Archived: Summerlands

The Care Quality Commission has reviewed the way it registers services for people with a learning disability. Our website includes this information about ‘registering the right support’. This was discussed with the manager who was aware of this guidance and understood how this should be considered with any future service developments.

The home did not have 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.

At the last inspection in January 2017, we identified breaches of Regulations relating to safeguarding, the management of risk, the manner in which people were treated and the governance systems. We made four requirements. The provider sent us an action plan stating the action they were taking to meet the requirements of the regulations. At this inspection we found the previous concerns had not been addressed and also identified additional breaches of regulations.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Monitoring systems were not effective in identifying areas for improvement and as a result, people’s safety and the service they received was compromised. We found continuing concerns with the management of medicines and health care needs, risk and care planning, quality of records, people were not treated with dignity and respect, their personal finances were not managed for their best interests and their legal rights were not protected. The home’s environment and facilities were not well maintained and robust recruitment procedures had not been undertaken.

Care files and individual risk assessments contained conflicting and out of date information which and did not reflect the care and support people needed. Action to meet health needs had not always been taken. Systems to manage medicines were inadequate and did not ensure people received all prescribed medicines safely.

There were insufficient staff employed. Staff had not received an induction, all necessary training and were not supported in their roles. Recruitment procedures had not ensured all necessary pre-employment checks had been completed before staff commenced working at the home.

Emergency procedures were inadequate to ensure people’s safety. Staff had not received fire awareness or other training to provide them with the knowledge as to what action they should take in the event of a fire placing them and people at risk. People were not supported to eat a balance healthy diet. People were not receiving adequate mental and physical stimulation.

Staff did not follow legislation designed to protect people’s legal rights. Although adults, people were not always treated as such or with dignity and respect.

People were happy with the food they received although healthy alternatives were not always offered or encouraged. People were not receiving adequate mental and physical stimulation and activities were limited.

People felt able to raise concerns with the acting manager who took time to listen to people and seek resolution for their concerns.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking further action in relation to the provider and will report on this when it is completed.

Summerlands is a privately owned care home close to the centre of Southsea. It comprises of a large Victorian villa situated in its own grounds. Accommodation is spread over four floors, with stair lifts between some of the floors. It is registered to provide care for up to 23 people some of who are living with a learning disability or autistic condition. The home is not registered to provide nursing care.

The home had a registered manager registered with the Care Quality Commission (CQC). However, we were told this person had recently left the home and was in the process of cancelling their registration. 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. An acting manager had just commenced employment at the home. We were supported by the acting manager and deputy manager throughout the inspection.

Window restrictors at the home did not meet current guidance for care homes, as set out by the Health and Safety Executive, meaning there was a risk of people falling. The temperature of the water from some taps and showers was above 50 degrees Celsius. This presented a potential scalding risk to people who used the service. The provider wrote to following our visit and confirmed that these issues had been addressed. Some areas of the home were not always clean and showerheads had lime scale on them.

Checks on people’s finances, both their day to day money usage and longer term financial accounts were not robust. There were no independent checks on some accounts. We have spoken to the local safeguarding adults team about this and the provider has written to us to say these processes will be changed. The provider was following local safeguarding processes and reported other types of concern to the local safeguarding adults team. Staff had received safeguarding training.

Medicines were not always managed safely and effectively. There were gaps in medicines records and medicines care plans were not always detailed or up to date. The acting manager was making changes to the storage of medicines, which they had identified as being inappropriate.

Proper recruitment procedures and checks were in place to ensure staff employed by the service had the correct skills and experience and there were sufficient staff available to support people’s care needs.

Staff told us they had undertaken a range of recent training and updating, although the training records were not always clear and some areas of training were out of date. Staff had regular supervision sessions, but it was not clear from records if annual appraisals had been undertaken. we have made a recommendation about this.

One person had been subject to a DoLS order under the MCA (2005), although the CQC had not been notified of this in line with legal requirements. Some people had signed their care plans to say they consented to the delivery of care, although it was not always clear if they fully understood what they were signing. we have made a recommendation about this.

People had access to health care services to help maintain their wellbeing. There were regular visits to general practitioners and other health and social care professionals. Advice from such interventions was incorporated into people’s care records.

People were supported to access adequate levels of food and drink. Specialist advice had been sought, were necessary, and guidance followed.

We observed there to be good relationships between people and staff. People looked happy and relaxed in staff company. Relatives told us they were happy with the care provided. People’s dignity was not always respected. We saw milk was placed directly in the teapot and a person on a softer diet did not have food that was served appropriately. People were being supported by independent advocates, as necessary.

Some care plans had good personal information about the individual and their particular likes and dislikes. Care records were not always up to date and risk assessments were being used to deliver care, rather than care preferences agreed with the individual. Reviews of care and risk assessments were not always timely or detailed. Changes to care delivery were not always appropriately recorded.

People were supported to attend various events and activities in the local community.

The acting manager told us there had been no formal complaints in the last year and relatives told us they had not raised any recent concerns.

Regular checks and audits had been carried out on the service by the previous registered manager, although the findings of these audits were different to the situation we observed at this inspection. Checks by the registered manager and the provider were not robust. Policies and procedures did not reflect current regulations. Staff were positive about the leadership of the new acting manager and felt she was making timely and appropriate changes. The acting manager advised us of a range of issues she felt needed improving and addressing and demonstrated some of the changes she wished to introduce. Staff told us there was a good staff team and felt well supported by colleagues.

Subsequent to the inspection the provider wrote to us and informed us that many of the short falls identified at the inspection had been, or where in the process of being, addressed.

We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to the Safe care and treatment, Safeguarding people from abuse, Dignity and respect and Good governance. You can see what action we told the provider to take at the back of the full version of the report.

During this inspection we spoke with nine people, including those with dementia, one relative and five staff members including the manager. Comment cards were received from three people.

All people spoken with told us they were happy with the care they received. They told us they felt very independent and able to exercise choices about their care and how they spent their days. One person told us, 'I have a routine but it's my routine. I get up and every morning two carers come and help me have a bath, then I usually go down for my lunch and then after lunch I just go out to the local shops'.

People were supported and had access to a range of services to ensure their overall needs were met. The manager had built good relationships with other professionals to ensure people received access to a range of health and social services.

The manager had an effective way of monitoring and assessing the service provided to people. People told us they felt safe, listened to and were involved in the decisions regarding their care and the running of Summerlands.

All people living in the home had assessments and care and support plans. These were individual and included relevant risk assessments. Each person had a key worker and their care and support plan was reviewed each month with their key worker.

The provider had taken the necessary action to improve the environment of the home. Adequate heating was provided in all areas of the home and a new stair lift had been installed. The home still needs refurbishment in some of the windows and one carpet in the home. The provider has a plan in place when these will be replaced or repaired. People told us they liked the environment of the home.

The home had an effective recruitment procedure. People told us they liked the staff and that they could meet their needs.

The home had a clear complaints procedure. People told us they would feel confident discussing any concerns with the manager and felt she would be able to resolve their complaint. Staff were able to tell us how they would ensure people who did not have verbal communication skills would be able to complain.