Somerleigh Court

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

People were supported by staff who were kind and knew them well. People and relatives told us they were happy with the care they received at Somerleigh Court and from the ‘Close Care’ domiciliary care service. One person said, “I’m looked after very well, and I get on with the staff.” One relative told us, “Dad’s been here for six years and I can't fault the care. I've been able to visit…I can visit whenever I need to.”

Risks to people associated with eating and drinking were assessed and planned for. People were supported by staff to eat and drink in line with their risk management plans. There was mixed feedback about the quality of food. The general manager told us a new catering manager had been appointed and they were planning to review people’s mealtime experiences.

People were supported by staff who were clear about their roles and what people needed from them. There were enough staff deployed to meet people's needs.

The home was clean and free from odours. Housekeeping staff completed cleaning schedules and frequent cleaning of regularly touched surfaces had been implemented. Improvements were needed to the environment on the second floor to ensure all surfaces could be effectively cleaned. The provider took immediate action to address this.

People were supported by staff who understood how to reduce the risk of cross infection. Staff wore personal protective equipment (PPE) and overall demonstrated good hand hygiene practice. The general manager addressed issues identified during the inspection immediately.

The provider had a regular programme of COVID-19 testing for people in the home, staff and visitors. All visitors, including professionals, were subject to a range of screening procedures, including showing evidence of vaccination and a negative lateral flow test before entry into the home was allowed.

Visits with relatives and friends were accommodated and adaptations made in response to the changing government guidelines. When visiting was restricted, staff supported people to keep in touch with loved ones through telephone and video calls and e-mails. Visitors told us they were kept up to date and visits were supported at all times if they were essential carers.

Rating at last inspection

The last rating for this service was Good (published 2 April 2020)

Why we inspected

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We also undertook this targeted inspection to check on a specific concern we had about the risk management of people eating and drinking.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

The overall rating for the service has not changed following this targeted inspection and remains good.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Somerleigh Court on our website at www.cqc.org.uk.

We found the following examples of good practice:

Staff had received infection control training and followed up to date infection prevention and control guidance to help people stay safe. Staff used personal protective equipment (PPE) correctly and in accordance with current guidance to minimise cross infection risks to people. Regular monitoring and audits were completed to make sure infection control standards were maintained.

Staff and people were regularly tested in line with the government's current testing programme. The home was clean and well maintained. Cleaning records showed increased cleaning of frequent touch points such as door handles and light switches.

All visitors were screened for any signs or symptoms of COVID 19 and underwent testing prior to their visit. Staff made sure all visitors wore the appropriate Personal Protective Equipment (PPE). When visiting was restricted, staff supported people to keep in touch with loved ones through telephone and video calls and

e-mails. For example, an international birthday party by video link for a person with family in several different countries. The registered manager kept people and families up to date through regular updates, emails and by telephone.

Staff had made adaptations to support effective communication with people because of wearing masks. For example, by speaking more slowly and clearly, offering visual choices and using whiteboards. To support people's mental and physical wellbeing and prevent isolation, activity co-ordinators provided people with extra support through small group and one to one activities to meet their individual needs. For example, people make personalised bookmarks with messages for loved ones as gifts.

Staff said they felt valued and that management support, teamwork and communication was good.

This service combines a nursing care home, known as Somerleigh Court and a domiciliary care agency known as Close Care.

The care home accommodates up to 40 people across three floors. The service is located in Dorchester and is a large purpose built building with rooms arranged over three floors. Each floor has a communal lounge and dining area. There is lift and stairs access to each floor. People are able to access a small secure outside space at the home.

Close Care is a domiciliary care agency. It provides personal care to people living in their own apartments in the purpose built apartment village surrounding Somerleigh Court. There are 68 apartments in the surrounding village. ‘Close Care’ provides a service to people living in the apartments. Not everyone living in the apartments receives a 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. At the time of inspection, Close Care was providing support to fifteen people.

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

Overall people’s medicines were managed safely. However, improvements were needed to the systems to ensure people’s creams were consistently applied as prescribed. The registered manager took immediate action to make changes to ensure this happened.

There was a friendly, welcoming and relaxed atmosphere at the home. Staff cared about people and were committed to providing them with quality care and support. The staff were kind and respectful.

People’s care needs were assessed and met. Each person had a care plan which gave staff details about how to support them in a way that respected their individuality. People received personalised care from staff who knew them well. Staff understood how people communicated.

There were safeguarding systems and procedures in place and staff knew how to report any allegations of abuse.

There were enough staff employed to work at the home and the domiciliary care service. They were safely recruited and trained.

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. However, the records to support this practice were not readily accessible to staff.

The service was well-led. People, staff and visitors spoke highly of the registered manager’s open and clear management style. Quality assurance and monitoring systems were in place to help drive improvements at the service.

People knew how to raise concerns and felt very confident the management team would address and rectify any problems.

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 Good (published 3 April 2018)

Why we inspected

The inspection was prompted in part due to safeguarding concerns received. A decision was made for us to bring forward the scheduled inspection.

