Somerset House

We found the following examples of good practice:

¿ The provider ensured people were supported to see their relatives safely and in line with the government guidance. The provider introduced a designated visitors' room that was divided by a screen and had a separate entrance for visitors.

¿ All staff had received training and followed correct infection control and were observed using appropriate personal protective equipment (PPE).

¿ There were safe arrangements in place for both professionals and relatives visiting the service, including a confirmed negative result of a lateral flow device test (LFD) and the requirement to show a COVID-19 vaccination pass. Visitors were reminded about the requirement to wear the required PPE and ensuring hand hygiene and sanitisation.

¿ The service was clean and fresh, the staff carried out a number of additional tasks which included additional cleaning of any regular touchpoint surfaces.

¿ The provider facilitated an additional site, adjacent to the main home that was used for staff COVID-19 testing and as a staff changing area. The provider adhered to the regular testing regime for both, the staff and people living at the service.

Somerset House is a residential care home providing accommodation and personal care for up to 24 people. The home specialises in the care of older people. At the time of the inspection there were 20 people living at the home. Accommodation is set our over two floors, with stair lifts to enable people to access all areas.

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

People felt safe at the home and with the staff who supported them. There were enough staff available to meet people’s needs and keep them safe. Risks to people were identified, and management plans were in place to mitigate the risks. People’s medicines were managed safely.

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 respected people’s choices and preferences.

People’s healthcare needs were identified and met. Staff worked with a range of healthcare professionals to meet people’s needs.

People were supported by caring staff who worked towards promoting their dignity and independence.

People felt confident to raise any concerns. People, their relatives and staff commented positively about the management of the service. There were systems in place to monitor the standard of care provided at the service.

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 6 February 2019) and there were breaches of regulation 12, (Safe care and treatment) and regulation 17, (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Somerset House provides accommodation and personal care for up to 24 people. At the time of the inspection there were 19 people living at the home. We undertook this unannounced inspection of Somerset House on the 14 and 15 January 2019.

At the last inspection the service was rated as Good. At this inspection we found the service Requires Improvement due to people being at risk of cross infection due to ineffective hand washing and hot surfaces that placed people at risk of burns. Audits were also required for infection control and environmental risks.

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 could be at risk of cross infection, due to lack of liquid hand soap and paper towels at the point of care.

Environmental risks to people posed by hot surfaces were not managed in line with the Health and Safety Executive’s guidelines.

People received their medicines when required although medicines were not always stored safely whilst the member of staff was in the process of administering medicines to people. People could also be at risk of cross infection due to the same medicines pot being used for administering medicines.

People's care plans were personalised and included their likes and dislikes. Care plan’s also contained people's individual needs and risk assessments although one required more information relating to their end of life care. People were involved in their care plan reviews and care plans recorded review dates.

People were support by staff who had suitable checks prior to working within the service.

Staff were kind and caring and able to demonstrate their understanding of different types of abuse and who to go to should they have concerns over people’s safety and welfare. Staff had a good understanding of how to promote independence, equality and diversity and privacy and respect.

Staff received supervision and an annual appraisal and training to ensure they were competent in their role. There were daily handover meetings and staff felt able to approach the manager and provider for advice should the need arise.

All people were happy with their care and no complaints had been received since the last inspection. Various ‘Thank-you’ cards and compliments had been received by the service.

People had access to various social activities and the service was actively engaging with the local community.

People told us they enjoyed the food provided at the service. The menu gave people various options each day and people could choose an alternative should they wish.

The provider had no quality assurance system in place for infection control and some environmental concerns such as hot surfaces were not covered within the health and safety audit.

We found two breaches 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 full version of the report.

Somerset House is a care home situated in Yatton. The home is registered to provide care for up to 26 older people. At the time of our inspection there were 18 people living at the home.

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 who lived at the home told us that they felt safe, and this was confirmed by family members we spoke with.

People were protected from the risk of abuse. Staff members had received training in safeguarding, and were able to demonstrate their understanding of what this meant for the people they were supporting. They were also knowledgeable about their role in ensuring people were safe and that concerns were reported appropriately.

Medicines at the home were well managed. People's medicines were stored, managed and given to them appropriately. Records of medicines were well maintained.

Staff at the home supported people in a caring and respectful way, and responded promptly to meet their needs and requests. There were enough staff members on duty to meet the physical and other needs of people living at the home.

People who chose to remain in their rooms for part of the day were regularly checked on.

Staff who worked at the home received regular relevant training and were knowledgeable about their roles and responsibilities. Appropriate checks took place as part of the recruitment process to ensure that staff were suitable for the work that they would be undertaking.

All staff members received regular supervision from the manager or senior carer, and those staff we spoke with told us they felt well supported.

The home was meeting the requirements of The Mental Capacity Act 2005 (MCA). Staff members had received training in MCA and DoLS, and were able to describe their roles and responsibilities in relation to supporting people who lacked capacity to make decisions.

People's nutritional needs were well met. Meals were nutritionally balanced and met individual health and cultural requirements as outlined in people's care plans. Alternatives were offered where required, and drinks and snacks were offered to people throughout the day.

People's food and liquid intake was recorded and monitored.

Care plans and risk assessments were person centred and provided guidance for staff about how they should work with people to meet their needs. Daily records of people's care were well maintained. Effective systems were in place to share information between outgoing and incoming staff at shift changes.

The home provided a range of individual and group activities for people to participate in throughout the week. Staff members engaged people supportively in participation in activities.

People's cultural and religious needs were supported.

People and their family members we spoke with knew how to complain.

Care documentation showed that people's health needs were regularly reviewed. The home liaised with health professionals to ensure that people received the support that they needed.

There were systems in place to review and monitor the quality of the service, and we saw action plans had been put in place and addressed where there were concerns. Policies and procedures were up to date and staff members were required to sign that they had read and understood any new or amended ones.

People who used the service, their relatives and staff members spoke positively about the management of the home.

People or their relatives had agreed with the care they received as detailed in their care plans. Procedures were in place which ensured that decisions were made in people's best interest when they lacked capacity to make decisions about their care and support.

People's needs were assessed before moving into the home and care plans were developed with the person to ensure that their needs were met.

People's health needs were met and staff supported them to attend appointments with health professionals when necessary.

The home arranged a programme of activities for people living at the home. One person told us 'the activities have been great, they help to keep me active'.

People knew how to raise concerns and they were confident that they would be listened to and acted on. Staff knew how to raise safeguarding concerns.

Staff said they were well supported by the management of the home. They told us they received regular training and supervision to enable them to carry out their roles effectively.

The home had systems in place to monitor and improve the quality of the service provided.

The people we spoke with who used the service all provided positive feedback regarding their experience of the service. Comments included 'staff listen to what I want and do what I ask' and 'my needs are catered for pretty well'.

We viewed four care plans. The planning was centred on the individual and considered all aspects of their individual circumstances. The care plans were detailed and specific to the individual's needs and preferences.

Although people advised that they were involved in discussions about their care and support there were not robust arrangements in place that demonstrated that consent had been provided in relation to the care received. People we spoke with were aware of the location of their care plan but they were unaware of the content of their plan.

Staff we spoke with were knowledgeable about the people they supported. Although staff had received training appropriate to their roles in some cases their mandatory training was not regularly updated. We found that there was not an adequate support structure in place for staff supervisions.

We found that the provider kept personalised care, treatment and support records secure and confidential for each person who uses the service. Records were stored in a secure accessible way that allowed them to be located quickly.