Southdowns Nursing Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

There was evidence of learning from incidents and accidents. Staff were able to tell us how to keep people safe from harm and abuse. Staff had received relevant training in relation to their roles. We observed there were enough staff to meet people’s needs. The premises were safe and well maintained. We observed the home was clean and staff followed infection prevention and control practices. There were safe practices in relation to safe and effective staffing and robust recruitment processes. People were given their medicine in a timely manner and administration of medicines was appropriately recorded. There were processes in place to support good medicines optimisation. We observed people’s individual risks were being managed and people had accessed external support to meet their individual needs.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The culture of the service was positive and one where learning was part of every day practice. The registered manager was available and approachable to staff, people and families. The staff team felt valued and well supported in their roles, and able to ask anything or make suggestions for improvement of the service. There were systems in place to monitor the quality of care, where changes were necessary, actions plans were routinely applied and monitored to ensure continued learning.

Staff explained that the registered manager and their colleagues helped them learn and improve practice when things went wrong. For example; lessons learnt were discussed in staff meetings, supervisions and daily handovers. The registered manager told us they investigated accidents/incidents events and had learnt from these. They gave an example of improvements they had made around people who experienced repeated falls, such as, sensor mats and 1-1 support. This had involved communication with family members and staff to ensure that restrictions were not unduly excessive.

Improvements had been made that ensured safety concerns and events were thoroughly investigated and reported on, and lessons were learned to embed good practices. The provider told us they used learning from events/incidents at other services within the group to improve oversight of care and ensure people's continued safety. The registered manager told us they reviewed accidents/incidents and had learnt from these. They gave an example of improvements they had made around consistently reviewing people's skin integrity to reduce the incidence of wounds and pressure damage. Peoples behaviours were now being monitored closely with the completion of Antecedent-Behaviour-Consequence (ABC) charts and regular review of successful de-escalation techniques. External health professionals told us, “They are receptive to advice and always look for good outcomes." Processes for investigating, analysing, and responding to accidents, incidents, complaints, and safeguarding alerts were in place. There were systems in place for families, people and staff to raise concerns or share their views. The service had a service improvement plan in place which detailed plans for ongoing improvements.

People couldn’t share their experience of moving in to Southdowns Nursing Home, but families told us "Everything is really good, they always have the right equipment to help my relative move, when they have appointments they arrange everything", and "We visited a few homes but when we visited here, they were interested and welcoming and everything went smoothly. We filled in a questionnaire about their health and social needs- they wanted to know all about them which I found re-assuring." Relatives told us their loved ones were supported to access health and social care services when needed, and this was reflected in peoples care notes. We were told "They can see a GP, Nurse, Chiropodist and Hairdresser," and "I know that they arrange hospital appointments and ensure they attend them, We are kept informed about health appointments."

Staff told us, "We have a 'this is me' document care plan on our system, we print it off along with their MAR record and medicines -we make sure they are dressed /clean unless they are too poorly, We ensure all new admissions are assessed before coming here -face to face -not just on the phone," and "We work closely with the GP surgery for things like flu jabs, covid and specialist appointments, We also have a hairdresser that comes in and a chiropodist every 6 weeks, If we are worried about their mental health or they fall more we contact the GP and then referral to the mental health team and fraility team."

Health professionals told us, “We are informed of all new admissions and a GP visit arranged, it’s a solid home-when people get poorly they consult with us in good time,” and “No concerns at all, they have a good knowledge of their residents,”

People were supported to safely access systems and transitions between services as needed. The management team advised that all people were assessed before admission to ensure their needs could be safely met. There was a comprehensive pre-administration process to ensure the service could meet people’s needs, both physically and socially. The care plan system used also had a 'hospital pack' (this is me) in place for each person, that ensured a smooth transition to hospital should the need arise. People’s care plans included reminders for staff of what to do if a person’s physical or mental health needs changed and who should be involved in the ongoing care. Staff and leaders demonstrated good knowledge of referring to external professionals when needed. Referrals to the multidisciplinary team had been requested via the GP, these included requests for support from Speech and Language therapists (SALT), the community nurses and the community mental health team.They also explained how they worked closely with the community rehabilitation team to prevent risk of people falling. Visiting professionals spoke of a positive relationship with the home and we saw that community nurses were informed of all new admissions and a GP visit arranged as soon as possible

Our observations found that people were comfortable with staff, we saw positive interactions, that assured us they felt safe and comfortable. People and their relatives told us that Southdowns Nursing Home was safe. One person said, "I feel very safe here, they are kind to me.” Relatives' comments included, “[Person] is content here, which means I am too, I am able to relax knowing they are safe" and “I have no concerns at all. The staff are gentle and kind I can talk to any of them if I was worried.”