We found no evidence during this inspection that people were at any ongoing risk of harm from these concerns.

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 service combines a care home, known as Somerleigh Court and a Domiciliary Care Agency known as Close Care.

Somerleigh Court is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care home accommodates up to 40 people across three floors. The service is located in Dorchester and is a large purpose built building with rooms arranged over three floors. Each floor has a communal lounge and dining area. There is lift and stairs access to each floor. People are able to access secure outside space at the home. There were 36 people living at the home at the time of our inspection.

Close Care is a domiciliary care agency. It provides personal care to people living in their own apartments in the village surrounding Somerleigh Court. There are 68 apartments in the surrounding village. Close care provides a service to older adults. Not everyone living in the village receives a 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. At the time of inspection, Close Care was providing support to 13 people.

At our last comprehensive inspection of both services on 10, 11 and 17 November 2016 we found that the provider did not have systems that effectively and consistently assessed and monitored the quality and safety of people using the service and therefore they did not have an effective system to identify areas for improvements.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Well Led to at least good. At this inspection we found that improvements had been made.

There was a registered manager in post. 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.

Care Home and Care at Home services.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of the risks that people faced and understood their role in managing these to ensure people received safe care.

People were supported by enough staff to provide effective, person centred support. Staff were recruited safely with appropriate pre-employment checks and received training and support to ensure that they had the necessary skills and knowledge to meet people’s needs.

People received their medicines as prescribed and staff worked with healthcare professionals to ensure that people received joined up, consistent care. Medicines were stored securely and recorded accurately.

People were supported from the spread of infection by staff who understood their role in infection control and used appropriate Personal Protective Equipment (PPE).

People were supported to make choices about all areas of their support and staff understood the principles of mental capacity. Where decisions were needed in people’s best interests, these were in place.

People were supported to have enough to eat and drink and there were systems in place to ensure that any concerns around weight loss were monitored. People’s preferences for meals were well known and choices were offered if people did not want the meal provided.

People were supported to receive personalised, compassionate end of life care and their wishes and preferences were recorded.

People and those important to them were involved in planning the support they would receive and also regularly asked for their views about the support and any changes to people’s needs. Reviews identified where people’s needs had changed and reflected changes to the support provided in response to this.

People were supported by staff who respected their individuality and protected their privacy. Staff understood how to advocate and support people to ensure that their views were heard and told us that they would ensure that people’s religious or other beliefs were supported and protected. Staff had undertaken training in equality and diversity and understood how to use this learning in practice.

Interactions with people were kind and caring and relatives told us that they had peace of mind that their loved ones were receiving safe, compassionate care.

People were supported to access social opportunities in the community, participate in group activities or have one to one time with staff in social activities which were meaningful to them. Visitors were welcomed at the home and kept up to date about their loved ones.

Staff were confident in their roles and felt supported by the registered manager. Feedback from people and relatives indicated that the management team were approachable, listened and took actions where necessary.

Quality assurance measures were used to highlight whether any changes to policy, processes or improvements in practice were required. We were given examples where feedback had been used to drive improvements at the home.

The service used innovative approaches to improve the care and treatment received by people and had clear development plans in place. Changes were made in collaboration with people, relatives and staff.

This inspection took place on 10, 11 and 17 November 2016 and was unannounced.

Somerleigh Court is registered to provide accommodation and nursing or personal care for up to 40 people. There were 37 people living at the service at the time of inspection. The home is situated in Dorchester and offers accommodation split over three floors. There are communal lounge and dining areas on each floor. There is lift access for the upper floors and all bedrooms have an en suite. There is a sensory garden to the side of the service which people are able to use and the main entrance is wheelchair accessible. Somerleigh Court also provides personal care support to 12 of the people who live in sheltered apartments around the home which they call the village. There are a total of 68 apartments in the village and people receive daily safety check calls and other services as part of their tenancy agreements.

There was a registered manager in post. 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.

People’s risks were not always recognised or managed safely. Risks around the use of pressure mattresses were not accurately managed and there were no risk assessments relating to the introduction of a pet to the home. Risks around peoples eating and drinking were not always identified.

Topical creams, as required medicines and nutritional supplements were not always given as prescribed.

There were sufficient staff to support people and we observed that call bells were answered promptly. There were systems in place to ensure that there were sufficient staff to meet people’s needs. People received support from staff who had been safely recruited and understood their needs.

People felt safe at the service, they were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff received training in a number of mandatory topics but did not receive training in specific conditions which reflected the needs of people at the home. There were plans in place to improve training opportunities for staff.

Mealtimes were not a sociable occasion. Very few people used the communal areas for their meals and we observed little social interaction at mealtimes. Use of chairs and over chair tables also made eating more difficult for some people.

Staff did not receive regular supervisions which meant that they did not have planned opportunities to discuss issues with people or discuss their own learning and development.

Assessments were completed in line with MCA and where necessary, best interest’s decisions were made. Decisions were evidenced, however assessments were not always signed or dated and in the case of covert medicines, had not included involvement of a relevant health professional and were therefore not in line with MCA best practice.

