Southbourne Care Home

Southbourne Care Home is a care home without nursing registered to provide accommodation and care for up to 27 people. People living at the service are mostly older people, some of whom may be living with dementia or a mental health illness. At the time of our inspection there were 27 people using the service.

People’s experience of using this service and what we found

People told us they were happy with the care they received, and people said they felt safe living there. Comments from people included; “I am safe and staff help me” and “I can talk to (named registered manager).” While a relative said; “I’m happy with everything and I know (named relative) is safe here.” People looked relaxed, happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service.

The environment was safe and there was equipment available which protected people from harm and supported staff. Health and safety checks of the environment and equipment were in place.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately. Medicines were ordered, stored and disposed of safely.

People were protected from abuse and neglect. People's care plans and risk assessments were clear. Records were accessible and up to date. The service used a computerised care planning system. The management and staff knew people well and worked together to help ensure people received a good service.

People were supported by staff who completed an induction, received appropriate training and support to enable them to carry out their role safely. This included fire safety and dementia care training. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and staff carried out activities to assist people. Staff knew how to keep people safe from harm.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

Staff told us the registered manager was available, assisted them daily and helped cover shifts when some staff had been absent with COVID-19. They went onto say how the registered manager was approachable and listened when any concerns or ideas were raised. One staff member said; “Very supportive team” and another “(named registered manager) has an open-door policy and we can talk to them at any time and about anything.” One relative said; “They (the registered manager) will sort things straight away if I ask anything.”

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

Rating at last inspection and update

The last rating for this service was good (published 24 October 2019).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service, staffing and management.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has not changed and remains good. We found no evidence during this inspection that people were at risk of harm from these concerns. Please see the Safe, Effective and Well led sections of this full report.

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

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

We found the following examples of good practice.

Systems were in place to help manage the risks and prevent the spread of COVID-19.

Visitors to the service had been restricted to essential visitors only. There was a clear system in place for visitors to ensure they followed the current guidance on the use of personal protective equipment (PPE) and social distancing.

Visitors were asked to consent to a rapid COVID-19 test, have their temperature checked, wash their hands and complete a health declaration before they would be allowed to enter the building.

The provider was currently considering how they could safely support family visits once the national lockdown was lifted. Staff were supporting people to maintain contact with their relatives through use of mobile phones and video calls.

Staff had received training in infection prevention and control and the use of PPE including masks, gloves, aprons and hand hygiene.

There were sufficient stocks of PPE available and staff were seen to be wearing PPE appropriately.

People and staff took part in regular COVID-19 ‘whole home’ testing. People and staff who tested positive followed national guidance and self-isolated for the required amount of time.

Cleaning schedules and procedures were in placed and had been enhanced to include more frequent cleaning of touch points, such as, handrails and light switches.

The provider had developed specific COVID-19 policies and procedures which had been reviewed and updated where necessary in line with the latest guidance. Regular audits and checks were in place to ensure optimum infection control practice was adhered to.

Southbourne Residential Care Home (hereafter referred to as Southbourne) is a residential care home providing personal and nursing care to 27 older people at the time of the inspection. The service can support up to 27 people who may need support with their physical and mental health and may be living with a dementia.

The service has gardens and is close to the sea and local parks, it is set over two floors which are made accessible by a lift.

People’s experience of using this service and what we found

People told us they felt happy and safe living in Southbourne. Medicines were managed safely and there were enough staff to meet people’s needs. The service was clean and fresh smelling throughout despite extensive renovation works. The service acted swiftly when a new risk emerged for a person and supported them to have choice but still remain safe.

People were supported by staff who had attended training in courses specific to their needs. People were offered a choice of food and drinks and told us they enjoyed the food. Mealtimes were calm and had a pleasant atmosphere. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff were kind and caring and knew people well. The service considered things that would make the environment homelier, such as people being able to make themselves drinks and having snacks whenever they wished to. The service had bought in some specialised electronic soft animals that behaved like pets to reassure and soothe people with advancing dementia who were comforted by animals. People were asked how they would like their care delivered and families were given opportunities to input into care planning where appropriate.

Care plans were personalised, and the manager had plans to further enrich them with people’s in-depth life histories. The service supported people to engage in activities both inside and outside of their home. People’s communication needs were being met and complaints were acted upon.

