Archived: Summerville

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensured that people who used the service could live as full a life as possible and achieve the best possible outcomes that included control, choice and independence. People using the service received planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

People told us they felt safe living at Summerville, we saw they were relaxed and confident with the staff who supported them.

Medicines were stored and managed safely. Policies and procedures supported the safe administration of medicines. People received their medicines when they needed them and staff who gave medicines were trained and their competency checked.

People were protected from abuse. When potential safeguarding incidents occurred, staff followed correct processes and reporting procedures and had received regular safeguarding training. Managers investigated concerns and informed the Local Authority safeguarding team and the Care Quality Commission (CQC) as required. A matter was being investigated by the Local Authority Safeguarding team and remained ongoing at the time of this inspection.

Staff were knowledgeable about the Mental Capacity Act 2005. They knew to seek consent for care and knew the process to help those who lacked capacity to make decisions. People’s needs were met by the adaptation and design of the service.

Care plans were up to date and contained the level of detail needed. Risks to people had been identified, detailed risk assessments were in place as well as guidance mitigate risk. Accurate records about people’s care and treatment had been kept and were up to date.

People’s care was based on their needs and preferences. People were supported to do things they enjoyed and independently choose how to spend their time. An appropriate accessible complaints system was in place.

People and their families were involved in assessments to ensure the service could meet their needs. Staff received training and support they required to enable them to fulfil their roles. 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 told or indicated to us they were happy living at Summerville and liked the staff team who supported them. They were supported to express their opinions about their care. People and staff had positive relationships. Staff understood people’s conditions and needs well and responded to provide the support they needed. Managers understood and met their regulatory responsibilities.

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 Requires Improvement (published 4 October 2018) and there was one breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

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.

This is the first inspection of Summerville with the additional regulated activity of personal care. The last inspection of Summerville care home took place in January 2017, this inspection focused upon the ‘well-led’ domain following concerns from a comprehensive inspection on December 2015. This inspection found that the 'well-led' domain had improved from requires improvement to good, thus making the service good overall.

We found that the service requires improvement. This is the first time the service has been rated Requires Improvement since the change of registration.

Summerville is a large detached ‘care home’ in Margate. 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.

Summerville provides personal care and support to up to four people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were three people living at the service at the time of the inspection.

Summerville also provides care and support to three people living in two ‘supported living’ settings, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. Not everyone at Summerville receives regulated activity; CQC only inspects the service being received by people provided with ‘personal care;’ help with tasks related to personal hygiene and eating. Where they do we also take into account any wider social care provided.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.” Registering the Right Support CQC policy

There was a registered manager for the 'care home' and the former deputy manager had now become the registered manager for the 'supported living' support provided by Summerville. Both registered managers were present during both days of the inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.’

Summerville supported people to live their lives to the full. The atmosphere was calm and friendly, staff and people talked and laughed together. Staff treated people with kindness and respect. A relative told us, “[loved one] has been a resident with Manor Care homes for 17 years now… Throughout that time I have always been very satisfied with the care he has received and the attitude of the staff." Another relative stated, "[Loved one] has been in the care of Manor Care Homes since 2003, and during all that time the care [they] has received has been exemplary."

However, despite positive feedback we found some shortfalls at the service. Medicine records were not always completed correctly. The manager used systems to continually monitor the quality of the service and this series of audits had identified medicine recording failings. Action had been taken to address these errors, however there remained gaps in medication recording sheets which indicate that the action taken was ineffective.

On the day of inspection, the registered managers took immediate action to improve how staff recorded action taken after conducting audits. The registered managers also assured us that the service was organising bespoke auditing training and that although action had been taken to address medicine recording errors, this would be stepped up and an action plan was in place to reduce medicine recording errors. We made a recommendation about this.

However, on the day of the inspection we noticed that there was an 'as needed' (PRN) medicine not signed on the medication administration records (MAR) chart. On investigation, we found that the PRN medicine was given to the person, yet the reasoning for administering the sedative was insufficient and indicates that staff did not take reasonable steps to use the least-restrictive strategies before using psychoactive medicine.

Medicines were not always stored safely. Checks were in place to monitor the temperature of medicines, and this was stepped up during a recent spell of hot weather. The registered managers took action to try to minimise the impact of the hot weather on medicines, by using fans and freezer packs. However, the registered managers did not seek advice from the pharmacy until the day of inspection, contrary to best practice guidance. After speaking to the pharmacist, medicines were removed so people were left without medicines, but the registered managers had put in place an appropriate risk assessment. We recommended that the registered managers update their policies and procedures in line with best practice guidance to ensure similar errors do not occur again in future.

People were protected from abuse. Staff knew what action to take if abuse was seen or alleged. The registered managers had made referrals to the local authority safeguarding team when required and these were investigated appropriately. Risks to people continued to be identified and mitigated against. People were encouraged to take positive risks by trying new experiences and opportunities to promote their wellbeing and independence.

Staff continued to be recruited safely. People had a choice in who they would like to care for them by meeting with prospective staff during in the recruitment process. There were enough staff to provide people with the care and support that they needed at all times.