People had a choice about what they had to eat and drink and where people needed specific diets or equipment to enable them to eat independently, these were provided.

Where referrals to healthcare professionals were required, these were made promptly.

People were supported to make decisions about their care and staff understood their role in supporting people to make choices.

People told us that their privacy was respected. One person explained “If staff need to do anything personal, they leave me and give me privacy and I ring when I want them back”.

People and their relatives were supported and involved in their end of life care. We saw that people had anticipatory care plans for end of life which included their wishes and those of their families where appropriate.

There were limited social opportunities for people and activities were not available at weekends. A high number of people at the service spent the majority of their time in bed and there were not sufficient opportunities for 1:1 time with people. Activities records showed that some people had very little interaction.

Peoples care records were not all person centred. Older style records were still in use for some people and were clinical in style, focussing on people’s medical needs.. Newer paperwork was being introduced which was person centred and included details about people’s likes and preferences, there was a schedule in place for all records to be moved onto the new paperwork.

People and relatives said that they were involved in reviews about their care and said that they would be confident to make a complaint or raise any concerns if they needed to.

Quality assurance measures did not consistently identify gaps or trends. Some audits were completed but had not identified gaps which we found during the inspection. Others were completed at random which meant that some areas were not audited for extended periods of time.

Staff had mixed views about whether they worked well and communicated as a team, we observed the use of some language which was not respectful. The registered manager told us that they were working to ensure that the staff worked well together.

Surveys were used to identify possible areas for improvements and there were clear actions in place to manage these. The service had a clear development plan which included target dates and review dates for actions identified.

We found a 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 report.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

Most people's needs were assessed and care and treatment was planned and delivered safely in line with their care plan. We observed people being treated with care and their safety considered when using equipment, including mobility aids and hoists. One person had slipped down their bed and their heel was pressing against the base of the bed board. This had created pressure and they were being assessed and treated for a pressure wound. We found there was no label or information in the person's room guiding staff to the correct mattress pressure setting. It was unclear at the time whether the mattress was calibrated to the correct setting for the person's weight. This meant that staff may not have been aware of the correct setting and the risk of further pressure wound damage. We spoke with the registered manager about this.

There was not always enough staff to ensure that people were protected from the risk of unsafe care.

Some people's care records were not always accurate and were sometimes incomplete. A re-positioning chart to help reduce pressure wounds did not indicate how often the person's position required moving or changing. This meant that staff might not have known how frequently they should be re-positioned and this could have led to the risk of pressure wounds. We found in one medicine administration record for skin creams, staff signatures were missing from six of eleven days of application. Compliance actions have been set and the provider must tell us how they plan to improve.

Is the service effective?

Most people's needs were assessed and care and treatment was planned effectively and delivered in line with their individual care plan. One person said, "Since being here, they've helped me to do more, I still need assistance but things are better." Senior staff had developed systems to identify where the service required improvements and had reviewed their processes of checking that staff were providing care effectively.

Is the service caring?

We observed that staff were caring and kind towards people when they carried out their care. We saw staff checking that people were comfortable and asking them whether they needed anything. One relative commented, 'I can't fault them, staff are very caring and attentive; they remember to knock before entering the room.'

Is the service responsive?

The provider responded to people's ideas and suggestions. Two people and a relative told us they would like more outings. We spoke with activity planning staff and they gave examples of trips and outings including a trip to a singing group and a visit to a local castle. They also provided spontaneous activities like nail painting and reading to people, and group activities like memory box activities, word games and music groups.

Is the service well led?

The provider listened to people's views and used their comments to improve the service. Surveys were sent to people who used the service and their representatives to gather their views about the home. As a result of the survey, the registered manager wrote to all relatives of people at the home to encourage their involvement with people's care reviews. One staff member had been involved in checking people's care records. This had improved the identification of areas in need of improvement. These were used to remind staff of progress the home was making and areas for further review and development.

People told us they were provided with a suitable choice nutritious food and drink, and we saw that people were supported to eat their meals where required.

Although people spoke highly of the staff and the care they received, they told us that at times there were not enough staff to meet their needs in a timely manner.

The home had some systems to identify, assess and manage risks to the health, safety and welfare of people using the service and others. However, the absence of the effective auditing of care plan documentation had not ensured all documentation was current or had been completed accurately.

People's records did not always contain accurate and appropriate information.

In this report the name of Jane Slater appears as a registered manager. They were not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time.

We spoke with one relative who said they were happy with the care that was provided at the home. They told us that there was good communication and they were kept informed about any changes in their family member's condition.

We also spoke with some of the staff on duty during our visit. These included three care staff, two qualified nurses, an activities co-ordinator, the head of care and the registered manager.

There were good quality monitoring systems in place. This meant that the service was operating effectively, assessing and managing the needs of the people using the service. The service had been accredited by the 'Gold Standards Framework in September 2011. The Gold Standards Framework (GSF) is a an approach to promote the best care for people nearing the end of life.