Summerville House

Summerville House is a residential care home providing personal and nursing care to 25 people aged 65 and over at the time of the inspection; some people were living with dementia. The service can support up to 26 people in one adapted building on two separate floors.

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

Improvements had been made to ensure people received safe care. Risks to people had been assessed and actions taken to mitigate them. Staff had received training in keeping people safe from the risk of abuse and knew what to look for and what actions they needed to take. Medicines were managed safely for people. There were enough staff on duty to keep people safe and recruitment processes were robust. The service was clean, and staff had the training and equipment needed to reduce the risk of the spread of infection. If things went wrong, action was taken to review the incident and any learning from this was used for future planning.

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. Although further work was needed to ensure records accurately reflected where people lacked capacity and who had been given legal powers to make decisions on their behalf.

Improvements had been made to the provision of meals and the choice that people could have. The registered manager had arranged a range of face to face training for staff to complete, which had improved staff competence and confidence. People’s needs had been assessed before moving in to the home. The décor of the service had been improved to make the home feel cleaner, brighter and more suited to the needs of people living with dementia.

Staff were kind, caring and took time to promote people’s independence. Staff knew about people’s life experiences and history. This were used to meet people’s preferences, likes and dislikes. Staff promoted people’s dignity, and ensured they treated those they supported with respect.

Improvements had been made to the range, frequency and quality of activities and entertainment provided. This included ensuring people living with dementia had access and that these activities were meaningful. Complaints were managed within the provider’s own procedures and were used to drive up quality and learning. End of life care planning took place for people who wished to do this, and staff were accessing enhanced training in this area.

The registered manager had provided much needed improvements to the quality of service provided. This had been very well received by people, relatives and staff. Improvement work was on-going, and there was a plan in place to measure this, with timescales for completion.

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 February 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 been made and the provider was no longer in breach of regulations.

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.

Summerville House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Summerville House is registered to accommodate up to 26 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit 22 people were living in the home, all of whom were living with dementia.

There was a registered manager working at the service. 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.

At the last inspection of Summerville House, we rated the home overall as good. At this inspection the overall rating has reduced to requires improvement. We also found the provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not all risks to people’s safety had been assessed and therefore mitigated. Staff practice was mixed which placed people at risk of avoidable harm. The provider had determined the number of staff required to meet people’s needs but this had not regularly been met. Staff told us they struggled to provide people with stimulation to enhance their wellbeing.

Staff working on the night shift had not all received training in how to give people their medicines safely. This meant there may have been a delay in people receiving medicines for pain or distress. Following the inspection visit, the registered manager told us this had been corrected.

Some staff were observed to lack the necessary skills when dealing with people living with dementia. Most had only received training in this area online via a computer. The provider told us training for staff in this area was being improved to give them better knowledge and skills.

Most people were treated with dignity and respect although this was not consistently applied by staff and some people did not always have choice or control over their care. People’s consent had not always been sought in line with the relevant legislation.

People did not always have a choice of food to eat and the dining experience required improvement. People who were at risk of not eating enough were monitored to ensure they had sufficient food to remain healthy. We were not made aware of any concerns regarding people's fluid intake however, the systems in place to monitor if people had received enough to drink were not robust and needed improving.

The current governance systems and processes in place were not all effective at monitoring the quality of care people received or to drive improvement within the home.

The premises would benefit from some improvements to help people living with dementia orientate themselves. We therefore recommend the provider consults appropriate guidance in this area to make the necessary improvements.

People received their medicines when they needed them and systems were in place to protect them from the risk of abuse. Any incidents or accidents that had occurred had been fully investigated and lessons learnt to try to prevent them from happening again.

When people became unwell, the staff acted quickly to ensure they received the appropriate medical advice. Staff were very happy working at the service. They felt supported, told us their morale was good and could develop and complete qualifications within care.

There was an open culture in the home. People and relatives could approach the staff or manager whenever they wished and were listened to and their opinions respected.

You can see what action we told the provider to take at the back of the full version of the report.

The home has had the current registered manager in post since before January 2011 when they were registered under the Health and Social Care Act 2008. 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.

At the last inspection in February 2016, we asked the provider to take action to make improvements to staff training, to safeguard people from unlawful deprivation of their liberty and to quality assurance processes. These actions have been taken.

Staff members received training, which provided them with the skills and knowledge to carry out their roles.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff made these for them in their best interests.

Good leadership was in place and the registered manager and provider monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible and to improve the quality of the care provided.

There was not enough for people to do during the day and they were sometimes bored. We have made a recommendation about the provision of activities.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them. There was adequate servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the registered manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

People received their medicines when they needed them, and staff members who administered medicines had been trained to do this safely. Staff received adequate support from the registered manager and senior staff, which they found helpful.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to go to, to make a complaint. The registered manager was supportive and approachable, and people or other staff members could speak with them at any time.

This comprehensive inspection took place on 9 February 2016 and was unannounced.

