include an action plan for the other breaches we identified.

We undertook this focused inspection on 13 August 2015 to check that they had followed their plan for improving the management of medicines and to confirm that they now met the legal requirements in all the areas in of concern we identified. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Southwinds on our website at www.cqc.org.uk

Southwinds provides accommodation and personal care for up to 25 people with a learning disability. There were 14 people living in the home on the day of our inspection.

You can read a summary of our findings from both inspections below.

There was 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.

At the focused inspection on 13 August 2015 we found the registered manager had made improvements to the way people's medicines were managed. People's prescriptions had been reviewed to ensure their prescribed medicines met their needs. However, reviews had not been carried out for some people who received pain relief medicines on an ‘as required basis’ to ensure their pain was still being managed appropriately.

At our last inspection we found there were no arrangements in place to monitor the quality of the service so that the information could be used to improve care for people. At the focused inspection we saw the registered manager had taken no action to address our concerns or meet the legal requirements of the Health and Social Care Act. The provider had not put in place arrangements to monitor the quality of the service including the need to check the accuracy of the care plans. People's level of risk was not reviewed regularly or updated to reflect accidents and incidents that had occurred, which could affect their safety. People living in the home had not been provided with opportunities to express their views anonymously, if they preferred, in a satisfaction survey.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

We inspected this service on 17 March 2015. The inspection was unannounced. The service provides accommodation and personal care for up to 25 people. There were 13 people living in the home on the day of our inspection.

There was 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.

At the last inspection in September 2014 compliance actions were issued as the provider was breaching legal requirements in the way medicines were managed. At this inspection we issued the provider with a warning notice as we found improvements were still required.

People told us they felt safe but we found they were not fully protected from risk because some of their risks had not been recognised or suitably assessed.

There had been no actions taken to update or identify some risks which affected the health and safety of people living in the home.

Staff received training to update their knowledge to care for people effectively. Staff were not provided with structured support systems to reflect on the care they provided to ensure their performance met people’s needs. Staff told us the understood the requirements of the Mental Capacity Act 2005 but did not put this into practice.

People were not involved in planning their care so that it met their individual needs, abilities and preferences. Staff chatted to people whilst they were delivering care but people were not supported to make choices for themselves about how they wanted to spend their time. People were not encouraged to maintain their independence or maintain independent living skills. People had limited involvement with the community they lived in.

There were no arrangements in place to monitor the quality of the service and use this information to improve care for people. People living in the home were provided with meetings but were not encouraged to express their views anonymously, if they preferred, in a satisfaction survey.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.You can see what action we told the provider to take at the back of the full version of the report.

This inspection was carried out by a CQC inspector. We spoke with nine people using the service, two relatives, three members of staff and the registered manager. We also reviewed records relating to the management of the service, which included four care records, staff training records, medication records and information relating to quality. We used the information to answer the five questions we always ask:

Is the service safe?

The provider had a system in place to monitor the quality of the service and ensure that people were safe. There was a current profile of risk in place for each person providing staff with the necessary information to keep people safe.

We found that annual reviews for each person had been completed by social workers and six monthly reviews of care and support had been carried out by the service. Where people's needs changed reviews had been held or information updated to provide a current record of people's support needs.

Some improvements had been made in managing medicines. There had been staff training in the safe handling of medicines and protocols established for some medicines that were given 'as required'. Cumulative totals of medicines in stock were not in place. It was therefore not possible to check that all medicines in stock were correct. Progress needs to continue. We identified other shortfalls in the way medicines were recorded and handled. We have asked the provider to tell us how they will make improvements.

Where people did not have capacity to make certain decisions, relatives, advocates and other professionals involved in the person's care had been involved in discussions to ensure decisions were made in the person's best interests. The provider had followed the principles of the Mental Capacity Act 2005.

We monitor the operation of the Deprivation of Liberty Safeguards (DoLS) that apply to hospitals and care homes. Training was being arranged for all staff in relation to the Mental Capacity Act 2005 and DoLS.. Key staff had information and knew how to make applications under this legislation. At the time of this inspection no one using the service was subject to DoLS.

Is the service effective?

We observed positive engagement between staff and people who used the service. Some people were unable to communicate verbally but had their own communication style using signs, sounds, body language and facial expressions. One person used Makaton, a language programme using signs and symbols to help people communicate.

People's health care needs were monitored closely. We saw that referrals had been made to a range of health professionals when concerns were identified in relation to people's health. We saw that each person had a six monthly or annual health check according to their GP's recommendation.

Some care and support records had been reviewed and updated. Some records had many additions and needed to be re-written for clarity and ease of use. We saw that some records relating to activities were not up to date and needed revision. Most information was in place although clarity was needed in some records.

Is the service caring?

We spoke with two relatives who visited the home regularly. They expressed high levels of satisfaction with the care and support provided by the home. One relative said, "I like the attention to detail and some strict routines. For instance X lost a lot of weight but has now regained weight because mealtimes and intake were monitored closely by staff. I am happy with the way staff deal with X. I know that X is safe and well-cared for." Another relative told us, "Staff are wonderful, nothing is too much trouble."

People we spoke with who used the service made the following comments: "It's good here everyone is nice". "I am happy here I like going out and doing the things I like". "It's good here, I watch sport and we play games together. We are all friends". "Staff are good to us and take us out."

