Archived: Summerfields House Rest Home

We inspected this service on 31 March 2017. This was an unannounced inspection. The service provides accommodation and personal care for up to 21 older people who may be living with dementia. There were 19 people living at the home on the day of our inspection. At our previous inspection visit on the 11 February 2015 the provider was meeting all the regulations relating to the Health and Social Care Act 2008.

The home does not need to have a registered manager, as the registered provider manages the home on a day to day basis.

We identified that not all risks had been proactively managed to keep people safe, which had led to one person being put at risk of harm. The provider following this event had put measures in place to minimise this risk.

People told us they felt safe with the staff and staff understood their role in reporting any concerns. People received their medicines at the right time and medicines were managed safely. There was enough suitably skilled staffed to support people according to their needs. Checks were carried out prior to staff starting work to ensure their suitability to support with people.

Staff gained people’s verbal consent before supporting them with any care tasks and helped people to make their own decisions when possible. Where people were unable to make decisions independently they were supported in their best interests and in accordance with the Mental Capacity Act. People received food and drink that met their nutritional needs and preferences, and were referred to healthcare professionals when needed to maintain their health and wellbeing.

Staff understood people’s needs, preferences and interests and were caring towards them. People were supported to maintain their dignity and privacy and relationships that were important to them.

People knew who the provider was and how to complain. When complaints were made these were responded to in line with the provider’s policy. Staff felt listened to and were happy to raise concerns. Quality monitoring checks were completed by the provider and they sought people’s opinions. When needed action was taken to make improvements.

Is the service safe?

All identified areas of need had a risk assessment and care plan in place to ensure people's safety and welfare. This meant that staff had guidance to follow to ensure people were provided with safe care.

Capacity assessments were in place for people that were unable to make decisions for themselves. This meant there was written evidence to demonstrate that when people lacked capacity they were supported in the least restrictive way.

At the time of our visit four people had authorisations under the deprivation of liberty safeguards. This legislation is in place to protect people who are unable to make their own decisions about their health and wellbeing. Records showed that the authorisations made were under very strict and time limited conditions which were kept under continuous review. The information seen demonstrated that the restrictions in place were in the best interests of each individual.

Suitable equipment was in place to support people in a safe way with their mobility needs. We saw that staff used the equipment confidently which indicated that moving and handling equipment was used frequently. Equipment was well maintained and serviced regularly to ensure it was safe to use.

The provider regularly carried out an analysis of incidents and accidents at the home. This provided information about the frequency of events and had been used to determine the staffing levels required to support people safely.

People told us they had no concerns regarding the staff that supported them. One person said; 'They [the staff] all seem very nice and helpful.' Another person said; 'The staff here are very good.'

Is the service effective?

Information in people's care plans included how they wished to be cared for. People spoken with confirmed that they were able to follow their preferred routines.

Where people were unable to make decisions due to lack of capacity, records demonstrated how decisions had been made in their best interests.

Is the service caring?

People using the service told us that they liked the staff and found them friendly and supportive. We observed a positive working relationship between the care staff and the people they supported.

People's preferences and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

Meals for people requiring a soft diet were blended together, rather than each food being blended separately. This meant that these meals were not presented to people in an appealing way.

We observed that when people were hoisted into armchairs they were left sitting on their sling. This meant that people's dignity and safety may be compromised through this practice.

Is the service responsive?

On the day of our visit the compliance manager was unable to locate minutes of meetings that were held with people using the service. Some people we spoke with were able to confirm that meetings took place and told us that they felt their views were listened to.

People told us that staff were responsive to their needs. One person said; 'The staff are always around and if you need them for anything they always seem happy to help.'

Staff were attentive to people's needs throughout our visit and we saw that people were provided with support promptly as needed.

We spoke with two people's visitors who confirmed that their relative's needs were met by the staff team. One visitor said; 'They have enough staff on duty here, so people don't have to wait for help and there are always staff in the lounge area.' The other visitor said; 'I'm very happy with the support my mum gets, she seems to be settling in well.'

Is the service well-led?

Staff were given an opportunity to express their views through supervision sessions and team meetings. One member of staff said; 'If I had any problems I would tell the owner or compliance manager, they are both very approachable.'

Quality assurance systems were in place to demonstrate how the service provided to people was monitored and improved upon as needed. Satisfaction surveys were sent to people's relatives and we saw that any identified areas for improvement were acted upon. Audits were undertaken regarding health and safety and care practices. Unannounced monitoring visits were undertaken by the provider and compliance manager. This was to check that people were receiving safe and effective care.

People using the service had care records which recorded how they wanted to be supported. The information we read in the care records matched the care, support and treatment we saw being delivered to people.

We saw that care records included information about how people made decisions or how decisions had been made in people's best interests.

People we spoke with told us they were happy with their care and the staff were responsive to their needs. We were told they were asked about the service that was provided and felt their views were listened to.

We saw that the provider had a system in place to regularly assess and monitor the service which focussed on service improvement.

People told us they felt safe living at the home and staff were aware of how to identify and report concerns about people's safety.

We saw that staff engaged with people in a caring and friendly manner, but there were occasions when people did not receive personalised and individual support from staff.

We found that some people's care needs had not been reassessed or reviewed following a change in their needs. This meant that some people were at risk, because appropriate plans were not in place to meet their needs.

We saw that people's care records did not always contain up to date information. This meant that information was not always recorded accurately to guide staff on how to support people.

We identified concerns around the numbers of staff on duty during the night. We were concerned that some people may be at risk during the night as there were not enough staff on duty to meet people's complex needs and respond to emergencies.

We found that the provider did not have effective systems in place to assess and monitor the quality of all aspects of the services provided.