Summerson House

Summerson House is a care home which provides residential care for up to six people who are living with a learning disability. At the time of our inspection six people were using the service.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

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

The registered manager and staff consistently demonstrated they valued and respected the people who used the service. The staff were passionate about supporting people to engage in meaningful activities and lead lives with meaning. The staff team had been trained to use positive behaviour support (PBS) and had fully implemented these techniques. Staff found this approach greatly reduced individual’s distress and enhanced people’s quality of life.

We found staff were committed to delivering a service which was person-centred. 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.

Staff took steps to safeguard vulnerable adults and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. People's support needs were thoroughly assessed. Staff actively promoted equality and diversity within the home.

Staff supported people to manage their healthcare needs and promoted their wellbeing. When necessary, external professionals were involved in individuals care. The staff supported people to eat varied appetizing meals. Medicine was administered in a safe manner.

Thorough checks were completed prior to staff being employed to work at the service. Staff had received appropriate training and supervision. The provider had enabled staff to access a varied and extensive range of condition specific training. The registered manager and staff had found the range of training they received assisted them to significantly improve people’s quality of life.

People’s voices were of paramount importance in the service. The registered manager understood how to investigate and resolve complaints.

The service was well run. Systems were in place, which effectively monitored how the service operated and ensured staff delivered appropriate care and treatment.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection

Good (report published 26 January 2019).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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.

People’s experience of using this service: People looked very comfortable and at home in their surroundings. Staff had worked very closely and sensitively with people to support them manage risk and reduce any distress they experienced.

Staff received a wide range of training around managing risk and ensuring people remained safe. Training included, safeguarding, first aid, fire safety and basic food hygiene. Checks were made on the ongoing competency of staff. Over recent months the provider had worked with staff to ensure policies and procedures around the management of people’s monies were consistently applied.

Systems and processes were in place and well monitored so the service was safe and run well. The provider had developed a robust risk assessments framework and the service manager was ensuring staff acted appropriately to mitigate any identified risks.

The provider had worked with staff over the last few months to ensure staff effectively reported any safeguarding matters. The provider had thoroughly investigated any concerns, and resolved these matters. All incidents were critically analysed, lessons were learnt and embedded into practice.

The provider had identified shortfalls in the practices at the service and acted to rectify these and ensure the home was well run. Staff told us the service manager had listened to their views about how to make the service better. The provider had asked their senior managers, human resources staff and quality teams to critically review the service. They had taken on board the findings and acted to ensure measure were put in place to resolve any concerns.

Rating at last inspection: Good (Report published on 23 June 2017).

Why we inspected: This was a focused inspection, completed to review the operation of the service following concerns being raised about how the registered manager ran the home.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Summerson House is a six bedded care home providing personal care to people with a learning disability. It is a purpose built house situated close to local shops and amenities.

The service had a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

At our comprehensive inspection on the 14 December 2016 we found that the provider had followed their plan which they had told us would be completed by the 30 April 2016 and legal requirements had now been met.

There were enough skilled and experienced staff on duty to meet people’s needs. Recruitment systems were robust, so helped the employer make safer recruitment decisions when employing new staff. New staff had received a comprehensive induction into how the home operated and their job role. This was followed by regular training updates, supervision and specialist training to meet the needs of the people using the service.

People’s needs had been assessed before they moved to the home and we found they, and if required, their relatives had been involved in planning care. Care files reflected people’s care and support needs, choices and preferences and these were accurate and up to date.

There was a strong person centred and caring culture in the home. Person centred means that care is tailored to meet the needs and aspirations of each person, as an individual. The vision of the service was shared by the management team and staff.

People felt safe living in this home and staff supported them to stay safe in the local community. We saw that people who lived in the home were comfortable with the staff who worked there, with a supportive working relationship.

Systems were in place to protect people from the risk of harm. Staff were knowledgeable about safeguarding people and were able to explain the procedures to follow should an allegation of abuse be made. Assessments identified risks to people and management plans to reduce the risks were in place to ensure people’s safety.