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at yearly safeguarding training. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored. One staff member said," I would discuss with the senior and take it to management, the training is very good, it opens your eyes to things, that I had not thought of before." Another said, "I would take it to nurse or manager, unless it was an accident then I would ring emergency call bell. We do training every year, we also get updates, we do have procedures and I would contact the local authority if I thought it hadn't been reported."

People were supported by staff who knew them well. Staff supported people with kindness, respect and followed good practice guidance when assisting them. Staff were mindful of people's characteristics and promoted their dignity, people were dressed in their own clothes, and well presented. Throughout the site visits, staff engaged positively with people, they sat with them and talked with them, listening and responding. People were observed to approach staff for assistance -and staff responded in a kind and respectful manner. Staff walked with people to direct them in a non controlling manner ensuring that the person was comfortable being directed, either to their room or to communal areas.

There were suitable procedures for safeguarding people. These provided guidance about the action to take if staff had concerns about the welfare of people. Training records showed staff had completed safeguarding training. There was a system in place for recording safeguarding concerns which helped management have oversight over this. The registered manager had appropriately made safeguarding referrals to the local authority when required. Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at yearly safeguarding training. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored. One staff member said, “I would report it to management. We do have procedures and I would contact the local authority if I thought it hadn’t been reported.” Another staff member told us, “We do training every year, and we get regular updates.”

People were not able to share their experiences so we contacted family members during the assessment process. "I have peace of mind knowing that my father is safe, and the management and staff do the best they can to protect my father - he is well known for not using his frame or taking his emergency pendant off. They do regular checks to reset the balance against safety and his independence."

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us “We read care plans and risk assessments; we are good at responding to risk. We pick up when people are not themselves. We also check peoples’ skin daily.” We discussed with staff, certain people who had either bruising or dressings on and they were able to discuss their treatment plans and any potential risks. Staff told us that additional checks were in place for people at risk of falls. These included sensor mats, location checks, appropriate footwear checks, and ensuring people were wearing their glasses if needed.

We spent time with people and staff both in communal areas and in peoples' bedrooms. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against peoples weight. Staff recorded these checks on the persons care documentation. People who were at risk from falls, had sensor mats that alerted staff the person was up and at risk. Call bells were in peoples' rooms, and there were risk assessments in place for those who couldn't' use a call bell and we saw that staff checked them regularly. We observed equipment being used appropriately to reduce people’s individual risks, such as pressure cushions and crash mats. People were moved with the correct equipment and assisted by staff in a safe way. corridors were free from obstruction, allowing people to walk safely if they choose to.

Since the last inspection in July 2023, improvements had been made to how risks to people's health and well-being were managed, this had ensured people received safe, continuous care. Care plans and risk assessments were person centred, comprehensive and were supported by decision specific physical and mental capacity risk assessments. These included those for skin integrity, wounds, nutrition and mobility. Wound care records were well documented and now followed the National Institute for Health and Clinical Excellence (NICE) guidelines. Care plans and risk assessments included clear guidance for staff on how to minimise risks, for example, for people at risk of pressure damage had risk assessments in place with directives for the prevention of pressure damage, such as regular turning, application of barrier creams and continence promotion. These were regularly reviewed. For people identified at risk of dehydration and malnutrition, there was evidence of monitoring and included actions by staff. The registered manager undertook an analysis of incidents and accidents and referrals were made for additional support where required, for example, in reach team, falls team, assistive technology, and GP involvement. Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

Not everyone was able to talk to us, but relatives told us, “I think its clean, safe and stylish," and "I have no concerns regarding the home, it smells nice and always well kept. I know my relative is safe. They have good equipment -all clean and well serviced I believe. No concerns at all -always looks well cared for.” We were also told, “My relative is generally safe and well looked after. They have had a few falls but these are mainly just slipping out of their chair. They let me know if she falls.”

Staff told us, "We get training in health and safety, fire, first aid and moving and handling, we do fire evacuations and tests,” and "We have systems to make sure the environment is kept safe. If we have a problem, we write it in maintenance log and its done. We all have to look at risk assessments for the environment -if something doesn’t work we report it like the lights or equipment -it gets sorted pretty quick.”

The premises were free of obstacles and hazards, and we observed people moving safely and independently without any staff assistance around the care home. Where staff were seen assisting people with equipment, they were doing so in a professional and safe way.

