Archived: Somerset

At the last inspection on 2 February 2017 we asked the provider to take action to make improvements to medicines management, staffing and the environment and this action has been completed.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like 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.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. We saw that incidents of suspected abuse had been reported to the local authority and CQC.

A range of audits were carried out both by the manager and provider. We saw where issues had been identified; action plans with agreed timescales were in place to help drive improvements. However the provider audits could be improved in order to identify where further guidance or support was needed to enhance people’s care.

Overall we saw people received their medicines safely and were well organised. Risk assessments were in people’s care plans for areas such as moving and handling and pressure area care so staff were aware of how to support people to remain safe. We saw the service worked with visiting professionals and followed their advice.

We saw people’s care plans contained some person centred detail. Staff knew people very well and the manager and deputy were supporting the staff team to re-write all the care plans and ensure more relevant and current information was included. These were not all complete and daily notes were also being improved. Staff had not always been proactive in identifying where support or equipment would benefit people.

We made a recommendation for the provider to continue to improve the quality monitoring systems.

Servicing and checks of the building and equipment were undertaken to ensure people’s health and safety. There was a maintenance person employed by the service.

Recruitment and selection was robust and appropriate checks had been undertaken before staff began work. There was sufficient staff working at the service to meet people’s needs. They felt supported through supervision, training, staff meetings and their involvement in running the service. Staff told us they felt well supported by the manager.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Observation of the staff showed they knew the people very well and could anticipate their needs. People and their relatives told us they were happy and felt very well cared for.

People had a choice of meals. We saw the mealtime experience was positive. People had their weight monitored to ensure they were receiving enough nutrition.

People’s hobbies and leisure interests were individually assessed. We saw there was a plentiful supply of activities.

People and relatives were regularly asked for their views. People and their relatives said they would talk to the manager or staff if they were unhappy or had any concerns. They told us they felt confident to do this.

This inspection took place on the 28 and 29 June 2016 and was unannounced. At our last inspection of the service on 26 September 2014 the registered provider was compliant with all the regulations in force at that time.

Somerset is registered to provide nursing and personal care for up to 46 people. The service supports older people, some of whom may be living with dementia and people with a physical disability. The home was once the village rectory in Wheldrake, which is about eight miles south of York. It is owned by Roche Healthcare Limited. The service is in the centre of the village and is set in mature, well maintained gardens. Somerset provides en-suite accommodation on two floors and there are two vertical passenger lifts to aid access to the upstairs rooms. At the time of our inspection there were 40 people using the service.

The registered provider is required to have a registered manager in post and there was a registered manager at this service. A registered manager is a person who has registered with the Care Quality Commission (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.

The recording and administration of medicines was not being managed appropriately in the service. This was a breach of Regulation 12 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There were insufficient numbers of suitably qualified, skilled and experienced persons employed in the service to meet people’s needs. The registered provider had employed a number of agency staff to fill the staff vacancies, but some people still felt vulnerable and did not feel the level of care always met their needs. We found that the staff induction, training and supervision programme was not robust and did not offer staff sufficient support to enable them to carry out the duties they were employed to perform. This was a breach of Regulation 18 (1) of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014.

There were insufficient working bathrooms for the number of people using the service. This was a breach of Regulation 15 (1) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that there was a quality assurance system in place but it was not always effective. During our inspection we had a number of concerns about staffing levels, staff induction, training and supervision, medicine management, the dining experience of people using the service and the involvement of people in developing their care plans. These issues had not been identified by the registered provider's monitoring systems. This was a breach of Regulation 17 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

People’s nutritional needs had been assessed and they told us they were satisfied with the meals provided by the home. However, the dining experience in the service could be improved. We have made a recommendation in the report about this.

The environment within the service was comfortable, clean and homely, but it did not reflect current best practice in dementia friendly design. We have made a recommendation around this in the report.

People told us that they felt safe living at the home. We found that staff had a good knowledge of how to keep people safe from harm and staff had been employed following appropriate recruitment and selection processes.

We observed kind and caring approaches from the staff team. People’s privacy and dignity were respected.

Staff provided people with explanations and information so they could make choices about aspects of their lives. Staff were overheard speaking with people in a kind, attentive and caring way. There were positive comments from relatives about the staff team and the staff team demonstrated to us that they had a good understanding about the Mental Capacity Act 2005.