The service was meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff had a good understanding and knowledge of this topic. People who used the service had been assessed to determine if a DoLS application was required and some people had authorised DoLS in place and staff were aware of any conditions attached to these.

Systems were in place to ensure people received their medications in a safe and timely way from staff who were appropriately trained. More robust monitoring of medication had been introduced since our last inspection.

People were supported to maintain good health because they had access to appropriate health care services. They were supported to eat and drink sufficient to maintain a balanced and varied diet.

Relatives of people who used the service, who we spoke with, told us they were very happy with how care and support was provided at the home. They spoke extremely positively about the staff and the way the home was managed.

There were extensive systems in place to monitor and improve the quality of the service provided. These had been improved and implemented since our last inspection and we saw these had been embedded into practice. There was an open and transparent culture where measures were put in place from lessons learnt from incidents or errors so that they were less likely to happen again.

The registered manager and staff we spoke with were very passionate about ensuring effective quality monitoring to continually improve the service and the wellbeing of people they supported.

Staff conveyed enthusiasm about the ethos of the home and said they were committed as a staff team to make a difference to people’s lives. A visiting health care professional told us, “The new manager needs considerable credit for the improvements to the home. The team are now fully on board with a positive pro-active approach.”

Records showed that systems for recording and managing complaints, safeguarding concerns and incidents and accidents were very well managed and organised.

Summerson House is a six bedded care home providing personal care to people with a learning disability. It is a purpose built house situated close to local shops and amenities.

No registered manager had been in place since August 2015. 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. It is a condition of the provider’s registration to have a registered manager and this was a breach of that condition.

In the last year there had been three managers, one of whom was registered but left in August 2015. Another previously registered manager for the home notified us in September 2015 that they would be adding this service to their registration but this had not occurred. A new manager was appointed in November 2015 but had yet to become the registered manager.

We found that the new manager was very open and transparent and their primary concern was the welfare of the people who used the service. Since being appointed they had critically reviewed the service and identified work was needed to make improvements to the operation of the home. We found that they had worked diligently to take action to make the identified improvements.

Prior to the inspection there had been a high level of staff vacancies and although the new manager was actively recruiting staff at the time of the inspection there continued to be vacancies. The registered provider had ensured that the staffing levels remained in line with those required either via the permanent staff completing additional shifts or the use of relief staff who knew the people. They were also actively recruiting new staff. However we had not been notified about these difficulties and should have been.

We found the care records were comprehensive however we found that they needed to be reviewed and updated.

We met with four of the people who used the service and we were able to speak with one person. Three of the people who used the service were unable to communicate verbally but we found that staff could readily interpret their facial and body language. We observed staff practices and saw that the people were treated with compassion and respect. We saw that people were very comfortable with each other and staff presence and there was lots of laughter.

There were systems and processes in place to protect people from the risk of harm. We found that staff understood and appropriately used safeguarding procedures.

Staff were aware of how to respect people’s privacy and dignity. We saw that staff supported people to make choices and decisions.

People were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. Each individual’s preference was catered for and people were supported to manage their weight.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control and first aid as well as condition specific training such as working with people who have learning disabilities. The manager confirmed that staff were also in the process of completing refresher mandatory courses over the next few months.

Staff had also received training around the application of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). The staff we spoke with understood the requirements of this Act and but needed to ensure that all of the DoLS authorisation were renewed as needed.

People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs and we observed that were sufficient staff on duty to meet people’s needs. We saw that six staff were on duty when the six people were at home and two staff were on duty overnight. The manager was on duty during the weekdays.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the registered provider had a system in place for dealing with people’s concerns and complaints. There was an accessible complaints policy and relatives were regularly contacted and knew how to complain.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. All relevant infection control procedures were followed by the staff at the home.