The environment was safe and well cared for. Care equipment we saw was in good working order and documentation to support regular servicing was seen. There was no clutter, and the home was accessible for people with mobility needs and safe for those who walk with purpose. Processes ensured the environment was safe and well kept. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. People had Personal Emergency Evacuation Plans (PEEPs) to ensure they were supported in the event of a fire. These were specific to people and their needs. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

People and relatives told us, " I think more staff would be good, but we are all going to say that because we see staff are busy. I don’t have complaints though," "Staff are visible, no problems with staffing that I have noticed," and "My observation is that staff are rushed and more staff would be beneficial."

Staff told us, “Staffing is ok -I think sometimes we need more staff but it depends on people's needs, if they are poorly they can be more confused but generally it's ok," and "We have enough staff, but more staff to answer bells whilst we are busy would be helpful."

Our observations showed us that staff were visible and available to support people’s requests for help and take the time to sit with people, to assist them with food and drink if necessary. People mostly received timely care, call bells were answered promptly. However there were people still receiving personal care just before lunch, which was not recorded as their choice.

The staffing levels were based on peoples’ needs and regularly reviewed. We looked at 6 months of rotas and the staffing levels were consistent supported by relief staff to cover sickness and holidays. Staff numbers and the deployment of staff had ensured people’s needs were met in a way that met their preferences. Care delivery was supported by records that evidenced that people’s care needs were being met. However, we noted that people were still receiving personal care at 12-1230, hours, which may be some peoples’ preference but this was not documented. This was fully discussed and the area manager immediately responded by increasing staffing levels. This was confirmed on the second site visit. Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

Visitors told us the home was always clean and well maintained. “There been a lot of decorating but it looks very nice, its clean and smells nice.” Another visitor said, "Really lovely environment, clean and never smells."

Staff told us they are well resourced for cleaning and infection control. One said, “Personal protective equipment (PPE) is not an issue, we have loads, and also cleaning products and equipment.” Staff said there are ongoing discussions in staff meetings about planned work and upgrades to the service. One staff told us, “It's really had a makeover, it's lovely now, clean and flooring has been changed and that has got rid of smells.” Staff told us they had received training in infection control and had regular spot checks to ensure they are doing it properly.

The home was clean and well maintained. Staff were seen using gloves and aprons appropriately.

The home provided people with a clean, newly decorated and well-maintained environment. People’s rooms were cleaned regularly by housekeeping staff and people commented positively, with no-one reporting any problems with the standard of cleanliness of the environment and equipment. Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice. The manager told us they ensured staff continued to follow Public Health England guidance to reduce the risk of COVID-19 reoccurring. People had received COVID-19 booster injections. The general environment was clean with no odours. We saw housekeeping staff undertaking cleaning in all parts of the home. Our observation of the environment raised no concerns about safety or cleanliness. People’s laundry was managed well and the laundry room was clean and well organised and had recently been upgraded. The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead to ensure compliance with the procedures and policies of the home.

People were not able to share their views about medication, but one family member we spoke with said, “Staff keep us informed of any changes, let us know what the doctor says. I trust them totally and get informed of changes. I have no concerns.”

Staff were knowledgeable about the medicines they administered, and the processes they needed to follow to ensure they were safe. Staff told us they had annual competency checks and refresher training to ensure their practice is up to date. One staff member said, “We receive training and spot checks as well as a competency assessment. If I was unsure of medicine, there is a BNF (British National Formulary) and we can check on line.We have gone back to paper due to pharmacy changes." Senior care staff (assistant practitioners ) who administer medicines told us they would speak with a nurse, if they had any concerns. One staff member said, “The nurses are always around if we need them.” We received some feedback from health professionals about medicine management. They told us staff knew people well and they had themselves received very positive feedback from family members about the way the service managed medicines for people.

People received their medicines as prescribed and these were administered by appropriately trained staff. We saw staff members giving people their medicines at the site visit, this was done professionally, sensitively and kindly. People had no concerns about the provision and administration of their medicines. The home was part of a project, ‘Medicines Optimisation in Care Homes’ under the Sussex Community NHS Trust and each person’s medicines was reviewed regularly. Risk assessments were in place for certain medicines. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. It had been noted in audits that counting of medicines were not consistently completed, this was being addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place however, some were generic and lacked personalisation, which the clinical lead said was something they were working on when reviewing care plans. The clinical room was clean and well organised. Medicines were stored safely as per manufacturers guidance in lockable cupboards and clinical fridge. Temperatures of both room and fridge were recorded daily. There were policies and training in place to ensure staff managed people’s medicines safely. The hospital admissions and discharge policy, reminded staff of the importance of a safe handover with any medicine changes recorded. There was a covert medicines policy in place for anyone who needed this, with clear explanations for staff should it be required.