During a routine inspection

About the service

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.

During a routine inspection

About the service: Summer Court is a residential care home which is registered to provide accommodation and personal care for up to 37 people who are living with a dementia related condition. At the time of the inspection there were 26 people using the service.

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.

During a routine inspection

This inspection took place on 14 November 2017 and was unannounced. At the last inspection in September 2015 the service was rated Good.

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.

During a routine inspection

This inspection took place on 16 September 2015 and was unannounced. We previously visited the service on 18 June 2014 and we found that the registered provider met the regulations we assessed.

The service is registered to provide personal care and accommodation for up to 37 older people, some of whom may be living with dementia. The home is registered to provide personal care and nursing care. On the day of the inspection there were 20 people living at the home. The home is located in Hornsea, a seaside town in the East Riding of Yorkshire. It is close to town centre amenities and is on good transport routes.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager in post who was not registered with the Care Quality Commission (CQC), although they were in the process of submitting their application. 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 told us that they felt safe living at Summer Court and we saw that the premises had been maintained in a safe condition.

We found that people were protected from the risk of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

The manager and some staff had completed training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). There was clear information available to staff in the manager’s office on the principles of the MCA and DoLS and staff were able to explain these principles to us. People were supported to make their own decisions when they had capacity to do so, and best interest meetings were held when people did not have the capacity to make decisions for themselves.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The manager told us that a new induction programme was being introduced by the organisation and this would result in more robust induction training for staff. The training records evidenced that most staff had completed training that was considered to be essential by the home and that most staff had achieved a National Vocational Qualification (NVQ).

New staff had been employed following the home’s recruitment and selection policies to ensure that only people considered suitable to work with older people had been employed. We saw that there were sufficient numbers of staff on duty to meet people’s individual needs. People told us that staff were caring and we observed that staff had a caring and supportive attitude towards people.

Medicines were administered safely by staff and the arrangements for ordering, storage and recording were robust. Staff who had responsibility for the administration of medication had completed appropriate training.

People told us they were happy with the meals provided by the home. We saw that people’s nutritional needs had been assessed and that their special diets were catered for. We saw there was a choice available at each mealtime. More care needed to be taken to ensure people received one to one support with eating and drinking.

There were systems in place to seek feedback from people who lived at the home and relatives / visitors. Feedback had been analysed to identify any improvements that needed to be made. There had been no formal complaints made to the home during the previous twelve months but there were systems in place to manage complaints if they had been received.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by the manager were designed to identify any areas that needed to improve in respect of safety and people’s care. We saw that, on occasions, incidents that had occurred at the home had been used as a learning opportunity for staff.

During a routine inspection

Our inspector visited the service and the information they collected helped answer our five questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

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.

During a routine inspection

We spoke with the area manager, the manager, a nurse, two care workers and two people who lived at the home as part of this inspection.

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.

During an inspection to make sure that the improvements required had been made

At the last inspection of the home in September 2012 we had issued a compliance action for outcome 1: Respecting and involving people who use services and outcome 7: Safeguarding people who use services from abuse. We received an improvement plan that recorded the improvements that would be made to ensure the service became compliant.

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".

During a routine inspection

We spoke with four people who lived at the home. They told us that staff respected their privacy and dignity and that staff knocked on doors before entering their room. However, we found that there was a lack of privacy and dignity shown towards people who were accommodated in the dementia unit.

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.