The registered provider had developed a range of systems to monitor and improve the quality of the service provided. However we found that after the registered manager had left, no one had completed the audits and monitored the performance. This lack of oversight had led to the records not being maintained and the position whereby the new manager needed to take a wide range of actions to improve the performance of the home.

We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also highlighted that the provider did need to ensure notifications were submitted in line with the requirements of The Care Quality Commission Registration Regulations 2009. You can see what action we took at the back of the full version of this report.

At the time of this inspection there were five people living at the home. Due to their health conditions and complex needs people were unable to share their views about the service that they received. We observed their experiences to support our inspection. We spoke with the registered manager, five staff and one relative.

Is the service safe?

We saw that safeguarding procedures were robust and staff understood how to safeguard the people they supported. A relative we spoke to told us, 'Oh, the service is very good. I have no concerns about the care here. My relative is safe.'

We spoke with staff about Deprivation of Liberty Safeguards (DoLS). The registered manager told us that there had been one application in the last year. They showed us the policy and procedures they followed and we found these were appropriate. They told us that all staff had received relevant training and had access to the policy and procedures. A deprivation of liberty application had been submitted to the local authority for one person.

Is the service effective?

People explained how their care and welfare needs were met. We saw that people had support with health appointments and that the service was flexible. Staff told us that they provided individualised support and demonstrated this when we observed their care practice. A relative told us, 'My relative is so happy at the home, he really does thrive there.'

Each staff member we spoke with told us they felt supported in their work. They told us they received a full training programme and had regular supervision and appraisals. One person told us, 'We are a close working team. Most of us have completed our NVQ's (National Vocational Qualifications) in health and social care.' They all told us that they felt supported by the manager and could approach them at any time for support or to raise any issues or concerns and that they would be responded to.

Is the service caring?

We saw that staff communicated well with people and were able to explain things in a way that could be easily understood. People were not rushed when care was delivered and we saw that staff interactions with people were caring.

We saw that staff treated people with respect and dignity. We saw that people were given choices in relation to their care. Staff told us they were all working to be dignity champions at the home.

Is the service responsive?

We observed that staff responded to requests for support. We observed that all people responded positively to all the staff. One person told us, 'I am going to college today.' People had been on holiday and for day trips to the coast. The staff told us, 'We have a minibus which makes things much easier. We can be really flexible so the journey is comfortable for people.'

The relative we spoke with told us that they were very happy with the service.

We observed as people were involved in decisions about their care. We saw that people got up at the time of their choosing. They were asked what they would like to eat and what they would like to do that day.

We saw that there was a complaints policy at the home. People told us they found the manager very approachable and would not hesitate to raise any issues or complaints.

People's care needs had been reviewed at least every six months. We saw that when people's requirements had changed the provider had responded appropriately and altered the care and support they delivered in line with these changes.

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

Is the service well-led?

We spoke with the registered manager. They showed us that there was an effective system to regularly assess the quality of service that people received. We found that the views and opinions of people, relatives and staff had been regularly gathered, recorded, analysed and responded to.

We saw the home had systems in place that ensured managers and staff learnt from any accidents, complaints, whistleblowing reports or investigations. This helped reduce the risks to people and helped the service to continually improve.

Staff told us they understood their roles and responsibilities. Staff had a good understanding of the ethos of the service and quality assurance processes were in place. This helped to ensure that people received good quality care at all times.

Peoples' needs had been assessed and care and support was planned and delivered in line with their individual care plan.

People lived in a clean and hygienic environment which helped to prevent the spread of infection. The expert by experience told us, 'The corridors were clean, the wood flooring was well kept and the walls nicely decorated'I was really pleased to see that everything had been made good'the tables in the kitchen and dining area were all clean.'

People were cared for, or supported by, suitably qualified, skilled and experienced staff. Appropriate checks had been undertaken before staff began working at the home. This meant people were cared for by suitable staff.

The provider had an effective system to regularly assess and monitor the quality of service that people receive. They also had an effective system in place to identify, assess and manage risks to the health, safety and welfare.