Summer Court

Summer Court is a residential care home providing regulated activity accommodation and personal care to up to 37 people. The service provides support to older people and people who are living with dementia. At the time of our inspection there were 15 people using the service.

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

The provider, management team and staff had worked hard to make improvements since the last inspection to people’s care, support and risk management, infection control practices, staffing levels, training, and to the governance systems at the home.

People's needs were assessed, monitored and reviewed. Care plans and risk assessments had been improved upon and were regularly reviewed to ensure these provided staff with accurate guidance on how to reduce risk to people. Accidents and incidents were documented, investigated and reviewed to identify any patterns and trends.

People were cared for safely and protected from the risk of abuse. People were supported with their medicines and good infection control practices were now in place.

Areas of the environment had been refurbished to ensure the home was suitably adapted, clean, and designed to meet people's needs.

There were enough suitably trained staff to meet people's needs. Additional staff had been recruited to support people to spend time in the way they preferred and doing things they enjoyed.

Improvements had been made in the monitoring of people’s nutrition and hydration, when required, and in the planning and delivery of people’s care; in particular their support to maintain personal hygiene. People were supported to promptly access health care services when needed.

The provider had strengthened governance arrangements for routine service monitoring and oversight, to ensure the quality and safety of people's care.

The management team were committed to driving continuous improvements and embedding an open and learning culture in the service. Regular meetings took place with people and staff. Staff were supported through team meetings, one to one supervisions and checks of competency.

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.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 3 March 2023). CQC served a Warning Notice to the provider due to the lack of good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 3 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We undertook this focused inspection to check whether the Warning Notice we previously served in relation to regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to good. This is based on the findings at this inspection.

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.

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

Follow up

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

Summer Court is a residential care home providing regulated activity accommodation and personal to up to 37 people. The service provides support to older people and people who are living with dementia. At the time of our inspection there were 25 people using the service.

The past three consecutive rated inspections have been rated requires improvement and breaches of regulation found. At this inspection the provider had failed to make sufficient improvement and the service had remained in breaches of regulation.

Systems in place to monitor and improve the quality of the service were not sufficiently robust to drive forward improvements. They had not identified all the areas we found at this inspection and where areas had been identified prompt action had not been taken to address them.

We continued to identify that risk management was not sufficient. Systems in place to support people with health conditions, such as fluid input and output charts were not always in place or able to be fully completed for staff to monitor and identify any increased risks. Although there was a system in place to monitor accident and incidents this continued to not be used effectively to reduce the risk of reoccurrence and ensure appropriate action was taken.

There continued to be insufficient staff to meet people’s needs as assessed, this included supporting people with bathing ,showering, and sufficient daily stimulation and activities.

Staff did not always wear and dispose of PPE in line with good practice which increased the risk of spread of infection. The service was not clean and tidy.

We continued to find concerns with staff training in relation to individuals health needs. The providers training matrix continued to have gaps in. Staff received supervision but these often-lacked individualised feedback on staff’s performance and development needs.

People were supported to access health care promptly, however work was required to ensure advice was implemented into care plans and practice.

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.

The area manager was open and honest during the inspection. They had recently taken over management responsibilities at the home which included the recruitment of a new manager.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 26 February 2020).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

We completed a targeted inspection of infection control at the service on 13 January 2022.

Why we inspected

We carried out an announced comprehensive inspection of this service on 26 February 2020. Breaches of legal regulations were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions; Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, infection prevention and control, staffing, person centered care and governance at this inspection. We have made a recommendation regarding medicines.

Please see the action we have told the provider to take at the end of this report.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

We found the following examples of good practice.

The building was clean and well maintained and furniture had been rearranged to promote social distancing.

People were supported to have visitors in line with national guidance and alternative arrangements were available to support people to maintain contact with their family and friends in the event of an outbreak. Processes were in place to ensure safe visiting practices were followed.

Staff were vaccinated and took part in regular testing for COVID-19. They appropriately wore personal protective equipment (PPE) to minimise the risk of infections spreading.

Risks to people and staff in relation to COVID-19 had been assessed.

The provider took prompt action to review their admissions processes to ensure they followed current guidance.

We found the following examples of good practice.

