Southdowns Nursing Home

Southdowns Nursing Home provides accommodation, personal and nursing care for up to 50 people living with physical frailty, sensory impairment, dementia, and mental health problems. There were 46 people living at the home at the time of our inspection. Accommodation is arranged over 2 floors and each person had their own bedroom. Access to each floor is gained by a lift, making all areas of the home accessible to people.

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

The governance systems in place did not support the service to consistently improve and sustain safe care delivery. Audit systems and processes failed to identify risks to people's safety. There was a lack of clear and accurate records regarding some people's care and support. For example, people who lived with emotional distress and how staff manage their needs safely.

Communication methods used between staff were not always used effectively to inform staff of changes to people’s care. Care records were missing vital points for staff to follow up on, such as recent incidents, bruising noted or who was not receptive to personal care. Changes to people’s health and well- being were therefore not always planned for and monitored effectively.

Whilst staff numbers were appropriate and based on peoples’ dependency needs, the deployment of staff had the potential to impact on peoples’ safety. For example, lack of supervision in communal areas.

People received care and support from staff who were appropriately recruited and trained to recognise signs of abuse or risk and understood what to do to safely support people. People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible.

Referrals were made appropriately to outside agencies when required. For example, GPs, community nurses and speech and language therapists (SALT). Notifications had been completed to inform CQC and other outside organisations when events occurred.

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 31 December 2019).

Why we inspected

We received concerns in relation to staffing, risk management and care delivery. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see safe and well led sections of this full report.

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

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

Enforcement

We have identified breaches in relation to safe care and treatment and good governance.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

The home was currently closed to all visitors apart from those who were on a palliative care pathway and end of life. Staff supported people to remain in contact with their families through a secured Facebook page, and phone and video calls at this time. There was a visiting policy to support visitors once the home re-opens. The provider has also constructed a room with a large window attached to a communal quiet room with a separate entrance. This will allow families to visit their loved ones safely.

There were systems in place to ensure that people who had tested positive for Covid-19 and were self-isolating were cared for in their bedrooms to minimise the risk of spreading the virus. The contingency plan demonstrated that the layout of the premises allowed zoning to reduce risk of Covid-19 spreading. Zoning is a strategy to dedicate one specific area of the home to people who have tested positive to Covid-19. This also allowed for a separate staff team to work safely. In practice this had been adapted and updated to reflect what they had learnt from experiencing an outbreak.

At the time of the inspection visit, the isolation period had passed and people were able to move around the home freely. People who chose to visit the dining areas or communal areas were supported by staff to maintain social distancing. For example, chairs and tables had been re-arranged to allow more space between people. We saw people engaging in a variety of activities with staff.

The home was clean and well maintained. There was regular cleaning throughout the day and this included high-touch areas. The housekeeping staff were knowledgeable regarding current Covid-19 cleaning guidelines and robust cleaning schedules were in place.

Staff were provided with adequate supplies of personal protective equipment (PPE) and staff were seen to be wearing this appropriately. There were infection control champions who took a lead in infection control training and undertook spot checks to ensure good practice was maintained. Staff had received specific Covid-19 training, and this included guidance for staff about how to put on and take off PPE safely. Hand sanitiser was readily available throughout the home. Regular testing for people and staff was taking place. All staff have a weekly polymerase chain reaction (PCR) and daily lateral flow test (LFT). In addition, they have their temperatures taken daily. People have a monthly PCR test with twice daily temperatures and oxygen level checks.

About the service:

Southdowns Nursing Home provides accommodation, personal and nursing care for up to fifty people living with dementia and mental health problems. There were 46 people living at the home at the time of our inspection. Accommodation is arranged over two floors and each person had their own bedroom. Access to the each floor is gained by a lift, making all areas of the home accessible to people. Southdowns Nursing Home is a large detached house in a residential area of St Leonards on Sea, close to local amenities.

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

People received safe care and support by staff who had been appropriately recruited, trained to recognise signs of abuse or risk and understood what to do to safely support people. One person said, “I feel safe, I trust the staff,” and “I am happy here.” People were supported to take positive risks, to ensure they had as much choice and control of their lives as possible. We observed medicines being given safely to people by trained and knowledgeable staff, who had been assessed as competent. There were enough staff to meet people's needs. The provider used a dependency tool to determine staffing levels. Staffing levels were regularly reviewed following falls or changes in a person's health condition. Safe recruitment practices had been followed before staff started working at the service.