We found that some people who used the service had limited input in the development of their care plans, but they were consulted about their day-to-day needs. Relatives said they were consulted about their family member's care and treatment when the person using the service lacked capacity.

People had access to external gardens and community facilities and most participated in the activities provided in the service. We saw that staff encouraged people to join in with social activities, but respected their wishes if they declined. Families and friends were made welcome in the service and there were unrestricted visiting hours each day.

The staff described the culture of the service as open and friendly, they also told us about the positive team approach and that they enjoyed coming to work. People said the registered manager was open, honest and easy to talk with and always available to them if needed.

Our inspector visited the service and the information they collected helped answer one of our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with staff and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Recruitment processes were in place and followed. These meant checks were undertaken to ensure people were protected from harm.

Is the service effective?

Not applicable.

Is the service caring?

Not applicable

Is the service responsive?

Not applicable.

Is the service well-led?

Not applicable.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were supported by a stable staff team who knew and understood people's care needs. People and their relatives (when appropriate) felt included in decisions made about their care and welfare.

The staff team were kind and friendly and talked to people about the care they provided, even when the person was unable to respond. People's privacy and dignity were respected and people's human rights were protected.

Whilst risk of harm to people was well managed the associated records were not always well maintained. This increased the risk of an individual receiving inappropriate or unsafe care.

Staff did not have a good understanding of the Mental Capacity Act 2005, and Deprivation of Liberty safeguards. This meant that people may not be safeguarded as required.

The service kept the home clean and hygienic to protect people against the risk of acquiring healthcare associated infections.

Records were in place detailing how people should be cared for. However, these were not always stored securely which meant that people could not be confident that the information about them remained confidential, and accessible only to those who needed it.

The provider did not have a robust recruitment process to ensure only suitably vetted people worked for the service. This could pose a risk to people. We have told the provider to address this.

Is the service effective?

People were encouraged and supported to be involved in the assessment of their needs. This ensured people's needs, wishes, choices and preferences were taken into account when care was planned.

Staff were knowledgeable about people's care needs and their overall wellbeing. This meant they noticed and reported changes in people's health promptly, so that expert advice could be sought in a timely way.

Staff felt valued and listened to. They were supported to attend training so they had the skills and knowledge to meet people's needs safely and effectively.

Is the service caring?

The observations we made during our visit demonstrated that staff had a warm and caring approach. One visitor told us. 'When we came to look round Somerset we noticed all the staff seemed to smile a lot and genuinely seemed to care about the people living here.'

One person who lived there told us 'The staff are really kind. They do anything for you.' They added 'I don't usually join in the activities, but they always ask me if I'd like to.' Another person commented 'I'm comfortable, I'm warm, and I'm clean. The girls are very nice.'

The service had made arrangements so that the staff team was sub-divided in order to provide support to a smaller number of people who lived there. This enabled closer relationships to develop and ensured people received most of their care from a small team of staff who knew them well. Staff told us overall that this system worked well.

Is the service responsive?

People and those that matter to them were encouraged to make their views known. Staff at the service spoke to people about what was important to them and shared this information with the staff team, so that support was person-centred.

Is the service well-led?

The service had a manager who was registered with the commission and was highly thought of by people who lived there, by visitors and by staff. People thought she was approachable and sorted any concerns out promptly and appropriately.

Staff felt valued and part of a team. Their views and opinions were listened to and valued.

The registered manager understood her responsibilities and overall was supported by senior management to deliver what was required.

Whilst the provider had a quality assurance system in place to monitor how the service was operating this needed to be built on and sustained. This was so that areas of concern such as those identified at inspection could be spotted more quickly, and acted on.

The care plans we looked at were personal and included essential risk assessments these records helped the care staff to understand people's needs and care for them appropriately.

People said they thought everybody was very kind to them. One person told us 'They couldn't be kinder.' One of the relatives we spoke with said 'It's the little things they do that make people happy.' We observed the care staff treating everyone with respect.

We spoke with four relatives who were visiting on the day of our inspection. They told us they felt the care staff were 'well trained' and 'well led by the manager'. The five care staff we spoke with also confirmed they had mandatory and additional training opportunities.

We saw the provider had systems in place to assess and monitor the quality of the service provided.