• Residents that were symptomatic and/or tested positive were isolated in single occupancy rooms. Where people were isolating clear signage was on their door to remind all staff and visiting healthcare professionals. A log of all staff interactions, including dates and times was in place to support each person.

• The staff checked residents for signs and symptoms of the virus. This included taking daily temperatures and looking for symptoms other people had experienced prior to testing positive.

• Plenty of clear signage was visible throughout the building and at all entry and exits points. These included reminders of the order for putting on and taking off Personal Protective Equipment (PPE) and how to wash hands correctly.

• Cabinets were available in designated areas so staff could change their PPE. The provider had ensured a good selection of different sizes of PPE were available to staff, such as gloves.

Further information is in the detailed findings below.

Summer Court is a care home providing personal care for up to 37 older people in one adapted building. At the time of our inspection 28 people lived at the service.

People’s experience of using this service

The provider had failed to address the concerns we found at the last two inspections and make the necessary improvements. There was a lack of effective systems to identify and sustain high quality care. Risk assessments and care plans remained generic and not specific to give staff the guidance they needed to reduce risk. Some medicines were not being administered at the correct time in line with best practice guidance.

There was insufficient staffing levels to ensure people’s needs were being met in a timely, dignified and respectful way. This had been identified by the provider and plans were in place to increase staffing numbers during the day. However, no interim measures were in place, such as the use of agency staff, to bridge this gap for people.

Staff were not suitably trained to meet people’s specific needs and checks had not taken place to ensure they were competent at carrying out tasks such as moving and handling people and administering medicines. We observed some poor moving and handling techniques being used by staff during our inspection. Staff did not receive meaningful supervision where they could discuss their concerns and plans for development. Staff told us the manager was approachable.

People told us the staff were kind and caring. Staff knew people well and tried hard to meet their needs. Interactions with people was task focused due to insufficient staffing levels. When staff had time, we observed some good interactions between people and staff.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

People were supported with activities within the home provided for by care staff. The provider had systems in place to safeguard people from abuse. However, the registered manager was slow to respond to recent incidents and implement measures to safeguard people from the risk of reoccurrence.

The registered manager was newly in post and had identified some concerns prior to our inspection. They were still in the process of developing an action plan to address these concerns.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 March 2019) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had not been made and the provider continued to be in breach of regulations. The service has been rated requires improvement for the last three inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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.

People’s experience of using this service: People were not always kept safe from risk, information for staff to follow was not always up to date or specific to their needs to keep individuals safe.

Information and records were not maintained to ensure people always received their medicines safely as prescribed.

Staff did not receive appropriate training or assessment of their competency to ensure they had the appropriate skills to meet peoples’ individual needs.

The provider had failed to implement sufficient oversight since the last inspection to ensure that improvements were made to the quality of the service people received.

People and their relatives told us they were happy with the care provided. All staff demonstrated a commitment to providing person-centred care, however this was not reflected within people’s care plans and associated records.

People had developed positive relationships with staff who had a good understanding of their individual needs. Staff were friendly and polite.

People were supported to maintain their independence. Some activities were available for people but further improvements were planned to increase these and include access to the local community.

Staff told us the registered manager, who was relatively new in post, was supportive and approachable. People knew the registered manager and told us they trusted them.

People and their relatives told us they were confident if they had any complaints the registered manager would address them appropriately.

The registered manager was developing action plans to address the concerns we identified as part of the inspection.

We have made a recommendation about staff training.

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

Rating at last inspection: Requires improvement (report published February 2018). This is the second overall rating of requires improvement for this service.

Why we inspected: This was a planned inspection based on the rating at the last inspection.

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

At this inspection we found breaches of Regulations 12 (Safe care and treatment), 18 (Staffing) and 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) 2014. Staffing was insufficient to meet people's needs and staff were not adequately supported. People's medicines were not managed safely and there was a risk of infection because of a lack of cleanliness. The service was not consistently well led. Checks and audits had not identified some of the problems seen by inspectors. You can see what action we took at the end of the full report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Summer Court provides accommodation and personal care for 37 people who are living with a dementia related condition. It is a detached property set out over two floors. There were 28 people at the service when we inspected. The service was one of five services run by Hexon Limited. The provider had employed a general manager to oversee the running of these services on their behalf. The general manager provided support to the managers.