Staff knew people and their needs well and received the training they needed to meet people’s needs safely and effectively. The training matrix tracked staff training and this had ensured all staff received the training and updates needed to provide safe consistent care. The staff rotas confirmed that staff deployment was consistent and that staff skills were considered when planning the rotas. A first aider and fire officer were deployed on each shift. The organisation was committed to developing staff and staff were attaining further qualifications whilst working at Southdowns Nursing Home. For example, assistant practitioners were being supported to do their training to become qualified nurses. A plan of supervision to support staff was available and this also included competency sessions on training received. One staff member said, “We have regular supervision and staff meetings we can go to the manager anytime we need to.” People’s nutritional and health needs were consistently met with involvement from a variety of health and social care professionals. Peoples’ weight was monitored and fortified food provided. People enjoyed the food and comments included, “very good food, plenty of homemade cakes and fresh food and snacks.” Visitors felt the chef was “Fantastic” and the food always ‘good’ and attractively presented.’

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.

Everyone we spoke to was consistent in their views that staff were kind, caring and supportive. People were relaxed, comfortable and happy in the company of staff and we saw lots of positive interactions during the inspection. Visitors told us, “The staff here are very committed and the atmosphere is really nice.” People’s independence was considered important by all staff and their privacy and dignity was also promoted.

Activities reflected people’s preferences and interests. People were encouraged to go out and meet family and friends and families were welcomed in to the home. Activities and the introduction of the Namaste sensory pathway was an important part of the positive culture of the service. Staff knew people’s communication needs well and we observed staff communicating with people in an effective way.

Staff were committed to delivering care in a person-centred way based on people's preferences and wishes. People were involved in their care planning as much as they could be and families told us that they were involved in the well-being of their oved ones. One visitor said, “I can’t thank the staff enough, they look after me as well.” People were encouraged and supported to be involved in the running of the home and some people were ambassadors and champions. For example, one person was the champion for safeguarding and attended training and was involved in the recruitment of staff. End of life care planning and documentation guided staff in providing care at this important stage of people’s lives.

People, their relatives and health care professionals had the opportunity to share their views about the service. Complaints made by people or their relatives were taken seriously and thoroughly investigated. The provider and registered manager were committed to continuously improve, and had developed structures and plans to develop and consistently drive improvement within the service and maintain their care delivery to a good standard.

Regular quality audits were completed to manage oversight of the service, The management team had recognised that improvements were needed to the management of medicines and recently introduced on-line electronic medicine administration records, with the aim to reduce errors.

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 25 April 2017)

The overall rating for the service has remained Good.

Why we inspected:

This was a planned inspection based on the previous rating.

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.

Southdowns Nursing Home provides accommodation, personal and nursing care for up to forty eight people living with dementia and mental health problems. There were 47 people living at the home at the time of our inspection. Accommodation is arranged over two floors and each person had their own bedroom. Access to the each floor is gained by a lift, making all areas of the home accessible to people. Southdowns Nursing Home is a large detached house in a residential area of St Leonards on Sea, close to local amenities.

A registered manager was responsible for the day to day management of the home. 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 an inspection in July 2015, Southdowns Nursing Home was rated as inadequate with breaches of regulation. At that time we took appropriate enforcement action. The provider sent us an action plan stating the breaches of regulation would be addressed by 30 December 2015. At our inspection in February 2016, we found our concerns had been addressed, although improvements were required. This inspection was to see if the improvements had been made and sustained. We found that improvements had been made and sustained.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, registered manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. People’s mental capacity was assessed and reviewed regularly to ensure that decisions made were still valid and in their best interest.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans had been developed and they were still looking to improve them by introducing a computer based system, which would include risk assessments and graphs to monitor falls and weight loss. Nurses wrote the care plans and all staff recorded the care and support provided and any changes in people’s needs. The registered manager said care staff were being supported to do this and additional training had been arranged for those who required it. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people's needs were met. There were systems in place for the management of medicines and people received their medicines in a safe way.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there were always sufficient number with the right skills when people moved into the home. The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people's needs. All new staff received an induction and told us that it was a good introduction to the service and felt supported by the care and management team. All staff received regular supervision from senior staff and felt that this gave them the opportunity to discuss any learning needs.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the registered manager was always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. A number of audits had been developed including those for infection control, care plans, falls, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

At the last inspection on 07 and 09 July 2015 they were rated as inadequate. The Care Quality Commission (CQC) issued Warning Notices after the inspection in respect of the safety and welfare of people, meeting peoples nutritional needs, staffing and treating people with respect and dignity. We found the provider had met the Warning Notices.