The service was well-led, with a positive manager who treated people with dignity and respect and care staff followed their good practise. Quality checks were undertaken on both the physical aspects of the service such as fire and building safety but also the quality of interactions of care staff with people.

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

Rating at last inspection

The last rating for this service was good (published 13 October 2018).

Why we inspected

This inspection was prompted in part due to quality concerns we had about two of the other homes in the provider group. However, we found no concerns during our inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Southbourne Care Home (referred to in this report as Southbourne) is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Southbourne accommodates up to 21 people in one adapted building. At the time of our inspection there were 17 people living in the home.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Following our previous inspection in February 2017 Southbourne had employed a new manager who provided day to day management and had made a number of improvements. Therefore, the rating at Southbourne improved to ‘Good’ in all areas and ‘Good’ overall.

People and relatives praised the staff and management of Southbourne. Comments we received included; “I have to say that the care here is fantastic. They are very caring with mum. She’s being really well looked after” and “The care is fantastic. Really caring.” People were held in high regard, had a good quality of life, had freedom to make choices and were supported to be independent. People were encouraged to go out into the community where possible. Staff treated people with respect and kindness.

People who lived in Southbourne were protected from risks relating to their health, mobility, medicines, nutrition and possible abuse. Staff had assessed individual risks to people and had taken action to seek guidance and minimise identified risks. Staff knew how to recognise possible signs of abuse. Where accidents and incidents had taken place, these had been reviewed and action had been taken to reduce the risks of reoccurrence. Staff supported people to take their medicines safely and staffs’ knowledge relating to the administration of medicines were regularly checked. Staff told us they felt comfortable raising concerns.

Action had been taken to ensure staff understood the Mental Capacity Act 2005, the principles of the Act and how to apply these. We found people were involved in all aspects of their care and their consent had been sought prior to any care being delivered. Where people had been unable to make a particular decision at a particular time, their capacity had been assessed and best interests decisions had taken place and recorded. Where people were being deprived of their liberty for their own safety the registered manager had made Deprivation of Liberty Safeguard (DoLS) applications to the local authority.

Improvements were in the process of being made to the environment and large building work was underway. Although the premises looked a little tired during our inspection, clear signage and door colours had been implemented in order to help people navigate the home and find their bedrooms. The plans for the future environment at Southbourne had been designed with people’s needs in mind. The manager told us about the new upcoming features which would improve the lives of the people who lived in the home, such as more outside space people could access and easily accessible facilities for people to make themselves drinks and snacks.

Recruitment procedures were in place to help ensure only people of good character were employed by the home. Staff underwent Disclosure and Barring Service (police record) checks before they started work. Staff knew how to recognise possible signs of abuse in order to protect people. Staffing numbers at the home were sufficient to meet people’s needs. Staff had the competencies and information they required in order to meet people’s needs. Staff received sufficient training as well as regular supervision and appraisal.

People, relatives, staff and healthcare professionals were asked for their feedback and suggestions in order to improve the service. People were provided with enough food and fluids to meet their needs. Care was taken to ensure people enjoyed their food and it met their personal preferences.

People had access to activities which met their needs. The manager and staff were continuously looking for ways to improve people’s lives through activities and engagement. During our inspection we saw people being encouraged to join in activities and enjoying themselves.

Further information is in the detailed findings below

The inspection took place on 27 and 28 February 2017 and the first day was unannounced.

A registered manager was employed at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was also one of the directors of the company that own the service and they were also registered as manager of another service owned by the provider. They were supported in their role by a recently appointed manager who had day to day control of the service.

Southbourne was rated as requires improvement at the comprehensive inspection in November 2014 and again in December 2015. CQC issued warning notices to the provider telling them they must take action. Although sufficient action was taken at that time to make improvements, these have not all been sustained.

At this inspection in February 2017 we found improvements to the quality assurance processes had not been sustained. Systems had not been established that ensured the provider could identify where person centred care had been compromised. For example, the systems had not identified the how the lack of personalised information in care plans had impacted on the person centred approach to people’s care. Also, the discrepancy with people’s finances had not been picked up. There was contradictory information with regard to some risks assessments. Improvements to the general environment such as signage had been needed for some time and had not been addressed. Issues relating to cleanliness in people’s bedrooms had not been identified and addressed.