A registered manager was in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 were kept safe most of the time and staff were knowledgeable about reporting any incidents of harm. However, there was inadequate action taken to report a significant safeguarding concern to the local authority. We received mixed views about staffing numbers although when we visited people were looked after by enough staff to support them with their individual needs. Satisfactory pre-employment checks were completed on staff before they were allowed to look after people living in the home. People were supported to take their medicines as prescribed and medicines were safely managed.

People were supported to eat and drink sufficient amounts of food and drink and there were choices of food from what was on the main menu. They were also supported to access health care services and their individual health needs were met.

The CQC is required by law to monitor the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. Assessments were in place to determine if people had the capacity to make decisions in relation to their care. When people were assessed to lack capacity, their care was provided in their best interests. However, DoLS applications had not been made to responsible authorities when some of the people had restrictions imposed on them. Therefore the provider was not acting in accordance with the requirements of the MCA.

People were supported by kind, respectful and attentive staff. People, or their relatives, were not given opportunities to be involved in the review of their individual care plans.

People were supported with a range of hobbies and interests that took part in and out of the home. Care was provided based on people’s individual needs. There was a process in place so that people’s concerns and complaints were listened and responded to.

Although the last Care Quality Commission rating of the home was available on the provider’s website, this was not on display in the home. This omission had reduced the provider’s ability to demonstrate that they operated a transparent culture as part of their duty of candour.

People were looked after by some but not all staff who were trained and supported to do their job. The registered manager was supported by a team of managerial, care and ancillary staff. Staff were supported and managed to look after people but the systems used to do so, were not robust enough to monitor the progress of the training of staff.

Staff, people and their relatives were able to make suggestions and actions were taken as a result.

Quality monitoring procedures were in place but these had not always been effective to detect the omissions that we had found during our inspection. In addition, there was a lack of reviewing and analysing information in relation to incidents that had taken place. Therefore, there were missed opportunities to take action, if needed, to improve the safety and quality of people living at Summerville House.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were in relation to lack of submission of DoLS applications to the appropriate authorities, staff training and quality assurance. You can see what action we told the provider to take at the back of the full version of the report.

The provider wrote to us and described the additional checks and audits that they would put into place. They told us that some new checks and quality audit systems would be put into place immediately and others would be fully in place by 31 July 2014.

During this inspection on 06 August 2014, we found that the provider had taken the appropriate action and had made the improvements required.

This is a summary of what we found:

Is the service safe?

Records we looked at showed us that risk assessments were completed where a risk had been identified. Measures were described and in place to reduce or eliminate such risks. Requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguarding (DoLS) were recognised by members of staff. Staff explained that they undertook regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way

Full information was on display to provide people with enough detail to take any concerns they may have to the relevant organisation. This information included details of the type of procedures and actions that would be taken by the supporting agency.

Records showed that equipment such as hoists had been regularly serviced and fire checks had been completed on extinguishers. This supported the safety of people who lived at the service, as well as the safety of visitors and staff.

Is the service effective?

Our observations showed us that people who lived at the service were relaxed and confident when they discussed matters with members of staff. Staff took action when they saw anyone who appeared to be unsure or uncomfortable. One person was sleeping a lot during the lunch time and staff tried to encourage this person to eat and to speak with them.

Nutrition was monitored by staff as they watched to see how much each person ate at meal times. The cook was told if a person did not eat their meal so alternative options could be offered. We saw staff appropriately encouraging people to eat their meals. and regular checks on people's weight supported the early detection of any problems. Our observations and review of records showed us that staff did provide alternative meals when needed.

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw that people were dressed cleanly and appropriately for the weather on the day of our inspection.

Although we spoke with people who lived at the service, not everyone was able to answer our questions. This was because some people lived with dementia. However, our observations showed us that staff spoke with respect and in an appropriate manner when they provided support or care to people in the home.

Is the service responsive?

We saw that people's individual physical needs were being met. People were gently encouraged to decide what they wanted to eat at lunch time. Staff showed people what their food choices were by providing each meal for them to see. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. This showed us that staff supported and involved people. They did not rush anyone into a quick decision and responded to all requests.

Is the service well led?

We saw that a number of quality assurance systems, such as the issue of questionnaires, were in place. However, we found that not all these records were monitored or regularly completed. This meant that there was no information to indicate how comments and suggestions made by people living at the service their representatives, or staff had been appropriately responded to.

Records showed that members of staff had recorded what routines they had completed for example areas cleaned within the building or in the kitchen area. However, there were no spot checks or audits to ensure these duties had been completed to an acceptable standard.

People did not always receive the care and support they required to improve their health and well-being. Assessments were completed and provided actions to reduce most risks identified. Care records were generally written in enough detail to provide guidance to staff members. However, care plans for social care needs and dementia care were not written in enough detail to meet people's individual needs. Care records showed that people had access to the advice or treatment of a health care professional.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. The cultural dietary needs of one person were not supported and they were not provided with alternative meals.

Medicines were stored appropriately and records were maintained to show all storage areas were kept at the correct temperature. Administration records were kept and people received their medicines in a safe way.

The service had a policy and procedure to guide people in how to make a complaint but there was inadequate information about taking complaints further.

We had not received notifications of events, such as the deaths of people at the service, which they are required to inform the commission about.