There was a registered manager employed at this service. They were supporting a new manager in post at the time of our inspection who was in the process of applying for registration. 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.

Risks to people had been identified but detailed guidance was not available for staff to ensure people received appropriate care and support in all cases.

Staff recruitment was robust.

Servicing and maintenance of the environment had been carried out in a timely manner.

People were not always supported to have maximum choice and control of their lives; the policies and systems in the service supported this practice but staff had not always followed the correct process for making best interest decisions.

People’s nutritional needs were met although recording on food and fluid charts was inconsistent.

Staff were described by some people as being caring and we saw positive interactions between people and staff.

There was a lack of appropriate and stimulating activities. Some people told us they were bored.

The environment did not reflect current good practice guidance for dementia friendly environments.

People knew how to make a complaint and we saw that where complaints had been made they were dealt with in line with company policy.

The quality assurance system was not effective. Audits had not identified failings identified at the inspection.

Documents were not always stored securely and in line with the Data Protection Act.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and 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?

There were risk assessments in place that identified any risks involved in a person's care and how these could be minimised. We found that there were sufficient numbers of staff employed to support the people who lived at the home. We saw that people's care assessments and plans were updated on a regular basis to ensure that the care they received continued to meet their needs.

Is the service effective?

Staff were aware of people's care needs and we saw that staff treated people as individuals. Staff respected a person's privacy and dignity and people told us that they were assisted with personal care in a sensitive manner. There were activities available that were intended to help people to retain their physical and cognitive abilities.

Is the service caring?

People told us that staff cared about them and that they were happy with the care and support they received. We observed warm and compassionate care on the day of this inspection.

Is the service responsive?

People were given a variety of opportunities to express their views about their satisfaction with the service. They told us that they were confident staff would listen to their concerns and help alleviate them whenever they could.

Is the service well-led?

The manager had introduced various audits to monitor that the home was safe and that staff were adhering to policies and procedures. Relatives and staff were consulted about their satisfaction with the way the service was operated.

The people who lived at the home told us that they were happy living there. They felt that they received the support they needed and that they had good rapport with staff. One person said, 'Staff are very good ' they help us when we need it and there is some banter between us'. We observed positive interactions between people who lived at the home and staff on the day of the inspection.

There had been a number of safeguarding investigations at the home since the previous inspection. These had resulted in a number of recommendations for improvement being made by the safeguarding adult's team. We saw that action had been taken by the organisation to improve practices at the home and that further training and supervision had been provided for staff, particularly around the areas of communication, recording and the administration of medication.

We saw that safe recruitment and selection processes were followed when new staff were employed. There were sufficient staff on duty but we noted that there were no domestic or laundry staff employed at weekends. This meant that nurses and care staff had other duties to perform in addition to providing care to people who lived at the home.

There were appropriate quality monitoring systems in place although there had been some delays in utilising these due to the transition to nursing care.

At this inspection we saw the manager had made the necessary improvements to ensure compliance with these outcomes. This had been done through in-house training and consultation with people who lived at the home.

We saw that staff had undertaken training on the principles of the Mental Capacity Act 2005 and on safeguarding adults from abuse. Their practice had been observed by the manager and any concerns had been raised with them. The manager and a senior carer had attended a Dignity Workshop.

We spoke with two people who lived at the home. They told us that they were supported to make day to day decisions such as how to spend the day, what time to get up and go to bed and what activities to take part in. They said that there was a choice of meals at the home and that they had discussed the menu at the last resident's meeting.

People told us that the staff were kind and helpful. They said that they treated them with respect and knocked on the door before they entered their bedroom. They said that they felt safe living at the home. One person said, "The staff are good and I could speak to any of them if I had a problem".

People told us that staff encouraged them to be as independent as possible and that they could choose how and where to spend their day. People told us that they liked the food provided at the home. One person told us, "I am on a low sugar diet but I still get nice food".

People told us that they liked the staff. One person said, "I get along with all of the staff - they are all pleasant and they make you feel comfortable". People told us that they liked living at the home but some people told us that they would appreciate being able to take part in more activities.

People were able to name a staff member who they would speak to if they had any concerns or wished to make a complaint.

We were concerned that care staff were not clear how to react to some safeguarding situations and, when the manager was not present at the home, how to make an alert to the local authority safeguarding adult's team.