People did not always receive care that was personalised for them. Some aspects of peoples care had been assessed and were being met. However, there was little evidence people were assessed as a whole person and plans put in place to put the person at the centre of their care. There was little information on care plans for staff to help them meet people’s social care needs. Some information about the person’s life, the work they had done, and their interests was recorded in their care files and this could have been used to develop personalised ways of stimulating and occupying people.

Only three hours staff time per week were allocated to providing activities. Four outside entertainers were booked each month. Staff did tell us that they had time to sit and chat with people and people confirmed this. We saw staff had some time to spend sitting with people. We also saw that one person was taken out shopping each week by a member of staff.

The financial records for three people contained small discrepancies between the records and the amounts of cash held. Following the inspection the manager sent information telling us the discrepancies had been accounted for in the way balances had been recorded and plans had been put in place to minimise the risk of this reoccurring.

One member of staff, whose first language was not English could not understand the questions we asked about reporting abuse. The management team told us they always ensured the staff member was on shift with other staff whose first language was the same. Following the inspection further systems were put in place to ensure all staff knew how to report any suspicions of abuse. We also raised concerns that staff whose first language was not English would not be understood by people living with dementia. However, we saw no evidence that this was the case. Interactions we saw were positive with many smiles and nods.

Risks to people’s health and welfare were minimised. Risks such as falls and pressure areas were assessed and well managed. However, some contradictory information in one person’s care plan meant they may be at risk of not having their nutritional needs met, although we saw no evidence of this.

The environment needed further improvement to make it suitable for people living with dementia. There was limited signage to help people find their way around. One toilet on the ground floor had no sign indicating it was a toilet. The provider told us they intended to refurbish the ground floor and would include many improvements to make the environment more suitable for people living with dementia. Some areas of the service, particularly bedrooms were untidy. For example, one bedroom had food all over the floor and another had a pile of dirty clothes on a table. The manager arranged for these matters to be dealt with straight away. Other areas of the service, such as the lounge, hallway and dining room were clean and free from offensive odours.

Staff did not have a good understanding of the principles of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). However, throughout the inspection we heard staff applying the principles of the MCA. That is staff assumed people had capacity to decide things for themselves. Staff asked people what they wanted to do and frequently offered choices of food and drink. Staff also asked people for their consent before they provided any care.

Not everyone living at Southbourne was able to tell us about their experiences. Therefore we spent some time in the main lounge and used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us. We saw some good interactions between staff and people living at the service. With people being engaged in conversations about what they liked to do. However, we noted that for over 30 minutes there was no interaction between staff and people in the main lounge.

People received personal care from staff that were trained and knowledgeable in how to support them. People’s needs were met by ensuring there were sufficient staff on duty. Relatives and visiting professionals we spoke with told us they felt there were enough staff available whenever they visited. During the inspection we saw people’s needs were met in a timely way and people did not have to wait for long periods of time for their needs to be met. Staff told us they felt there were enough staff available. People were protected from the risks of unsuitable staff being employed to care for them, as there were robust recruitment procedures in place.

People’s needs were met by kind and caring staff. We saw people were relaxed and happy in staffs’ presence. Staff carried out their duties in a caring and enthusiastic way. Comments from people included “They (staff) do more than is asked of them.” Comments from visitors included “Everyone’s very helpful – can’t fault it” and “Lovely people, and they (staff) are looking after her [relative] very well.” People’s privacy and dignity was respected and all personal care was provided in private.

People’s care plans were reviewed regularly. People and their relatives were supported to be involved in making decisions about their care. The manager had started to hold more regular meetings for people and their families where they could raise any concerns. People and their relatives were confident that if they raised concerns they would be dealt with.

People’s medicines were managed safely and they were supported to maintain good health. Records showed people had seen their GPs and health and social care professionals as needed. One visiting healthcare professional told us that the home was very good at contacting them when required. They said staff always acted on any advice given.

People were supported to maintain a healthy balanced diet. People told us they were happy with the meals served to them and always had a choice of main meal. Meals at Southbourne were not cooked at the service but at another nearby service operated by the same provider. They were then transported to Southbourne in a sealed system. The management told us there was always sufficient food available and staff had access to food at other times if needed, for example if someone wanted a sandwich in the middle of the night.