Staff were able to tell us in detail about people's needs and how they supported them. We asked staff to engage with people who could not tell us their views of the service. People were asked for their views and responded positively with smiles and gestures indicating they were happy in their home. People were comfortable and relaxed in the company of staff.

Is the service responsive?

We saw from reviews of people's care needs that plans of care had been adapted when there had been a change in a person's needs or wishes.

Staff had responded to a suggestion from a social worker to consider a referral to an independent advocate for a person. The advocate had been involved in making a decision in the person's best interests.

When people's health needs had changed, external health professionals had been contacted in a timely way. Their advice had been sought, recorded and actioned.

Is the service well-led?

The provider is also the registered manager and has worked daily in the home since it was established many years ago.

People's views about the service are sought in reviews, questionnaires to relatives and people using the service, meetings of people using the service, staff meetings, staff supervision and appraisals.

Checks were completed to ensure the home provided a safe place to live. Risk assessments reviewed and reduced the risks to people. Incidents and accidents were monitored to ensure people's safety and wellbeing.

We inspected Southwinds on a follow up inspection. At our previous inspection in October 2013 we had concerns about the management of medication within the service and their recruitment procedures. We had also received information of concern about the staffing levels of the service at night. We returned to see if improvements had been made and to see if there were issues with inadequate staffing. This inspection was unannounced which meant the service did not know we were coming.

We spoke with the manager and deputy manager and looked at records.

We found that although some improvements had been made in the management of medication, the service still required some improvement.

We found that the correct recruitment procedures were being followed.

We saw records and the manager told us that there was sufficient staffing during the night.

This was an unannounced inspection. This meant the manager and staff did not know we were visiting. During this inspection we spoke with people that lived at the home, staff and the manager. We spent some time observing in the lounge as some people could not tell us about their experiences.

People we spoke with said they were happy living at the home. One person told us: "I'm happy here. I can go to my bedroom when I want. I do lots of drawing and writing".

Plans of care identified the support people needed. They gave information about the way people expressed their wishes and the help people needed to make decisions about their care.

People were supported to have their health and personal care needs met. People had regular health check-ups and were supported to receive specialist health care support.

Arrangements were in place to make sure that people had their nutritional needs met. Some people could be more involved in planning and preparing their meals.

Improvements were needed in the way the home managed people's medication. There was no system in place to check that people were having their medication as prescribed.

The home needed to ensure that all employment checks were made on staff that provided support to the people that lived at the home.

Surveys were in place to gain the views of people that lived at the home. These could be provided in a more suitable format. The home was monitoring the quality of care it provided to people.

We inspected Southwinds on a planned unannounced inspection which meant the service did not know we were coming.

Some people who used the service were unable to communicate with us due to their complex needs. Other people told us they liked living at Southwinds and had lived there along time. Some people had attended day services so we were unable to talk with them.

We observed that staff treated people with dignity and respect and offered appropriate and timely support when necessary.

Staff told us they were happy at Southwinds and felt they had sufficient training to ensure they completed their care roles effectively. They told us they felt supported by the manager and could go to them at anytime.

The service followed Staffordshire and Stoke- on -Trent's safeguarding policy and staff we spoke with were aware of the procedure and what constitutes abuse.

Quality assurance systems were in place to ensure the quality of the service being delivered was constantly monitored.

People who were able to talk to us said they were happy at the service. They told us that they took part in some activities and sometimes went out. Some people said they helped around the service for example helping with the laundry and in the garden. We observed that there was more that could be done to promote people's choice and independence.

People were sometimes consulted about their care and about the service through 'resident' meetings. The service did ask people to complete surveys but there had not been any for sometime.

People were having their health and personal care needs met. They saw the doctor, dentist and optician. When needed they went to see consultants who monitored their condition and reviewed their medication. Specialist such as occupational therapists and speech and language therapists visited the service to give people support.

People said they felt safe at the service. However staff were not fully aware of how to refer allegations of abuse. People may not always have their rights upheld as staff did not know about all the provisions of the Mental Capacity Act 2005.

The service did not have adequate systems to review and monitor the care people were receiving as the managers were providing direct care to people.

We spent two hours observing people in the lounges. We spoke to three people that lived at the service and asked them about the activities they do and about the choices they made about their lifestyle.

People had a schedule that showed how their social care needs such as activities and trips out were to be met. We saw that most people were taking part in some activity including playing cards, reading, games and playing musical instruments. However one person with high dependency needs did not have the staff support to undertake an activity. One person told us that they were a bit bored and wanted more things to do. People said that when the weather was fine they helped in the garden. We observed that some people spent time in their bedrooms watching TV and a few people were out in the community at day services. Although most people went out at least once a week the opportunity for some people to access the community was limited both by staffing levels and the lack of a driver for the mini bus. It was not clear how much choice people were provided with over meeting their social care needs. Two people said that they did not have a choice over meals and for those that needed staff support to access the community this appeared to be initiated by the staff rather than people making the choice to go out.

People could attend ‘resident’ meetings where social care issues were discussed. We also saw that an advocacy service was supporting people to make choices about their future care needs.

We observed that most people had staffing support to have their needs met but there were times when there was not sufficient staffing to fully support people's social care needs. This was partially due to the reduction in available day care provision, staff shortages and the increased needs of some people. People told us that they had previously gone out several days a week but this had now been reduced. The staff confirmed this to be the case. People told us that they got on with the staff. We did observe times when a small group of less dependent people were left alone to take part in activities when they may have needed staff support to make the activities more meaningful.