We also asked the provider to make improvements to the monitoring and assessing of the quality of the care and support provided. The provider sent us an action plan stating they would be addressed by 30 December 2015. We found our concerns had been addressed, although additional improvements were required.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider, manager and staff had an understanding of their responsibilities and processes of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. However we found that the DoLS applications were not all completed properly, for example they lacked the reason that the application had been made. We also found that the conditions of the standard authorisation granted for some people were not followed or reflected within the care plan. We have recommended that further expert advice is sought to underpin the training received.

We also found that whilst there was an organisational induction process in place, not all staff had been signed off as competent and there were no competency assessments for staff that deemed them competent to undertake care delivery. This is an area that requires improvement.

The care planning system had been reviewed and records for each person were specific to their needs, with guidance for staff to ensure people received the support and care they needed and wanted. Staff said the care plans were still being developed and they were still looking to improve. Nurses wrote the care plans and all staff were expected to record the care and support provided and any changes in people’s needs. The manager said care staff were being supported to do this and additional training had been arranged. Food and fluid charts were completed and showed people were supported to have a nutritious diet.

Staff and relatives felt there were enough staff working in the home and relatives said staff were available to support people when they needed assistance. The provider was actively seeking new staff, nurses and care staff, to ensure there was a sufficient number with the right skills when people were able to move into the home. The manager told us it had been difficult to recruit nurses with the right knowledge and understanding of supporting people with dementia, a deputy manager had been appointed and the provider continued to advertise for full time nurses. However, they had to rely on staff doing overtime and on agency staff at times.

Pre-employment checks for staff were completed, which meant only suitable staff were working in the home.

The provider had made training and updates mandatory for all staff, including safeguarding people, moving and handling, management of challenging behaviour, pressure area care, falls prevention and dementia care. Staff said the training was very good and helped them to understand people’s needs.

All staff had attended safeguarding training. They demonstrated a clear understanding of abuse and said they would talk to the management or external bodies immediately if they had any concerns, and they had a clear understanding of making referrals to the local authority and CQC. People said they were comfortable and relatives felt people were safe.

Visits from healthcare professionals were recorded in the care plans, with information about any changes and guidance for staff to ensure people’s needs were met. There were systems in place for the management of medicines and we observed staff completing records as they administered medicines.

Staff had a good understanding of people’s needs and treated them with respect and protected their dignity when supporting them. A range of activities were available for people to participate in if they wished and people enjoyed spending time with staff.

Staff said the management was fair and approachable, care meetings were held every morning to discuss people’s changing needs and how staff would meet these. Staff meetings were held monthly and staff were able to contribute to the meetings and make suggestions. Relatives said the management was very good; the manager was always available, they would be happy to talk to them if they had any concerns and residents meetings provided an opportunity to discuss issues with other relatives and staff.

The provider had systems in place to review the support and care provided. A number of audits had been developed including those for care plans, medicines and health and safety. Maintenance records for equipment and the environment were up to date, such as fire safety equipment and hoists. Policies and procedures had been reviewed and updated and were available for staff to refer to as required. Staff said they were encouraged to suggest improvements to the service and relatives told us they could visit at any time and they were always made to feel welcome and involved in the care provided.

People we were able to speak with who lived in the service told us they liked living at 'Southdowns Nursing Home.' We were told, "I am very lucky to live here, sometimes I grumble but the staff understand me so well,' and, "It is nice here.' We also spoke with relatives/visitors. One visitor told us, 'Wonderful place, the staff are very committed.'

People's views and experiences were taken into account in the way the service was provided and delivered in relation to their care. When individuals were unable to personally be involved in decisions about their care, families and next of kin were approached and consulted. We found that care and treatment was planned and delivered in a way that ensured people's safety and welfare. There were effective recruitment and selection processes in place and staff records and other records relevant to the management of the service were accurate and fit for purpose.