The manager and registered manager were open and approachable and they told us of their plans to improve the service. Staff spoke positively about the manager. One told us “You can talk to [name] about anything.” Staff also praised the registered manager, they told us “If you want anything [name] will arrange it.” Staff told us they felt well supported and received regular supervision.

We have made recommendations in relation to medicines management, the MCA and the environment.

We found two 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 this report.

This inspection took place on the 20 April 2016 and was an unannounced focussed inspection.

The home had previously been inspected on 17 and 18 November 2014 in response to concerns we had received. At that time we identified concerns over keeping people safe, staff training, staffing and staff recruitment. Breaches of legislation were identified in relation to quality assurance, person centred care, cross infection and record keeping.

In December 2015 we carried out a comprehensive inspection at the home to see what progress had been made. We found that although there had been improvements there were still areas that caused us concern. The provider and registered manager had not completed all areas of their action plan. The home was rated as ‘requires improvement’ overall, and breaches of legislation were identified.

Following the inspection of 2 December 2015 we issued the provider and registered manager with a warning notice in relation to Regulation 17 (1) and (2) (a) (b) and (c) of the Health and Social Care Act (Regulated Activity) Regulations 2014 (Good Governance). The provider and registered manager needed to comply with the warning notices by 25 March 2016.

The registered manager sent us an action plan telling us what actions they had taken to improve.

This focussed inspection was carried out to ensure the provider had met the detail of the warning notices for Regulation 17 (Good Governance). Other areas for improvement identified during the inspection of 2 December 2015 remain part of the home’s ongoing action plan, and will be looked at on the next comprehensive inspection.

We found that the provider and registered manager had taken sufficient action to meet the requirements of the warning notice.

There was a registered manager in post. A registered manager is a person who has registered with the CQC 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.

Staff recruitment processes and records had been strengthened to help protect people and provide greater assurance of their character and work performance. References had been obtained and disclosure and barring service (police) checks had been undertaken before any new staff started to work with people. Systems had been put in place to assess any risks in relation to staff recruitment and gaps in people’s employment history had been explored. The provider was taking steps to see this was backdated for staff that had been employed by the home for some time.

Systems for the management and assessment of risks had been improved. Records of risk assessments had been strengthened, spot checks were taking place and regular audits were being carried out to identify risks, for example from the environment. Where risks were identified there were management plans in place to reduce them where possible. New systems had been put into place to ensure the risks of cross infection were reduced. This included more regular audits, cleaning schedules and improved equipment.

Records, policies and procedures had improved. People’s care plans reflected their needs, wishes and aspirations regarding their care in more detail, and inconsistencies in people’s plans had been removed.

Action plans for the development of the service had been implemented and had been or were being completed. These had been shared amongst the management team so that clearer objectives that were measurable and achievable were in place. The registered manager and trainee manager (who was in day to day control of the home under the supervision of the registered manager) were meeting regularly to review the plans and ensure they had been completed and improvements were sustained.

Quality assurance systems including regular audits of the service were being completed. These had led to improvements for people, and positive feedback from relatives and people living at the home. Professional advice was being taken and acted upon, and the home’s management was undertaking assessments of the services they provided against best practice in dementia care. This had led to new action plans in areas such as the development of memory boxes and changes to the decor.

This report only covers our findings in relation to compliance with the warning notice for Regulation 17 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Southbourne care home on our website at www.cqc.org.uk.

The ratings identified on the inspection of 2 December 2015 have not been changed as a result of this inspection but will be updated at the next comprehensive inspection. A comprehensive inspection will take place to inspect all five questions relating to this service. These questions ask if a service is safe, effective, caring, responsive and well led. At the next inspection we will also check to ensure improvements made for this inspection have been sustained.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

This is a summary of what we found:

Is the service caring?

People who were able to speak with us told us they were very happy with the level of care and support they received. One person told us 'People are very kind. They've a big job to do.' Another said 'The girls are sweethearts'. Staff we spoke with told us they enjoyed working with people who lived at the home. One told us 'I like everything about (my job). I just love looking after the people'.