Staff had regular training and felt supported by the registered managers and provider. The service developed around the needs and wishes of people. Staff worked well together and demonstrated a shared vision for the service, that Summerville was peoples home. The provider often visited Summerville and had both oversight of the service and a great relationship with people and staff. Staff told us that the registered managers were approachable and that they frequently worked 'on the floor' so they knew people and staff intently.

People continued to be protected from the spread of infection. Staff had infection control training and a cleaning schedule was in place. As a result, the premises was clean and well maintained and people took an active in role in keeping it so by stripping and making their beds, hoovering and watering the garden. Peoples rooms were customised according to their taste and preferences and there were different areas around the property for staff to spend quietly or to socialise.

The provider and registered managers attended local forums for social care professionals. They had also researched guidance from specialist organisations which had enabled them to share knowledge and implement best practice within the service.

People were supported to live healthy lives as far as possible. People were encouraged to exercise and to eat healthily. Each week people chose the menu with the support of staff. People were then involved in food shopping and in preparing and cooking meals. Meal times were relaxed and trimmings were available at the table for people to customise the meal to their taste.

When people were unwell, staff responded quickly and people were supported to access health care services. The provider worked in partnership with a range of healthcare professionals to ensure people received appropriate care and treatment. Accidents and incidents were recorded by staff and these were analysed by both the registered managers and health professionals to identify patterns and if lessons could be learnt.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People and their representatives regularly met with staff to ensure that care plans and support reflected their care needs.

The registered managers appropriately investigated complaints, compliments and incidents. People had access to an accessible complaints procedure which was explained to them by staff. A complaints policy was also known to staff and families and both felt confident that any issues raised would be swiftly resolved.

Staff had recorded the wishes of people and their families if they were to fall ill and pass away.

The registered managers sought feedback from people using the service, as well as staff, relatives and health professionals. Feedback was then used to make positive adaptions to the service. The service had recently developed a system to increase engagement with the public whilst out in the community, to build understand and to capture feedback.

People’s information was kept securely and staff respected people’s privacy, dignity and confidentiality.

We found one breach 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.

Summerville is a privately owned care home providing personal care and support to up to four people who may have learning disabilities and complex needs. People may also have behaviours that challenge and communication and emotional needs. There were four people living at the service at the time of the inspection.

Rating at last inspection

At the last inspection, the service was rated Good overall and Requires Improvement in the ‘Well –led’ domain.

Why we inspected

We previously carried out an unannounced comprehensive inspection at this service on 7 December 2015. A breach of a legal requirement was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Good governance.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. 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 Summerville on our website at www.cqc.org.uk.

At this inspection we found the service had improved. We found the service remained Good overall and is now rated Good in the ‘Well –led’ domain.

Why the service is rated Good in the Well- led.

Staff were aware of the ethos of the service, in that they were there to work together to provide people with personalised care and support that promoted people’s independence and autonomy. Staff and people were part of the continuous improvement of the service.

People and staff told us they thought the service was well led. Staff told us that there was an open and inclusive culture within the service. They said they could talk to the registered and deputy manager about anything and they were always supportive. The registered manager told us, "We want to increase people's independence. We want to encourage them to do as much as possible. We want people to enjoy their lives”.

The provider had systems in place to monitor the quality of the service. There were records to show that any identified shortfalls had been addressed and improvements made. The provider asked people, staff and relatives their opinion about the service and had included other stakeholders, like doctors or community specialists, about what action they thought the provider could take to make improvements.

The registered manager was aware of submitting notifications to CQC in an appropriate and timely manner in line with CQC guidelines.

People who used the service were unable to tell us about their care due to their level of learning disability. However, they indicated that they were happy with their care and knew the staff well. We observed staff interacting with people in a positive manner and saw that they were able to manage behaviours that challenge positively, appropriately and effectively. People's care records had been reviewed and were person centred, accurate and up to date. The manager had met with people using the service along with their families and representatives to update their care plans, which included initial assessments, risk assessments and mental capacity assessments.

We found that the provider had introduced robust recruitment processes and that all staff had received criminal records checks. Staff we spoke to told us that they had worked at the service for a number of years and knew the people who used the service well.

We found evidence that the provider had sought advice and guidance from outside professionals in regards to managing risks and behaviours that challenge and that monitoring and auditing processes had been introduced to ensure peoples care plans remained up to date and fit for purpose.

People were supported to make some choices regarding how they spent their time. However, we found that arrangements were not in place to assess the special needs of people who lacked capacity to make specific decisions. This had resulted in some people not being fully supported to make informed decisions that were in their best interests.

We found that some staff were able to demonstrate they had knowledge and understanding of people's needs, knew people's routines and how they liked to be supported. However, we found that care was not planned around the outcomes of assessments of the person's needs. People's individual plans had not been reviewed to ensure that they remained relevant. The provider had not taken action to ensure that staff provided consistent care and support to people.

The provider had processes in place to manage people's medicines safely and had taken appropriate action where necessary.

We found that the provider did not operate an effective recruitment procedure which ensured that all the necessary checks were completed satisfactorily before someone began working at the service.