We observed staff communicating with people clearly and at an appropriate pace about their care. For example we saw that staff explained clearly and slowly to one person about how they could manoeuvre their walking aid independently. We saw they walked with the person to help them walk independently. This told us that staff took the time to ensure the person was supported and communicated with about their care in ways they could understand.

Is the service responsive?

Prior to the inspection we had received concerns that activities were no longer being provided at the home since the change of ownership. We had been told this was because staffing levels had been cut. We found that there were not enough activities or stimulation being provided for people to meet their needs for social interaction. One visitor told us about their experiences with their relation. They told us 'We came and took her out every day. We got her wheelchair out on the bus and she was able to speak to people. She was really happy and chatty and smiling. She doesn't really have anyone to talk to in there. The residents are almost always asleep in the lounge.' This demonstrated to us that people would benefit from appropriate and targeted activities being provided. We saw that some action had been taken by the manager to respond to concerns raised with her about the lack of activities provided, but that this was very much 'work in progress'.

During the inspection discussions with a person who lived at the home highlighted a concern about the way they had been spoken to by a staff member. We discussed this with the manager, who informed us they had been made aware of the concern by the person two days previously. No action had been taken to investigate the concern further or give feedback to the person who raised the concern. This told us the provider had not always responded to complaints and comments about the home or services provided.

Is the service safe?

Staff and visitors told us they were concerned that there were not enough staff on duty at certain times of the day, and that they had raised their concerns with the provider. We saw there had been repeated incidents where people had fallen and injured themselves that had been unwitnessed. We found that there were not enough staff on duty to provide care or observation for people to support them safely. We found that the provider had not responded to the concerns raised to identify the risks to people from the staffing levels in place.

We found that many people's risk assessments or care plans had not been updated since February or March 2014. This gave us concerns that people's up to date care needs or risks had not been identified or included in plans of care. This left people at risk of unsafe or inappropriate care.

We found that where some people lacked capacity to make decisions the provider had not acted in accordance with legislation to ensure people's rights were protected. This was because they had not ensured that best interest decisions had been made and recorded.

CQC is responsible for monitoring the deprivation of liberty safeguards which applies to care homes. No-one at the home was subject to an authorisation by the Court of Protection. However the home manager was aware that following a recent Supreme Court judgement, applications would need to be made to ensure that where people had been deprived of their liberty, through for example locked doors, this was lawful. No action had yet been taken to do so, and the provider had not taken advice about appropriate actions they should be taking. This meant that the provider had not acted to ensure that people's rights were protected and that where people were being deprived of their liberty this was not in accordance with the protection of legislation.

We saw routine maintenance and risk assessments of the premises had been undertaken.

Is the service effective?

We saw that people were receiving healthcare from community medical and nursing services. However, we found that people's care plans and assessments had not been regularly updated since the new provider had taken over the home. This meant that people's up to date needs could not be identified or met effectively. Care given was not being evaluated so the provider could not assure us that it was effective.

We found that records overall were poorly maintained. Some records were poorly completed or did not link to other records. This led to difficulties in tracking people's current care needs or identifying risks.

We did not see that the home had responded to people's needs and put clear strategies in place to support people with their confusion or ensure any risky behaviours were managed. This left people at risk of receiving inconsistent or inappropriate care.

Is the service well led?

Since the last inspection the home had changed ownership and the registered manager had left. A manager had been moved from another home owned by the provider to manage Southbourne and they had been there for about four weeks when we inspected the home. Prior to that management was being provided by another manager from within the company. The manager in post told us they had not yet made an application to register as the manager at Southbourne but intended to do so. They are referred to throughout this report as the manager.

People we spoke with told us they liked the manager. They told us she was approachable and felt confident speaking with her. One said 'The manager is very understanding and I could report anyone to her.'

We identified concerns over the lack of clear management systems at the home. We saw that there were plans in place to carry out effective audits to ensure the quality of the services provided. However we saw these had not started or been completed at Southbourne. This meant we could not clearly identify the quality of the services or systems provided.

We found there was a lack of documentation and a lack of consistency with record keeping. This told us that proper systems were not in place to ensure records were managed, completed or used effectively to safeguard or improve people's care.

We were told by the provider that they did not yet know what the clear direction was for the future of the home with regard to dementia care. This gave us concern that the home's management were not clear about the home's admission criteria or what developments were needed.